Impact of Umbilical Cord Milking and Delayed Cord Clamping on Hematological Parameters in Term Neonates: A Case Control Study

Abstract

Introduction Placental transfusion is additional volume of blood transferred to the baby during birth. A newborn who receives placental transfusion at birth obtains 30% more blood volume than the newborn whose cord is cut immediately. Receiving an adequate blood volume from placental transfusion at birth may be protective for the distressed neonates. It provides sufficient iron reserves for the first 3 to 6 months of life there by preventing or delaying iron deficiency anemia until the use of iron fortified food is implemented. There are 2 ways of placental transfusion, they are delayed cord clamping and umbilical cord milking. Delayed cord clamping (defined as clamping till cessation of pulsations or up to 60-180 s) leads to improvement in levels of hemoglobin and hematocrit at 6 weeks of age. However, universal application is limited due to concerns for the risk of hypothermia, and delay in initiation of resuscitation if required. Umbilical cord milking involves milking the entire contents of the umbilical cord towards the baby with in 20 s. Umbilical cord milking can be used in deliveries where delayed cord clamping is not feasible. Objective Comparison of hematological parameters (cord hemoglobin at birth, hemoglobin, hematocrit, and bilirubin levels in term neonates at 48 h with umbilical cord milking and delayed cord clamping). Methods and Analysis In this study all the term neonates delivered by vaginal delivery and lower segment caesarean section born to nonanemic mothers were considered eligible. All newborns with no risk factors underwent delayed cord clamping (n = 148) and those term neonates in whom delayed cord clamping was not feasible and/or currently WHO guidelines recommend for immediate cord clamping were allocated for umbilical cord milking (n = 121). Cord hemoglobin at birth, hemoglobin, hematocrit, and bilirubin (direct and indirect) were sent at 48 h. These parameters were compared between 2 groups. Results At birth cord hemoglobin was 15.36 and 15.46 (mean difference = 0.1) in DCC and UCM, respectively. At 48 hours, mean hemoglobin was 18.73 and 18.95 (mean difference = 0.22, P = .3591). Mean hematocrit was 52.22 and 53.28 (mean difference = 1.06, P = .0989), and mean total bilirubin levels was 11.24 and 10.56 (mean difference = 0.69, P = .466). Conclusion There were no statistically significant differences in the hematological parameters in full term neonates at 48 h, between delayed cord clamping and umbilical cord milking groups.