Umbilical Cord Milking vs Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants
Neha Kumbhat, Barry Eggleston, Alexis S Davis, Sara B DeMauro, Krisa P Van Meurs, Elizabeth E Foglia, Satyan Lakshminrusimha, Michele C Walsh, Kristi L Watterberg, Myra H Wyckoff, Abhik Das, Sara C Handley, Generic Database Subcommittee of the National Institute of Child Health and Human Development Neonatal Research Network, Richard A Polin, Abbot R Laptook, Martin Keszler, Angelita M Hensman, Elisa Vieira, Lucille St Pierre, Anna Maria Hibbs, William E Truog, Eugenia K Pallotto, Prabhu S Parimi, Cheri Gauldin, Anne Holmes, Allison Knutson, Lisa Gaetano, Brenda B Poindexter, Kurt Schibler, Stephanie L Merhar, Cathy Grisby, Kristin Kirker, C Michael Cotten, Ronald N Goldberg, Joanne Finkle, Kimberley A Fisher, Matthew M Laughon, Carl L Bose, Janice Bernhardt, Gennie Bose, Cindy Clark, Stephen D Kicklighter, Ginger Rhodes-Ryan, Donna White, David P Carlton, Ravi M Patel, Yvonne Loggins, Colleen Mackie, Diane I Bottcher, Andrew A Bremer, Rosemary D Higgins, Stephanie Wilson Archer, Gregory M Sokol, Dianne E Herron, Jon E Tyson, Amir M Khan, Kathleen A Kennedy, Claudia Pedrozza, Elizabeth Eason, Emily K Stephens, Georgia E McDavid, Karen Martin, Donna Hall, Sharon L Wright, Pablo J Sánchez, Leif D Nelin, Sudarshan R Jadcherla, Patricia Luzader, Erna Clark, Julie Gutentag, Courtney Park, Julie C Shadd, Melanie Stein, Hallie Baugher, Jacqueline McCool, Marie G Gantz, Carla M Bann, Dennis Wallace, Kristin M Zaterka-Baxter, Jenna Gabrio, David Leblond, Jeanette O'Donnell Auman, David K Stevenson, Valerie Y Chock, M Bethany Ball, Melinda S Proud, Elizabeth N Reichert, R Jordan Williams, Waldemar A Carlo, Namasivayam Ambalavanan, Monica V Collins, Shirley S Cosby, Tara McNair, Uday Devaskar, Meena Garg, Teresa Chanlaw, Rachel Geller, Edward F Bell, Tarah T Colaizy, Dan L Ellsbury, Michelle L Baack, Karen J Johnson, Mendi L Schmelzel, Jacky R Walker, Claire A Goeke, Tracy L Tud, Chelsey Elenkiwich, Megan M Henning, Megan Broadbent, Laurie A Hogden, Jane E Brumbaugh, Jonathan M Klein, John M Dagle, Janell Fuller, Robin K Ohls, Sandra Sundquist Beauman, Conra Backstrom Lacy, Carol Hartenberger, Mary Hanson, Elizabeth Kuan, Eric C Eichenwald, Barbara Schmidt, Haresh Kirpalani, Soraya Abbasi, Christine Catts, Aasma S Chaudhary, Sarvin Ghavam, Toni Mancini, Jonathan Snyder, Carl T D'Angio, Ronnie Guillet, Anne Marie Reynolds, Holly I M Wadkins, Michael G Sacilowski, Mary Rowan, Rosemary L Jensen, Deanna Maffett, Diane Prinzing, Ann Marie Scorsone, Kyle Binion, Stephanie Guilford, Constance Orme, Premini Sabaratnam, Daisy Rochez, Emily Li, Jennifer Donato, Satyan Lakshminrusimha, Rachel Jones, Luc P Brion, Maria M DeLeon, Frances Eubanks, Pollieanna Sepulvida, Diana M Vasil, Bradley A Yoder, Mariana Baserga, Stephen D Minton, Mark J Sheffield, Carrie A Rau, Jill Burnett, Brandy Davis, Susan Christensen, Manndi C Loertscher, Trisha Marchant, Earl Maxson, Kandace McGrath, Jennifer O Elmont, Melody Parry, Susan T Schaefer, Kimberlee Weaver-Lewis, Kathryn D Woodbury, Seetha Shankaran, Girija Natarajan, Sanjay Chawla, Kirsten Childs, Bogdan Panaitescu, John Barks, Diane F White, Neha Kumbhat, Barry Eggleston, Alexis S Davis, Sara B DeMauro, Krisa P Van Meurs, Elizabeth E Foglia, Satyan Lakshminrusimha, Michele C Walsh, Kristi L Watterberg, Myra H Wyckoff, Abhik Das, Sara C Handley, Generic Database Subcommittee of the National Institute of Child Health and Human Development Neonatal Research Network, Richard A Polin, Abbot R Laptook, Martin Keszler, Angelita M Hensman, Elisa Vieira, Lucille St Pierre, Anna Maria Hibbs, William E Truog, Eugenia K Pallotto, Prabhu S Parimi, Cheri Gauldin, Anne Holmes, Allison Knutson, Lisa Gaetano, Brenda B Poindexter, Kurt Schibler, Stephanie L Merhar, Cathy Grisby, Kristin Kirker, C Michael Cotten, Ronald N Goldberg, Joanne Finkle, Kimberley A Fisher, Matthew M Laughon, Carl L Bose, Janice Bernhardt, Gennie Bose, Cindy Clark, Stephen D Kicklighter, Ginger Rhodes-Ryan, Donna White, David P Carlton, Ravi M Patel, Yvonne Loggins, Colleen Mackie, Diane I Bottcher, Andrew A Bremer, Rosemary D Higgins, Stephanie Wilson