Umbilical cord milking for neonates who are depressed at birth: a randomized trial of feasibility

Girish, Meenakshi; Jain, V C; Dhokane, Rohinie; Gondhali, Shital B; Vaidya, Ashish; Aghai, Zubair H.

doi:10.1038/s41372-018-0161-4

Cited by 29 publications

(27 citation statements)

References 31 publications

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“…Thus, there is an urgent need for high quality evidence to compare the use of UCM to ICC in infants that need resuscitation. Two recent trials from India demonstrated that it is feasible to study term and preterm who are depressed at birth ( 54 , 55 ). We need to determine if umbilical cord milking provides a superior placental transfusion and improves neonatal outcomes compared to current approaches.…”

Section: Discussionmentioning

confidence: 99%

Umbilical Cord Milking: A Review

Katheria

2018

Front. Pediatr.

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This is a review of umbilical cord milking, a controversial technique where the umbilical cord is squeezed several times before it is clamped an cut. While not physiological or natural for newborns, the question lies as to whether it is useful in certain circumstances, namely the depressed newborn. Here we review the literature and discuss why it could be considered as an alternative for the current practice of delayed cord clamping.

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Section: Discussionmentioning

confidence: 99%

Umbilical Cord Milking: A Review

Katheria

2018

Front. Pediatr.

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“…This corresponds with the practice of fluid resuscitation of severely depressed neonates in which intravascular volume is increased. Fluid replacement in the form of UCM was therefore suggested by Girish et al (2018) to prevent brain injuries associated with reduced cerebral blood flow at birth when intact resuscitation was impractical.…”

Section: Discussionmentioning

confidence: 99%

Effect of placental transfusion on neonatal resuscitation attempts

Emerson

Laws

2019

Journal of Paramedic Practice

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Objective: Overall, neonatal mortality has been shown to be reduced by: placental transfusion (the transfer of blood from the placenta to the neonatal circulation after birth); delayed cord clamping (DCM) (waiting for the umbilical cord to stop pulsating before clamping and cutting the cord); and umbilical cord milking (UCM) (clamping and cutting the cord immediately before milking the cord towards the neonate to expel remaining volume). This systematic review aimed to determine whether placental transfusion negatively impacts resuscitation by delaying it or has any effect on infant mortality, and to identify any barriers to performing it. Methods: CINAHL, MEDLINE, AMED and the British Nursing Index were searched using key terms to identify relevant English language publications between 2017 and 2019. Results: Five papers were selected for critical analysis—three randomised control trials and two cohort studies. Conclusion: Placental transfusion was not found to have a negative impact on neonatal resuscitation but, equally, had no significant effect on Apgar at 5 minutes; however, Apgar is a crude measure of infant mortality. The question remains around the proven multifaceted benefit of placental transfusion in the prehospital environment, which requires further research. There is evidence to suggest prehospital clinicians should be looking to change practice. Further research, considerations and consultations are required to ascertain the best way to implement the procedure with a balanced and proportionate approach considering neonatal thermoregulation and maternal management. The main reported barrier to placental transfusion was a lack of appropriate equipment.

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“…The sample included 1845 newborns with GA between 34 6 and 41 6/7 weeks. The selected studies were conducted in the United States, 26 India, [27][28][29][30][31][32] Egypt, 33,34 and Italy. 35 The sample size of the studies ranged from 24 to 300 newborns.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…35 The sample size of the studies ranged from 24 to 300 newborns. UCM was compared with DCC in six RCTs 28,29,[31][32][33][34] and ICC in four RCTs. 26,27,30,35 One RCT 28 included DCC as control and DCC with milking the cut cord (DCM).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Effects of cord milking in late preterm infants and full‐term infants: A systematic review and meta‐analysis

Ortiz‐Esquinas¹,

Rodríguez‐Almagro

Gómez‐Salgado

et al. 2020

Birth

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Background Umbilical cord milking (UCM) consists of performing several milkings of the cord from the placenta to the newborn. The objective was to evaluate the effects of UCM on newborns ≥34 weeks’ gestation. Methods Searches were conducted in MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, and the clinicaltrails.gov database for randomized clinical trials (RCT), with no time or language restrictions, and for articles that compared UCM with other strategies. The main results were initial hemoglobin and hemoglobin after 6 weeks. The data were collected by two reviewers and the quality of the studies was assessed using the Cochrane Manual methodology. Results The sample included 1845 newborns in 10 RCTs. The use of UCM in ≥34 weeks’ gestation newborns was not related to initial hemoglobin levels (pooled weighted mean difference: (PWMD = 0.40 g/L [−0.16 to 0.95]) or after 6 weeks (PWMD = 0.07 g/L [−0.29 to 0.27]). A reduction in hemoglobin levels was also observed at 6 weeks when the control group had undergone late clamping (PWDM = 0.16g/L [−0.26 to −0.06]). Conclusions UCM produced no differences in hematologic variables for newborns with ≥34 weeks of gestation relative to controls. However, a slight decrease in hemoglobin levels is observed at 6 weeks when the control group is made up of newborns with late clamping.

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Umbilical cord milking for neonates who are depressed at birth: a randomized trial of feasibility

Abstract: UCM is feasible for term and late preterm infants who are depressed at birth. A larger clinical trial is needed to evaluate long-term benefits of UCM in neonates with HIE.

Cited by 29 publications

References 31 publications

Umbilical Cord Milking: A Review

Umbilical Cord Milking: A Review

Effect of placental transfusion on neonatal resuscitation attempts

Effects of cord milking in late preterm infants and full‐term infants: A systematic review and meta‐analysis

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