A Randomized Clinical Trial of Umbilical Cord Milking vs Delayed Cord Clamping in Preterm Infants: Neurodevelopmental Outcomes at 22-26 Months of Corrected Age

Katheria, Anup; Garey, Donna; Truong, Giang; Akshoomoff, Natacha; Steen, Jane; Maldonado, Mauricio; Poeltler, Debra; Harbert, Mary J.; Vaucher, Yvonne E.; Finer, Neil N.

doi:10.1016/j.jpeds.2017.10.037

Cited by 59 publications

(47 citation statements)

References 21 publications

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“…21 The study also assessed neurodevelopmental outcomes at 22 to 26 months and found that infants randomized to umbilical cord milking had higher language and cognitive scores compared with those randomized to DCC. 22 Umbilical milking is a process that can be performed within 20 seconds in which the unclamped umbilical cord is grasped and the blood is pushed toward the infant before it is clamped. 5 It may potentially have application for infants who require resuscitation immediately after birth and would benefit from a placental transfusion.…”

Section: Discussionmentioning

confidence: 99%

Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care Units

Tran

Parucha²,

Jegatheesan

et al. 2019

Am J Perinatol

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Objective To assess the current practice of delayed cord clamping (DCC) and to determine patient and hospital factors that predict DCC. Study Design The California Perinatal Quality Care Collaborative (CPQCC) collects data on preterm and acutely ill infants. In 2016, 52 CPQCC neonatal intensive care units (NICUs) collected data on DCC. Hospital and patient characteristics were analyzed using multivariable logistic regression. Results Of 5,332 deliveries, 1,555 (29%) newborns received DCC. Hospital rates ranged from 0 to 74.5% and increased from 21 to 37% throughout 2016. Infants delivered at <32 weeks or with birth weight <1,500 g were more likely to receive DCC (odds ratio: 2.80; 95% confidence interval: 2.33, 3.36). Cesarean delivery was associated with less likelihood of DCC (odds ratio: 0.68; 95% confidence interval: 0.59, 0.79). After risk adjustment, 17 (33%) hospitals had higher than expected DCC rate. Hospitals with less than 50 NICU beds are more likely to practice DCC, whereas Level 3 American Academy of Pediatrics NICUs, nonprofit owned hospitals, and teaching institutions were less likely to practice DCC (p < 0.001). Conclusion There are opportunities to implement quality improvement activities to increase DCC rates.

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Section: Discussionmentioning

confidence: 99%

Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care Units

Tran

Parucha²,

Jegatheesan

et al. 2019

Am J Perinatol

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“…Umbilical cord milking may be an alternative to delayed cord clamping in emergency situations [40]. Two randomised trials including 255 babies <33 weeks’ gestation offered broad reassurance that short-term outcomes are broadly equivalent [41], and one follow-up study suggested better cognitive and language scores in those randomised to cord milking [42]. However, animal studies show that cord milking causes considerable haemodynamic disturbance, and a recent clinical trial has shown quadrupling of the incidence of severe intraventricular haemorrhage with cord milking compared to delayed cord clamping in preterm infants calling into question the safety of this procedure [43].…”

Section: Delivery Room Stabilisationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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“…While there remain theoretic concerns regarding overtransfusion, polycythemia, hyperbilirubinemia, and delayed resuscitation when implementing any placental transfusion technique, these concerns have not been substantiated in any systematic reviews of short-term outcomes or in studies of neurodevelopmental follow-up. 10,[27][28][29][30] Existing studies of delayed cord clamping and umbilical cord milking have largely been performed in singleton pregnancies, and effectiveness in multiple gestations is unknown. Because of the relatively higher rates of morbidity and mortality in multiple gestations, we hypothesize that the benefit of placental transfusion may be magnified in this population.…”

mentioning

confidence: 99%

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

et al. 2019

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Objective Our aim was to evaluate the effect of umbilical cord milking on outcomes for preterm multiples. Study Design We implemented a policy of cord milking in neonates born at less than 30 weeks' gestation in September 2011. We compared cord milking in multiples with a historical cohort. Multivariable logistic regression models estimated the effect of cord milking on a composite neonatal adverse outcome. Secondary outcomes were hematocrit at birth, need for blood transfusion, and inotrope use. Results We identified 149 neonates (120 twins, 29 triplets), 51 historical controls, and 98 neonates with cord milking. Cord milking was associated with a lower rate of adverse composite neonatal outcome in univariable analysis (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.15–0.84). However, in multivariable modeling, the effect was not significant (adjusted OR [aOR]: 0.54, 95% CI: 0.23–1.28). Hematocrit was 4.6 unit % (95% CI: 2–7.3) higher in the cord milking group, and cord milking was associated with a lower rate of blood transfusion (aOR: 0.28; 95% CI: 0.1–0.74; p = 0.01). There was no difference in inotrope administration. Conclusion Umbilical cord milking was not associated with a decrease in composite neonatal adverse outcome. However, we observed an increase in hematocrit and decreased need for blood transfusion in neonates with cord milking.

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A Randomized Clinical Trial of Umbilical Cord Milking vs Delayed Cord Clamping in Preterm Infants: Neurodevelopmental Outcomes at 22-26 Months of Corrected Age

Cited by 59 publications

References 21 publications

Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care Units

Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care Units

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

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