Grand Rounds

Is Umbilical Cord Milking of Benefit to Preterm Infants?

BACKGROUND AND PURPOSE:

Hemodynamic instability remains a concern in preterm infants
Placental transfusion – cord milking – could potentially help stabilize hemodynamics in very preterm infants
El-Naggar et al. (Arch Dis Child Fetal Neonatal Ed., 2018) assessed whether umbilical cord milking (UCM) at birth improves systemic blood flow and short-term outcomes

Randomized clinical trial (RCT)
Participants
- Infants born to eligible women presenting in preterm labor
- Between 24w0d and 30w6d
Infants received either
- Immediate Cord Clamping (ICC)
  - Within 10 seconds
- Umbilical Cord Milking (UCM)
  - Infant at or below the level of the placenta
  - Approximately 20 cm of the cord milked towards the umbilicus three times, allowing for refilling prior to clamping
Primary outcome: Systemic blood flow as represented by echo-derived superior vena cava (SVC) flow at 4-6 hours after birth
Secondary outcomes
- Cardiac output | Neonatal morbidities and mortality

73 infants were randomized
- Mean (SD) gestational age: 27 (2) weeks
- Mean (SD) birth weight: 1040 (283) g
Hgb on admission was higher in the UCM than in the ICC group
- 16.1 vs 15.0 g/L (p=0.049)
No statistically significant differences were found between groups in SVC flow at
- 4-6 hours: 88.9±37.8 and 107.3±60.1 mL/kg/min, p=0.13
- 10-12 hours: of age: 102.5±41.8 and 90.6±28.4 mL/kg/min (p=0.17)
No statistically significant differences in secondary outcomes
- Cardiac output
- Neonatal morbidities

Cord milking was not shown to improve functional cardiac outcomes, nor neonatal morbidity or mortality

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