Neurodevelopmental Outcomes at 2 and 3.5 Years for Very Preterm Babies Enrolled in a Randomized Trial of Milking the Umbilical Cord versus Delayed Cord Clamping

Abstract

Background: Guidelines published by the International Liaison Committee for Resuscitation and by the World Health Organization recommend delaying cord clamping at birth as part of routine care for infants. Objective: To study the use of milking of the cord 4 times as an alternative to enhance the redistribution of placental blood into the baby. Methods: This is a prospective cohort study of neurodevelopmental assessment by the Bayley III method of very preterm infants who had participated in a trial of delayed cord clamping versus cord milking at birth that was conducted in a neonatal tertiary care hospital. The primary outcomes were differences in cognitive, motor and language development at 2 and 3.5 years. Two-tailed analyses were performed with the χ² test, Fisher's exact test, t test, Mann-Whitney U test and ANCOVA. Results: Out of the 58 infants enrolled in the original study, 39 infants (67%) were assessed at 2 years and 29 (50%) at 3.5 years of age. Neurodevelopmental outcomes at 2 and 3.5 years did not significantly differ between the two groups for the three Bayley III composite scores. At 3.5 years there was a trend towards higher scores for girls in the language composite scores (girls: mean = 121.6, SD = 15.22; boys: mean = 101.07, SD = 19.84) and on the motor scale (girls: mean = 124.60, SD = 18.15; boys: mean = 97.86, SD = 17.23). Conclusions: In this small number of participants followed up at 2 and 3.5 years of age, milking of the cord 4 times did not have any long-term adverse effect on neurodevelopmental outcome, suggesting that cord milking could be used as an alternative to delayed cord clamping.

Inotropes for preterm babies during the transition period after birth: friend or foe?

“…Two studies comparing delayed cord clamping of 30 or 60 s with four times milking of the cord in preterm infants <32 weeks showed similar patterns for increasing blood pressure during the first week of life in both groups with very low need for inotrope treatment 51 52. A neurodevelopmental follow-up study at 3.5 years corrected age showed no difference for both groups in the first comparison study 53. In January 2017, the large Australian Placental transfusion study has completed enrolling more than 1600 preterm infants into a randomised controlled trial of comparing immediate with delayed cord clamping of more than 60 s 54.…”

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

“…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.…”

Randomised control trial showed that delayed cord clamping and milking resulted in no significant differences in iron stores and physical growth parameters at one year of age

“…Data accumulated to date shows that DCC, when compared to early cord clamping, improved haematological outcomes with respect to haemoglobin and serum ferritin at two to six months of age, but not later in term (1,9,10,12,13,(21)(22)(23) and preterm neonates (24). DCC has also been reported to improve the neurodevelopmental outcome at four years of age (25), but have comparable effects to UCM in preterm neonates (26). UCM also resulted in improved haematological status in term (8) and preterm infants (24).…”