Umbilical cord milking in preterm neonates requiring resuscitation: A randomized controlled trial

Mohan, Ganesh; Shashidhar, A; Chandrakala, B; Nesargi, Saudamini; Rao, Prasanna N

doi:10.1016/j.resuscitation.2018.07.003

Cited by 31 publications

(22 citation statements)

References 19 publications

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“…When compared with ICC, intact cord milking was not associated with an increased risk of IVH (grade 3 or more) (RR 0.69 (95% CI 0.38 to 1.24), p=0.22, I 2 =0%, 8 studies19 21 22 24 27–29 32 (n=598)) (figure 3). Only one study on cut UCM reported on this outcome30 and found no difference (online supplementary table 4).…”

Section: Resultsmentioning

confidence: 91%

“…Meta-analysis found no significant effect on mortality with UCM when compared with DCC (RR 0.93 (95% CI 0.55 to 1.55), p=0.77, I 2= 0%, 4 studies8 16–18 (n=890)) (figure 2) .There was no significant difference in mortality between the I-UCM and ICC groups (RR 0.85 (95% CI 0.49 to 1.46), p=0.56, I 2= 27%, 10 studies19 21–24 27–29 31 32 (n=698)) (figure 3). Cut UCM did not have a significant effect on mortality when compared with ICC (RR 1.00 (95% CI 0.35 to 2.90), p=1.00, I 2 =34%, 2 studies26 30 (n=260)) (online supplementary table 4).…”

Section: Resultsmentioning

confidence: 96%

“…Nineteen RCTs [5 RCTs (n=922) comparing UCM with DCC,8 15–18 14 RCTs (n=1092) comparing UCM with ICC19–32] were included in this systematic review. Milking was performed on an intact cord (I-UCM) in 16 RCTs, while cut UCM was performed in 3 studies 20 26 30. Eighteen studies were available as full articles and one was a conference abstract 23.…”

Section: Resultsmentioning

confidence: 99%

“…The authors found no significant benefits or harms from UCM; however, the overall quality of evidence was graded low to very low 34. In our systematic review, 10 additional studies8 15 18 20 21 27 28 30–32 have been included besides those summarised in the Cochrane review. While the Cochrane review included few studies that allowed cord milking as a cointervention in the DCC group,35 36 we excluded those studies in order to determine the standalone effects of UCM in preterm neonates.…”

Section: Discussionmentioning

confidence: 99%

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

Balasubramanian

Ananthan

Jain

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo conduct a systematic review and meta-analysis of the efficacy and safety of umbilical cord milking in preterm infants.DesignRandomised controlled trials comparing umbilical cord milking with delayed cord clamping/immediate cord clamping in preterm infants were identified by searching databases, clinical trial registries and reference list of relevant studies in November 2019. Fixed effects model was used to pool the data on various clinically relevant outcomes.Main outcome measuresMortality and morbidities in preterm neonates.ResultsNineteen studies (2014 preterm infants) were included. Five studies (n=922) compared cord milking with delayed cord clamping, whereas 14 studies (n=1092) compared milking with immediate cord clamping. Cord milking, as opposed to delayed cord clamping, significantly increased the risk of intraventricular haemorrhage (grade III or more) (risk ratio (RR): 1.95 (95% CI 1.01 to 3.76), p=0.05). When compared with immediate cord clamping, cord milking reduced the need for packed RBC transfusions (RR:0.56 (95% CI 0.43 to 0.73), p<0.001). There was limited information on long-term neurodevelopmental outcomes. The grade of evidence was moderate or low for the various outcomes analysed.ConclusionUmbilical cord milking, when compared with delayed cord clamping, significantly increased the risk of severe intraventricular haemorrhage in preterm infants, especially at lower gestational ages. Cord milking, when compared with immediate cord clamping, reduced the need for packed RBC transfusions but did not improve clinical outcomes. Hence, cord milking cannot be considered as placental transfusion strategy in preterm infants based on the currently available evidence.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Balasubramanian

Ananthan

Jain

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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show abstract

“…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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Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

et al. 2023

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ImportanceInterventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials.ObjectiveTo evaluate multiple perinatal interventions across clinical settings for reducing the risk of severe intraventricular hemorrhage (sIVH) and cystic periventricular leukomalacia (cPVL) in preterm neonates.Data SourcesMEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception until September 8, 2022, using prespecified search terms and no language restrictions.Study SelectionRandomized clinical trials (RCTs) that evaluated perinatal interventions, chosen a priori, and reported 1 or more outcomes (sIVH, cPVL, and severe brain injury) were included.Data Extraction and SynthesisTwo co-authors independently extracted the data, assessed the quality of the trials, and evaluated the certainty of the evidence using the Cochrane GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Fixed-effects pairwise meta-analysis was used for data synthesis.Main Outcomes and MeasuresThe 3 prespecified outcomes were sIVH, cPVL, and severe brain injury.ResultsA total of 221 RCTs that assessed 44 perinatal interventions (6 antenatal, 6 delivery room, and 32 neonatal) were included. Meta-analysis showed with moderate certainty that antenatal corticosteroids were associated with small reduction in sIVH risk (risk ratio [RR], 0.54 [95% CI, 0.35-0.82]; absolute risk difference [ARD], −1% [95% CI, −2% to 0%]; number needed to treat [NNT], 80 [95% CI, 48-232]), whereas indomethacin prophylaxis was associated with moderate reduction in sIVH risk (RR, 0.64 [95% CI, 0.52-0.79]; ARD, −5% [95% CI, −8% to −3%]; NNT, 20 [95% CI, 13-39]). Similarly, the meta-analysis showed with low certainty that volume-targeted ventilation was associated with large reduction in risk of sIVH (RR, 0.51 [95% CI, 0.36-0.72]; ARD, −9% [95% CI, −13% to −5%]; NNT, 11 [95% CI, 7-23]). Additionally, early erythropoiesis-stimulating agents (RR, 0.68 [95% CI, 0.57-0.83]; ARD, −3% [95% CI, −4% to −1%]; NNT, 34 [95% CI, 22-67]) and prophylactic ethamsylate (RR, 0.68 [95% CI, 0.48-0.97]; ARD, −4% [95% CI, −7% to 0%]; NNT, 26 [95% CI, 13-372]) were associated with moderate reduction in sIVH risk (low certainty). The meta-analysis also showed with low certainty that compared with delayed cord clamping, umbilical cord milking was associated with a moderate increase in sIVH risk (RR, 1.82 [95% CI, 1.03-3.21]; ARD, 3% [95% CI, 0%-6%]; NNT, −30 [95% CI, −368 to −16]).Conclusions and RelevanceResults of this study suggest that a few interventions, including antenatal corticosteroids and indomethacin prophylaxis, were associated with reduction in sIVH risk (moderate certainty), and volume-targeted ventilation, early erythropoiesis-stimulating agents, and prophylactic ethamsylate were associated with reduction in sIVH risk (low certainty) in preterm neonates. However, clinicians should carefully consider all of the critical factors that may affect applicability in these interventions, including certainty of the evidence, before applying them to clinical practice.

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Umbilical cord milking in preterm neonates requiring resuscitation: A randomized controlled trial

Abstract: Clinical trials registry -India CTRI/2015/01/005436, www.ctri.nic.in.

Cited by 31 publications

References 19 publications

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

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

Umbilical Cord Milking: A Review

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

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