The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial
M I March, M R Hacker, A W Parson, A M Modest and M de Veciana
Delayed cord clamping has been shown to decrease the need for transfusion in preterm neonates, but may delay resuscitation. The aim of this study was to determine whether umbilical cord milking compared with immediate cord clamping in extremely preterm deliveries reduces the need for neonatal red blood cell transfusion.
Women admitted to a tertiary care center and expected to deliver between 24 to 28 completed weeks of gestation were randomized to cord milking before clamping or immediate cord clamping. The primary outcome was the risk of neonatal transfusion, reported as risk ratio (RR) and 95% confidence interval (CI).
Of 113 women who were enrolled and randomized, 56 were assigned to cord milking with 36 remaining eligible and completing the study and 57 were assigned to the control group with 39 remaining eligible and completing the study. Albeit not statistically significant, neonates in the cord milking group were less likely to require transfusion compared with those in the control group (RR: 0.86; 95% CI: 0.73 to 1.0). Neonates whose cords were milked had higher hematocrits at birth (P=0.004) and were less likely to develop an intraventricular hemorrhage (P=0.0195).
Milking the umbilical cord of a preterm neonate is an easy intervention with the potential to improve perinatal outcomes. Our results suggest that milking of the cord increases the neonate’s initial hematocrit and may lessen the need for transfusion in the neonatal period. The observed reduction in the incidence of intraventricular hemorrhage may have important long-term implications that warrant further study.
The paper addresses milking of umbilical cord in an effort to reduce the need for blood transfusions and the incidence of IVH in ELBW infants. The small sample size failed to show a statistical decrease in the need for blood transfusions. It remains unclear as to whether the difference in grade 1 and 2 IVHs was secondary to the higher incidence of chorioamnionitis and sepsis in the control group, rather than a direct positive effect of umbilical cord milking on the study infants. The incidence of higher grades IVHs was similar, and there were no follow-up data to assess the long term developmental outcome. Further large, multicenter studies are needed before the risks and benefits of umbilical cord milking are delineated.
Sandra Brooks, M.D.