Effect of umbilical cord milking versus delayed cord clamping on preterm neonates in Kenya: A randomized controlled trial

Abstract

Background Delayed cord clamping (DCC) is a placental to new-born transfusion strategy recommended by obstetric and gynaecological societies. Though not widely adopted, umbilical cord milking (UCM) may achieve faster transfusion when DCC cannot be performed such as when a neonate requires resuscitation. Methods Pragmatic, two-arm, randomized clinical trial in which consenting women in spontaneous labour or provider-initiated delivery at 28 to less than 37 weeks at Kenyatta National Hospital in Nairobi, Kenya, were enrolled. At delivery, stable preterm infants were randomized to UCM (4 times) or DCC (60 seconds). Neonatal samples were collected for analysis at 24 hours after delivery. Maternal primary PPH (within 24 hours) and neonatal jaundice (within 1 week) were evaluated clinically. The primary outcome was the mean neonatal haemoglobin level at 24 hours after birth. Modified Intention to treat analysis was used for all outcomes. P-value was significant at p<0.05. Results Between March 2018 to March 2019, 344 pregnant women underwent screening, and 280 eligible participants were randomized when delivery was imminent. The intervention was not performed on 19 ineligible neonates. Of the remaining 260 neonates, 133 underwent UCM while 128 underwent DCC. Maternal and neonatal baseline characteristics were similar. The mean neonatal haemoglobin (17.1 vs 17.5 grams per decilitre, p = 0.191), haematocrit (49.6% vs 50.3%, p = 0.362), anaemia (9.8% vs 11.7%, p = 0.627), maternal PPH (2.3% vs 3.1%, p = 0.719) were similar between UCM and DCC respectfully. However, neonatal polycythaemia (2.3% vs 8.6%, p = 0.024) and neonatal jaundice (6.8% vs 15.6%, p = 0.024) were statistically significantly lower in UCM compared to DCC. Conclusion UCM compared to DCC for preterm neonates resulted in similar outcomes for neonatal haemoglobin, haematocrit, anaemia and maternal primary PPH and a lower proportion of neonatal polycythaemia and clinical jaundice. UCM offers a comparable method of placental transfusion compared to DCC and may be considered as an alternative to DCC in preterm neonates at 28 to <37 weeks’ gestation.

Effects of spontaneous first breath on placental transfusion in term neonates born by cesarean section: A randomized controlled trial

“…Another research comparing UCM with DCC for preterm newborns found that neonatal Hb and Hct levels were similar. UCM and DCC are two ways of placental transfusion that are similar ( 40 ). UCM effectively accelerates placental transfusion at the moment of birth, with advantages comparable to DCC ( 22 ).…”

Placental Transfusion Strategies in Preterm Infants in Low- and Middle-Income Countries: A Systematic Review and Network Meta-Analysis

“…The PRISMA flow is shown in online supplementary Figure 1. Of the included RCTs, 18 enrolled 2,253 newborns born at <34 weeks of gestation [25, 27-33, 36, 38, 41, 43-45, 47-50] and 9 enrolled 883 LPT newborns [24, 26, 34, 35, 37, 39, 40, 42, 46]. Intransitivity was assessed by comparing the characteristics of included studies.…”

“…Of the 27 included RCTs, 7 had a low ROB [25, 26, 36, 38, 39, 42, 45]. While 6 RCTs had some concerns [27, 31, 33, 37, 40, 43], 14 had a high ROB [24, 28-30, 32, 34, 35, 41, 44-50].…”

Umbilical Cord Milking in Newborns: Scoping Review

“…The cord was then released at the placental end and allowed to refill with blood for a brief 1 to 3 seconds pause between each milking motion (12, 14, 18-24, 27, 29-36, 39-41, 42, 43, 45-49, 53, 58, 66, 69, 74, 76-78) . In general, the entire procedure was completed in not more than 30 s. After this, the umbilical cord was clamped and cut at 2-3 cm from the umbilicus and the infant taken to the warmer for routine newborn care (20,23,26,35,43,48,50,61,69,74,77) .…”