Early Cardiac and Cerebral Hemodynamics with Umbilical Cord Milking Compared with Delayed Cord Clamping in Infants Born Preterm

Abstract

To evaluate changes in cerebral oxygenation, peripheral arterial oxygenation, respiratory status, and administered fraction of inspired oxygen during the first 10minutes of life in premature infants receiving umbilical cord milking compared with delayed cord clamping (DCC). Premature infants born at 230/7 to 276/7weeks of gestation were randomized to umbilical cord milking or DCC. A near infrared spectroscopy sensor, pulse oximeter, and electrocardiogram electrodes were placed. Pulse rate, cerebral tissue oxygenation, peripheral oxygen saturation, airway pressure, and fraction of inspired oxygen were collected for 10minutes in the delivery room. Longitudinal models were used to compare effects of umbilical cord milking and DCC. Fifty-six infants had cerebral oximetry and advanced monitoring at birth. There was an increased incidence of severe intraventricular hemorrhage in infants who received umbilical cord milking compared with DCC (P=.0211). Longitudinal models suggested that peripheral oxygen saturation was higher in the umbilical cord milking group in the first 4minutes (P=.0221) and that mean airway pressures were lower in the umbilical cord milking group after the first 7minutes (P=.0072). No statistical differences were observed for fraction of inspired oxygen, cerebral tissue oxygenation, or heart rates. The data suggest that the rapid transfer of blood during umbilical cord milking may facilitate lung expansion with improved pulmonary blood flow, but may also increase cerebral blood flow, resulting in severe intraventricular hemorrhage. ClinicalTrials.gov: NCT03145142.