Umbilical cord milking in preterm infants: a systematic review and meta-analysis

Balasubramanian, Hari; Ananthan, Anitha; Jain, Vaibhav; Rao, Shripada; Kabra, Nandkishor S

doi:10.1136/archdischild-2019-318627

Cited by 46 publications

(32 citation statements)

References 42 publications

(120 reference statements)

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“…This population was not included in our study, most of the premies we studied had a mean gestational age of 32 weeks where the risk has been reported to be lower [20]. A recent systematic review reports the risk of severe IVH in preterm infants <34 weeks gestational age [21]. Data on IVH are still limited in gestational groups greater than 28 weeks to confidently exclude any risk and unfortunately due to limitations in availability of cranial ultrasound in our setting, this study was unable to provide any further data on this outcome.…”

Section: Plos Onementioning

confidence: 99%

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

et al. 2021

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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.

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Section: Plos Onementioning

confidence: 99%

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

et al. 2021

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“…При сцеживании в отличие от немедленного пережатия пуповины была меньше частота трансфузии ЭСК крови (ОР 0,56 (95% ДИ 0,43-0,73), p < 0,001), но не отмечалось улучшения клинических исходов. Таким образом, на основании имеющихся данных не рекомендуется проводить сцеживание пуповины у глубоконедоношенных новорожденных [30].…”

Section: сравнительный анализ частоты заболеваний при различных способах профилактики и лечения ран у исследуемых групп пациентовunclassified

The effectiveness of umbilical cord milking/ delayed cord clamping and recombinant human erythropoietin in reducing red blood cell transfusions in extremely and very low birth weight infants

Шарафутдинова

Balashova

Kirtbaya

et al. 2021

Voprosy gematologii/onkologii i immunopatologii v pediatrii

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Anemia of prematurity is one of the most common and serious problems of neonatology. The main focus is to prevent of anemia in preterm infants. The aim of the study was to assess effectiveness of umbilical cord milking/delayed cord clamping and erythropoietin therapy in reducing red blood cell transfusions in extremely and very low birth weight infants. This clinical study was approved by the Commission on ethics of biomedical research (Protocol No. 12 November 17, 2016) and approved by the Scientific Council of National Medical Research Center for obstetrics, gynecology and perinatology named academician V.I. Kulakov of the ministry of Healthcare of the Russian Federation (Protocol No. 19 of November 29, 2016). Analysis of 482 extremely and very low birth weight infants was conducted (from 2008 to 2018). Umbilical cord milking or delayed umbilical cord clamping, both, and in combination with recombinant human erythropoietin therapy, decreasing the phlebotomy losses significantly reduces the need for transfusions of red blood cells in extremely and very low birth weight infants. The effectiveness of erythropoietin therapy, time of its start and various treatment schemes remain controversial, therefore further researches are necessary.

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“…(16) Previous studies have shown increased risk of severe IVH with UCM among very premature newborns (< 28 weeks). (17,18) 1. Anticipation, preparation and having trained providers working as a team are essential for newborn resuscitation.…”

mentioning

confidence: 99%

Singapore Neonatal Resuscitation Guidelines 2021

Biswas¹,

Ho²,

Yip³

et al. 2021

smedj

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Neonatal resuscitation is a coordinated, team-based series of timed sequential steps that focuses on a transitional physiology to improve perinatal and neonatal outcomes. The practice of neonatal resuscitation has evolved over time and continues to be shaped by emerging evidence as well as key opinions. We present the revised Neonatal Resuscitation Guidelines for Singapore 2021. The recommendations from the International Liaison Committee on Resuscitation Neonatal Task Force Consensus on Science and Treatment Recommendations (2020) and guidelines from the American Heart Association and European Resuscitation Council were compared with existing guidelines. The recommendations of the Neonatal Subgroup of the Singapore Resuscitation and First Aid Council were derived after the work group discussed and appraised the current available evidence and their applicability to local clinical practice.

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Umbilical cord milking in preterm infants: a systematic review and meta-analysis

Cited by 46 publications

References 42 publications

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

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

The effectiveness of umbilical cord milking/ delayed cord clamping and recombinant human erythropoietin in reducing red blood cell transfusions in extremely and very low birth weight infants

Singapore Neonatal Resuscitation Guidelines 2021

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