BACKGROUND AND PURPOSE:

• Gomersall et al. (Pediatrics, 2020) performed a systematic review and meta-analysis to assess effects of umbilical cord clamping timing and cord milking in infants ≥ 34 weeks’ gestational age

METHODS:

• Systematic review and meta-analysis
• Data sources
  • Literature and trial registries through July 2019
• Inclusion criteria
  • RCTs
  • Studies that compared different policies and procedures regarding umbilical cord management in late preterm infants (34w0d to 36w6d) and term infants (≥37w0d)
• Study design
  • Two authors independently assessed eligibility of trials and extracted data
  • Certainty of evidence was assessed with GRADE criteria
  • Perinatal outcomes chosen based on clinical relevance and likelihood of influencing practice

RESULTS:

• 46 studies | 9159 women and their infants
• Compared to early cord clamping (ECC) <30 seconds, all of the following umbilical cord management strategies improved hematological measures (Hgb and Hct at 24 hours after birth)
  • Delayed cord clamping (DCC) ≥30 seconds (33 studies)
  • Intact-cord milking (1 study)
  • Cut-cord milking (2 studies)
• Alternative umbilical cord management strategies (delayed clamping and milking) may not have an effect on
  • Survival without neurodisability (authors note that there are limited studies with this finding as an endpoint)
  • Anemia in early infancy
  • Maternal postpartum hemorrhage
• No differences were found in major neonatal morbidities in studies comparing methods for optimizing placental transfusion
  • DCC vs cut-cord milking (3 studies)
  • Longer delays in clamping (7 studies)
  • Physiologic parameters (3 studies)
• Strategies that promote increased placental transfusion may be associated with greater phototherapy use
• Evidence for all outcomes was low or very low certainty

CONCLUSION:

• Compared to ECC, both DCC and cord milking increases hemoglobin and hematocrit after birth in infants ≥34 weeks’ gestational age
  • Data consistent with Cochrane review
• Further RCTs are necessary to assess longer term benefits
• The authors state

Compared to ECC, DCC (at ≥30 seconds) and cord milking led to increased hemoglobin and hematocrit immediately after birth in infants ≥34 weeks’ gestational age

The effects of later clamping or use of cord milking in term and late preterm infants on survival without neurodisability, anemia in early infancy, or maternal PPH (and most other outcomes reported) are uncertain 

Learn More – Primary Sources:

Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis

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