Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants

Abstract

Background and objective: Delayed cord clamping (DCC) is recommended for premature infants to improve blood volume. Most preterm infants are born by cesarean delivery (CD), and placental transfusion may be less effective than in vaginal delivery (VD). We sought to determine whether infants <32 weeks born by CD who undergo umbilical cord milking (UCM) have higher measures of systemic blood flow than infants who undergo DCC.

Methods: This was a 2-center trial. Infants delivered by CD were randomly assigned to undergo UCM or DCC. Infants delivered by VD were also randomly assigned separately. UCM (4 strippings) or DCC (45-60 seconds) were performed. Continuous hemodynamic measurements and echocardiography were done at site 1.

Results: A total of 197 infants were enrolled (mean gestational age 28 ± 2 weeks). Of the 154 infants delivered by CD, 75 were assigned to UCM and 79 to DCC. Of the infants delivered by CD, neonates randomly assigned to UCM had higher superior vena cava flow and right ventricular output in the first 12 hours of life. Neonates undergoing UCM also had higher hemoglobin, delivery room temperature, blood pressure over the first 15 hours, and urine output in the first 24 hours of life. There were no differences for the 43 infants delivered by VD.

Conclusions: This is the first randomized controlled trial demonstrating higher systemic blood flow with UCM in preterm neonates compared with DCC. UCM may be a more efficient technique to improve blood volume in premature infants delivered by CD.

Trial registration: ClinicalTrials.gov NCT01866982.

Copyright © 2015 by the American Academy of Pediatrics.

Figures

FIGURE 1

CONSORT diagram: study enrollment, intended randomization, and actual randomization.

FIGURE 2

Continuous hemodynamic measurements over 24 hours of life. Dotted line, UCM; solid line, DCC; CO, cardiac output by electrical cardiometry; HR, heart rate; MAP, mean arterial pressure; Spo2, pulse oxygen saturation; SV, stroke volume by electrical cardiometry; Sto2, cerebral saturations by near-infrared spectroscopy. *Paired t test = P < .05 for hourly averages. MAP was significantly higher in UCM infants treated with UCM for the first 15 hours (HR 3–15 beats per minute; χ2 = 5.05, P = .02).