Delayed Cord Clamping Versus Cord Milking In Preterm Neonates

Abstract

Abstract Background Current guidelines suggest delayed cord clamping (DCC)as it reduces mortality and allows more placental transfusion. Another technique, umbilical cord milking (UCM), provides a placental transfusion without delaying resuscitation and can be completed as quickly as immediate cord clamping Objective To Investigate clinical and laboratory effects of UCM compared to DCC in preterm neonates. Subjects & Methods Preterm neonates <37 weeks were randomized into two groups DCC for 6o seconds and UCM (stripping 20 cm of umbilical cord 4 times at a speed of 10 cm /second towards the baby then cord was clamped. After stabilization of neonates, blood samples were taken after two hours for all neonates for assessment of hemoglobin, hematocrit and bilirubin. Results Most of the neonates included in our study were born through lower segment caesarean section (LSCS) 73(73%) in DCC group and 86(86%) in UCM group. On the other hand, 27(27%) of neonates in DCC group and 14 (14%) in milking group were delivered by vaginal delivery (VD). There was statistical significance increase of LSCS than VD. (p = 0.023) Instrument used during delivery was forceps 3% for DCC and 2% for UCM group and ventose was not used on any of our neonates. Tactile stimulation and warming were performed for all our neonates. Some neonates required interventions for resuscitation like oxygen supplementation (31 % DCC and 36% UCM), positive pressure ventilation (23%DCC, 28 %UCM), fluid bolus (none in DCC group and 2% in UCM group) or intubation (7% DCC, 9% UCM) noting that no cases required any drug e.g. adrenaline intervention. Positive pressure ventilation without intubation included ambu bag or neopuff was used in 23% and 28 % in DCC group and UCM group respectively. No statistical difference was found in the abovementioned data. Apgar score was recorded for every neonate at 1 and 5 minutes of resuscitation to assess transition and any need for further resuscitation measures. Apgar at 1minute median 6 in DCC and CM group(p = 0.346). Apgar at 5minutes median 8.5 in DCC group and 9 in CM group(p = 0.646). No statistical difference was found in Apgar scores between two groups. Laboratory data including serum hemoglobin, hematocrit and bilirubin level were recorded from a blood sample taken within 2 hours of delivery. The mean hemoglobin, hematocrit in the DCC group was 17.06 (2.35) mg/dl, 48.32 (6.86) mg/dl respectively. The UCM group hemoglobin and hematocrit mean was 17.16 (2.34) mg/dl and 49.11(6.55) mg/dl respectively. Mean for serum bilirubin in DCC group was 3.15(3.02) g/dl and for UCM group was 2.91(2.43) mg/dl. No statistical difference was found between DCC and UCM in the laboratory data. Conclusion UCM and DCC resulted in comparable clinical and laboratory results including resuscitating maneuvers used, hemoglobin, hematocrit bilirubin at 2 hours of life implying that similar amount of placental transfusion occurs in both the groups with no increased risk in UCM group. UCM can be performed in any low resource setting and provides adequate placental transfusion to the premature newborn without delay of resuscitation, making it feasible for depressed neonates as well.