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Grand Rounds

Is Umbilical Cord Milking of Benefit to Preterm Infants?

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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

METHODS: 

  • 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 

RESULTS: 

  • 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

CONCLUSION: 

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

Learn More – Primary Sources: 

Cord milking versus immediate clamping in preterm infants: a randomised controlled trial

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Related ObG Topics:

What is the Optimal time of Cord Clamping in Preterm Newborns?
Is There Benefit to 3 Minute Delay in Umbilical Cord Clamping?
ACOG Committee Opinion on Delayed Cord Clamping

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