Interdisciplinary Maternal Perinatal Australasian Collaborative Trials (IMPACT) Network

The Interdisciplinary Maternal Perinatal Australasian Collaborative Trials (IMPACT) Network was formed in 1994 within the then Australian Perinatal Society and in 1997 became a subcommittee of the Perinatal Society of Australia and New Zealand (PSANZ) dedicated to improvement of maternal and perinatal health by promoting well-designed randomised controlled trials (RCTs), and dissemination and application of their results.

This website has been developed for investigators, health care professionals and consumers to learn more about the conduct of clinical trials, the clinical trials in maternal and perinatal health taking place across Australia and New Zealand, and how the IMPACT Network for Improving Mothers and Babies Health can facilitate the design and set-up, execution and timely completion of these trials.

News & Events

  • Delayed Versus Early Umbilical Cord Clamping for Preterm Infants: A Systematic Review and Meta-Analysis

    Delayed Versus Early Umbilical Cord Clamping for Preterm Infants: A Systematic Review and Meta-Analysis

    Michael Fogarty, David A. Osborn, Lisa Askie, Anna Lene Seidler, Kylie Hunte, Kei Lui, John Simes, William Tarnow-Mordi

    Abstract

    Objective

    To compare the effects of delayed versus early cord clamping on hospital mortality (primary outcome) and morbidity in preterm infants using Cochrane Collaboration Neonatal Review Group methodology.

    Data Sources

    MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Chinese articles, cross-referencing citations, expert informants and trial registries to 31 July 2017.

    Study Eligibility

    RCTs of delayed (≥ 30 seconds) vs early (<30 seconds) clamping in infants born <37 weeks gestation. Before searching the literature we specified that trials estimated to have cord milking in >20% of infants in any arm would be ineligible.

    Study Appraisal and Synthesis

    Two reviewers independently selected studies, assessed bias and extracted data. Relative risk (i.e. Risk Ratio, RR), risk difference (RD) and mean difference (MD) with 95% confidence intervals (CI) were assessed by fixed effects models, heterogeneity by I2 statistics and the quality of evidence by Grading of Recommendations Assessment, Development and Evaluation (GRADE).

    Results

    Eighteen RCTs compared delayed vs early clamping in 2834 infants. Most infants allocated to have delayed clamping were assigned a delay of 60 seconds or more. Delayed clamping reduced hospital mortality (RR 0.68, 95% CI 0.52 to 0.90; RD -0.03, 95% CI -0.05 to -0.01, P=0.005; number needed to benefit 33, 95% CI 20 to 100; GRADE high, with I2=0 indicating no heterogeneity). In three trials in 996 infants ≤28 weeks gestation, delayed clamping reduced hospital mortality (RR 0.70, 95% CI 0.51 to 0.95; RD -0.05, 95% CI -0.09 to -0.01, P=0.02, number needed to benefit 20, 95% CI 11 to 100; I2=0). Subgroup analyses showed no differences between randomized groups in Apgar scores, intubation for resuscitation, admission temperature, mechanical ventilation, intraventricular hemorrhage, brain injury, chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, late-onset sepsis or retinopathy of prematurity. Delayed clamping increased peak haematocrit by 2.73 percentage points (95% CI 1.94 to 3.52; P<0.00001) and reduced the proportion of infants having blood transfusion by 10% (95% CI 6 to 13%, P<0.00001). Potential harms of delayed clamping included polycythemia and hyperbilirubinemia.

    Conclusions

    This systematic review provides high quality evidence that delayed clamping reduced hospital mortality, which supports current guidelines recommending delayed clamping in preterm infants. This review does not evaluate cord milking, which may also be of benefit. Analyses of individual patient data in these and other RCTs will be critically important in reliably evaluating important secondary outcomes.

     

    CLICK HERE to go to The New England Journal of Medicine APTS results article

     

  • Randomised clinical trials in perinatal health care: a cost-effective investment

    As health care costs rise, cost-effective alternatives to unevaluated interventions with uncertain effectiveness are needed. In clinical research, return on investment compares the value of improvements in health and cost savings to society achieved by clinical trials with the amount invested to fund them.Research into return on research investment in Australia,2 the United States,1 and the United Kingdom3 has assessed health gains across a range of medical specialties from the perspective of research funders rather than the health services; Dutch researchers have examined the return on investment of obstetric trials, emphasising the effect of cost savings in promoting change in clinical practice.

    We applied the methods of the Dutch researchers to exploring the health outcomes and costs of treatment interventions in maternal and perinatal health that have been evaluated in randomised clinical trials (RCTs), and calculated the potential cost savings and improved patient outcomes achievable by implementing efficacious treatment interventions.

  • Latest IMPACT news...

    Congratulations to William Tarnow-Mordi, his team and all members of the IMPACT Network who were involved with the BOOST II Trial.

    They were awarded First Runner Up in the Australian Clinical Trials Alliance (ACTA) Trial of the Year Award 2017. This prestigious award was announced along with the winner at the Clinical Trials National Tribute and Awards Ceremony held in Sydney on Friday 19th May. This is a fantastic achievement for the trial investigators and great news for the IMPACT Network. Following on from the win by the PPROMT trial last year it is absolutely awesome to again see maternal and perinatal health blazing the trail of clinical trials.

    William Tarnow-Mordi receiving the award from Minister Greg Hunt. 

    May 2017 William Tarnow

     

    19th May was a big day for clinical trials research in Australia as Minister Hunt took the opportunity of the awards ceremony to announce the allocation of $33 million from MRFF and other sources to support clinical trial research.

     

     

     

    Most significantly this included $5 million to ACTA over the next four years to ‘support their work in ensuring Australia maintains its world-leading clinical trial standards and continues to support the clinical trials sector’.  This is unlikely to involve any finances reaching clinical trials networks directly but will still provide support for the work we do and is a big signal for future support of clinical trials.

    See link here for 7 News clip about $33 million federal budget funding allocated to medical trials and featuring IMPACT member Dr Adrienne Gordon

    See link here for Sydney Morning Herald article on premature babies benefiting from practice change as a result of evidence from the BOOST II trial