Neonatal/Infant Resuscitation
Neonatal/Infant Resuscitation 3
Katherine Coughlin, MD (she/her/hers)
Attending Neonatologist
Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns
San Diego, California, United States
Evidence supports delayed cord clamping (DCC) for all preterm births due to a reduction in mortality. Umbilical cord milking (UCM) is not recommended due to an increased risk for severe intraventricular hemorrhage. It is unclear whether umbilical cord milking is preferable to early cord clamping (ECC) in preterm infants when DCC cannot be performed.
To compare outcomes in preterm infants who received ECC as compared to those who received UCM.
A retrospective cohort study of infants born either < 32 weeks GA at birth or < 1500g at a single center between 2018-2021. UCM was performed by milking the intact cord 4 times prior to cord clamping. ECC was defined as cord clamping prior to 60 seconds.
705 infants were included for analysis, of which 299 (42%) received ECC and 406 (58%) received UCM (240 infants who received DCC were excluded). Infants in the UCM group were more likely to be male (54 vs 46%, p=0.03), receive antenatal steroids (95 vs 90%, p=0.04), more likely to cry before cord clamp (68 vs 58%, p=0.02), had a higher GA at birth (28.4 vs 27.7 weeks), p< 0.001) and higher birth weight (1229 vs 1097g, p< 0.001).
After adjustment for gestational age, UCM infants had a higher 5-minute temperature in the delivery room (36.8 vs 36.7 degrees C, p=0.05), a higher admission hemoglobin (16.3 vs 15.3 g/dL, p< 0.001), and were less likely to receive a blood transfusion (31 vs 49%, p=0.001). There were no differences in IVH, severe IVH, or PVL between infants with UCM and early ECC.
In this cohort, infants who received UCM had similar outcomes to those infants receiving ECC after adjustment for gestational age. In addition, UCM infants had higher hemoglobin and were less likely to receive a blood transfusion in the NICU. Given the concerns regarding cord management in infants that cannot receive delayed cord clamping, our data is reassuring that milking may not be associated with increased harm in this population and may have hematologic benefits. Prospective, large, randomized trials of non-vigorous preterm infants are needed to elucidate whether these benefits are associated with UCM rather than differences in baseline characteristics.