Background
It has been established that delayed umbilical cord clamping in preterm infants results
in improvement in neonatal anemia, need for transfusion, incidence of necrotizing
enterocolitis, and intraventricular hemorrhage by increasing neonatal circulating
blood volume. However, the effects of umbilical cord milking as an alternative to
delayed clamping in preterm infants are unclear.
Objective
The primary objective of this study was to compare the effect of delayed clamping
vs milking of the umbilical cord on the initial hematocrit concentration in preterm
births (23–34 weeks gestation). In addition, we sought to compare the effects of delayed
clamping vs milking on the incidences of intraventricular hemorrhage, necrotizing
enterocolitis, and need for transfusion (secondary objectives).
Study Design
The study was an unblinded randomized controlled trial of singleton preterm infants
who were born 23 weeks 0 days to 34 weeks 6 days gestation and were assigned to 1
of 2 controlled study groups: delayed cord clamping for 60 seconds or milking of the
cord towards the infant 4 times before clamping. Randomization occurred via block
randomization with an allocation ratio of 1 to 1. The patients’ third stage of delivery
was standardized for route of delivery and randomization arm. All comparisons were
preformed with an intent-to-treat analysis approach. The study was powered at 80%
with a probability value of .05 for the primary outcome measure of a hematocrit difference
of 3% between the 2 groups.
Results
Of the 204 randomized patients, 104 were assigned to the delayed subgroup, and 100
were assigned to the milking subgroup. There were no significant differences in baseline
maternal characteristics noted between groups. Though there was not any statistically
significant difference in neonatal outcomes between the cord clamping and milking
groups, the occurrences of transfusion (15.5% vs 9.1%; P=.24), necrotizing enterocolitis (5.8% vs 3.0%; P=.49), and intraventricular hemorrhage (15.5% vs 10.1%; P=.35) were all lower in the milking group. The milking group had higher initial hematocrit
concentration compared with the delayed clamping group, although this was not significant
(51.8 [6.2%] vs 49.9 [7.7%]; P=.07]. Peak bilirubin levels and need for phototherapy were similar between groups.
Conclusion
This study demonstrates that milking the umbilical cord may be an acceptable alternative
to delayed cord clamping because there were similar effects on neonatal hematocrit
concentrations and the need for neonatal transfusions and no increased risk for complications
or neonatal morbidity. The present data support the concept that milking of the umbilical
cord may offer an efficient and timely method of providing increased blood volume
to the infant.
Key words
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Article Info
Publication History
Published online: February 17, 2019
Accepted:
January 28,
2019
Received in revised form:
January 26,
2019
Received:
November 9,
2018
Footnotes
The authors report no conflict of interest.
Cite this article as: Shirk SK, Manolis SA, Lambers DS, et al. Delayed clamping vs milking of umbilical cord in preterm infants: a randomized controlled trial. Am J Obstet Gynecol 2019;220:482.e1-8.
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© 2019 Elsevier Inc. All rights reserved.
