Cord milking versus immediate clamping in preterm infants: a randomised controlled trial

El-Naggar, Walid; Simpson, David; Hussain, Arif; Armson, Anthony B; Dodds, Linda; Warren, Andrew E.; Whyte, Robin; McMillan, Douglas

doi:10.1136/archdischild-2018-314757

Cited by 31 publications

(26 citation statements)

References 37 publications

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“…33 A few additional studies have included multiple gestations but did not analyze them separately. 15,[34][35][36] This study has some notable limitations including sample size. This limitation will need to be addressed through the evaluation of multiple gestations within large randomized trials of cord milking and delayed cord clamping.…”

Section: Commentmentioning

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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Section: Commentmentioning

confidence: 99%

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

et al. 2019

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“…The sample included 2083 preterm infants with GA between 23 and <37 weeks. The selected studies were from Japan [32], the United Kingdom [33], the United States [17,22,25,26,[34][35][36], Turkey [19,37], India [18,20], South Korea [21], Canada [24,26], Ireland [26], and Germany [26].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The sample size of the studies ranged from 26 to 215 infants. UCM was compared with DCC in five RCTs [17,22,25,26,36], with ICC in twelve RCTs [16,[18][19][20][21]23,24,[32][33][34][35]37].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eleven studies [17,21,[23][24][25][26][32][33][34][35][36] evaluated the risk of mortality in 1409 infants at <37 weeks GA and found no significant reduction in the risk of mortality regarding the UCM group versus the control group (RR = 0.71 [95% CI 0.47-1.08]). Similarly, in nine studies [17,21,24,26,[32][33][34][35][36] that evaluated the mortality of 1067 infants at <33 weeks GA, no reduction in the risk of mortality was found in the intervention group versus the control group (RR = 0.66 [95% CI 0.43-1.03]). No significant differences were found in the sub-analysis by type of control (Tables 2 and A3).…”

Section: Mortalitymentioning

confidence: 99%

“…Despite the demonstrated benefits of UCM for preterm infants, it is still not standard practice in delivery care and requires a new review due to the large number of RCTs published in recent years [16][17][18][19][20][21][22][23][24][25][26]. It would be especially interesting to determine the benefits and risks by gestational age and by type of clamping (DCC or ICC) in the most significant variables.…”

Section: Introductionmentioning

confidence: 99%

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Umbilical Cord Milking in Infants Born at <37 Weeks of Gestation: A Systematic Review and Meta-Analysis

Ortiz‐Esquinas¹,

Gómez‐Salgado

Rodríguez‐Almagro

et al. 2020

JCM

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Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects of UCM in newborns <37 weeks’ gestation. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database for randomized UCM clinical trials with no language restrictions, which we then compared with other strategies. The sample included 2083 preterm infants. The results of our meta-analysis suggest that UCM in premature infants can reduce the risk of transfusion (relative risk (RR)= 0.78 [95% confidence interval (CI),0.67–0.90]) and increase hemoglobin(pooled weighted mean difference (PWMD)= 0.89 g/L[95%CI 0.55–1.22]) and mean blood pressure (PWMD=1.92 mmHg [95% CI 0.55–3.25]). Conversely, UCM seems to increase the risk of respiratory distress syndrome (RR = 1.54 [95% CI 1.03–2.29]), compared to the control groups. In infants born at <33 weeks, UCM was associated with a reduced risk of transfusion (RR= 0.81 [95%CI 0.66–0.99]), as well as higher quantities of hemoglobin (PWMD= 0.91 g/L[95%CI 0.50–1.32]). UCM reduces the risk of transfusion in preterm infants, and increases initial hemoglobin, hematocrit, and mean blood pressure levels with respect to controls.

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Association of Umbilical Cord Management Strategies With Outcomes of Preterm Infants

Jasani

Torgalkar

et al. 2021

JAMA Pediatr

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IMPORTANCEIt is unclear which umbilical cord management strategy is the best for preventing mortality and morbidities in preterm infants.OBJECTIVE To systematically review and conduct a network meta-analysis comparing 4 umbilical cord management strategies for preterm infants: immediate umbilical cord clamping (ICC), delayed umbilical cord clamping (DCC), umbilical cord milking (UCM), and UCM and DCC.DATA SOURCES PubMed, Embase, CINAHL, and Cochrane CENTRAL databases were searched from inception until September 11, 2020.STUDY SELECTION Randomized clinical trials comparing different umbilical cord management strategies for preterm infants were included.DATA EXTRACTION AND SYNTHESIS Data were extracted for bayesian random-effects meta-analysis to estimate the relative treatment effects (odds ratios [OR] and 95% credible intervals [CrI]) and surface under the cumulative ranking curve values. MAIN OUTCOMES AND MEASURESThe primary outcome was predischarge mortality. The secondary outcomes were intraventricular hemorrhage, severe intraventricular hemorrhage, need for packed red blood cell transfusion, and other neonatal morbidities. Confidence in network meta-analysis software was used to assess the quality of evidence and grade outcomes.RESULTS Fifty-six studies enrolled 6852 preterm infants. Compared with ICC, DCC was associated with lower odds of mortality (22 trials, 3083 participants; 7.6% vs 5.0%; OR, 0.64; 95% CrI, 0.39-0.99), intraventricular hemorrhage (25 trials, 3316 participants; 17.8% vs 15.4%; OR, 0.73; 95% CrI, 0.54-0.97), and need for packed red blood cell transfusion (18 trials, 2904 participants; 46.9% vs 38.3%; OR, 0.48; 95% CrI, 0.32-0.66). Compared with ICC, UCM was associated with lower odds of intraventricular hemorrhage (10 trials, 645 participants; 22.5% vs 16.2%; OR, 0.58; 95% CrI, 0.38-0.84) and need for packed red blood cell transfusion (9 trials, 688 participants; 47.3% vs 32.3%; OR, 0.36; 95% CrI, 0.23-0.53), with no significant differences for other secondary outcomes. There was no significant difference between UCM and DCC for any outcome. CONCLUSIONS AND RELEVANCECompared with ICC, DCC was associated with the lower odds of mortality in preterm infants. Compared with ICC, DCC and UCM were associated with reductions in intraventricular hemorrhage and need for packed red cell transfusion. There was no significant difference between UCM and DCC for any outcome. Further studies directly comparing DCC and UCM are needed.

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Cord milking versus immediate clamping in preterm infants: a randomised controlled trial

Abstract: NCT01487187.

Cited by 31 publications

References 37 publications

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

Umbilical Cord Milking in Infants Born at <37 Weeks of Gestation: A Systematic Review and Meta-Analysis

Association of Umbilical Cord Management Strategies With Outcomes of Preterm Infants

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