Archer, Gregory M Sokol, Dianne E Herron, Jon E Tyson, Amir M Khan, Kathleen A Kennedy, Claudia Pedrozza, Elizabeth Eason, Emily K Stephens, Georgia E McDavid, Karen Martin, Donna Hall, Sharon L Wright, Pablo J Sánchez, Leif D Nelin, Sudarshan R Jadcherla, Patricia Luzader, Erna Clark, Julie Gutentag, Courtney Park, Julie C Shadd, Melanie Stein, Hallie Baugher, Jacqueline McCool, Marie G Gantz, Carla M Bann, Dennis Wallace, Kristin M Zaterka-Baxter, Jenna Gabrio, David Leblond, Jeanette O'Donnell Auman, David K Stevenson, Valerie Y Chock, M Bethany Ball, Melinda S Proud, Elizabeth N Reichert, R Jordan Williams, Waldemar A Carlo, Namasivayam Ambalavanan, Monica V Collins, Shirley S Cosby, Tara McNair, Uday Devaskar, Meena Garg, Teresa Chanlaw, Rachel Geller, Edward F Bell, Tarah T Colaizy, Dan L Ellsbury, Michelle L Baack, Karen J Johnson, Mendi L Schmelzel, Jacky R Walker, Claire A Goeke, Tracy L Tud, Chelsey Elenkiwich, Megan M Henning, Megan Broadbent, Laurie A Hogden, Jane E Brumbaugh, Jonathan M Klein, John M Dagle, Janell Fuller, Robin K Ohls, Sandra Sundquist Beauman, Conra Backstrom Lacy, Carol Hartenberger, Mary Hanson, Elizabeth Kuan, Eric C Eichenwald, Barbara Schmidt, Haresh Kirpalani, Soraya Abbasi, Christine Catts, Aasma S Chaudhary, Sarvin Ghavam, Toni Mancini, Jonathan Snyder, Carl T D'Angio, Ronnie Guillet, Anne Marie Reynolds, Holly I M Wadkins, Michael G Sacilowski, Mary Rowan, Rosemary L Jensen, Deanna Maffett, Diane Prinzing, Ann Marie Scorsone, Kyle Binion, Stephanie Guilford, Constance Orme, Premini Sabaratnam, Daisy Rochez, Emily Li, Jennifer Donato, Satyan Lakshminrusimha, Rachel Jones, Luc P Brion, Maria M DeLeon, Frances Eubanks, Pollieanna Sepulvida, Diana M Vasil, Bradley A Yoder, Mariana Baserga, Stephen D Minton, Mark J Sheffield, Carrie A Rau, Jill Burnett, Brandy Davis, Susan Christensen, Manndi C Loertscher, Trisha Marchant, Earl Maxson, Kandace McGrath, Jennifer O Elmont, Melody Parry, Susan T Schaefer, Kimberlee Weaver-Lewis, Kathryn D Woodbury, Seetha Shankaran, Girija Natarajan, Sanjay Chawla, Kirsten Childs, Bogdan Panaitescu, John Barks, Diane F White
Abstract
Objective: To compare in-hospital outcomes after umbilical cord milking vs delayed cord clamping among infants <29 weeks of gestation.
Study design: Multicenter retrospective study of infants born <29 weeks of gestation from 2016 to 2018 without congenital anomalies who received active treatment at delivery and were exposed to umbilical cord milking or delayed cord clamping. The primary outcome was mortality or severe (grade III or IV) intraventricular hemorrhage (IVH) by 36 weeks of postmenstrual age (PMA). Secondary outcomes assessed at 36 weeks of PMA were mortality, severe IVH, any IVH or mortality, and a composite of mortality or major morbidity. Outcomes were assessed using multivariable regression, incorporating mortality risk factors identified a priori, confounders, and center. A prespecified, exploratory analysis evaluated severe IVH in 2 gestational age strata, 22-246/7 and 25-286/7 weeks.
Results: Among 1834 infants, 23.6% were exposed to umbilical cord milking and 76.4% to delayed cord clamping. The primary outcome, mortality or severe IVH, occurred in 21.1% of infants: 28.3% exposed to umbilical cord milking and 19.1% exposed to delayed cord clamping, with an aOR that was similar between groups (aOR 1.45, 95% CI 0.93, 2.26). Infants exposed to umbilical cord milking had higher odds of severe IVH (19.8% umbilical cord milking vs 11.8% delayed cord clamping, aOR 1.70 95% CI 1.20, 2.43), as did the 25-286/7 week stratum (14.8% umbilical cord milking vs 7.4% delayed cord clamping, aOR 1.89 95% CI 1.22, 2.95). Other secondary outcomes were similar between groups.
Conclusions: This analysis of extremely preterm infants suggests that delayed cord clamping is the preferred practice for placental transfusion, as umbilical cord milking exposure was associated with an increase in the adverse outcome of severe IVH.
Trial registration: ClinicalTrials.gov: NCT00063063.
Keywords: Neonatal Research Network; intraventricular hemorrhage; placental transfusion.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Source: PubMed