93: Delayed clamping versus milking of umbilical cord in preterm infants, a randomized controlled trial

Abstract

Despite the large number of studies investigating delayed clamping, few studies have compared delayed clamping versus milking across all modes of delivery with multiple neonatal parameters.The goal of this study was to compare the neonatal outcomes of intraventricular hemorrhage, necrotizing enterocolitis, and need for transfusion between delayed cord clamping versus milking in preterm births of 23-34 weeks, with the aim to determine whether milking of the umbilical cord is an acceptable alternative. This study was a randomized controlled trial of preterm infants born 23 weeks 0 days to 34 weeks 6 days into two standardized study groups 1) delayed cord clamping for 60 seconds or 2) milking of the cord towards the infant 3 times prior to clamping. All comparisons were preformed using an intent to treat analysis approach. Of the 204 patients that underwent randomization, 104 were assigned to the delayed subgroup and 100 were assigned to the milking subgroup. Complete data on the primary outcomes was available for 204 of the infants (100.0%). No statistical difference was noted between the groups when evaluating maternal age, maternal race, prenatal care, maternal complications and comorbidities, obstetrical outcomes, or neonatal outcomes. However, there was a trend toward higher hemoglobin, fewer neonates with low hemoglobin defined as <15.6, fewer transfusions, and fewer incidences of IVH and NEC in the milking group, although again no values reached statistical significance. The major findings of this study demonstrate that milking the umbilical cord may be an acceptable alternative to delayed cord clamping as there was no increased risk for complications or neonatal morbidity, and similar, or possibly slightly improved, effects on the hemoglobin levels and need for neonatal transfusions. These findings are paramount in cases of abruption or poor neonatal effort, where 30-60 seconds of delayed clamping may delay necessary resuscitation by the neonatal teams. The present data support the notion that milking of the umbilical cord may offer an efficient and timely method of providing increased blood volume to the infant without interfering with neonatal resuscitation in cases where delayed umbilical cord clamping is not an option.View Large Image Figure ViewerDownload Hi-res image Download (PPT)