Abstract
Background: Delayed cord clamping (DCC) and umbilical cord milking (UCM) are two recently advocated interventions to enhance placental transfusion at birth. DCC and MCM might increase blood volume and help neonates to transition from fetal to neonatal circulation. Objective: To evaluate the effects of delayed cord clamping (DCC), umbilical cord milking (UCM), and immediate cord clamping (ICC) on very low birth weight (VLBW) neonates. Methods: At our institution, ICC was routinely done until December, 2012 when it was replaced by DCC. UCM was implemented in March, 2015. Neonatal outcomes were compared among ICC, DCC, and UCM. Results: A total of 94 neonates met inclusion criteria. Comparing with ICC neonates, DCC and UCM neonates had higher hematocrits, fewer blood transfusions, and lower incidence of chronic lung disease at 36 completed weeks of gestation. All groups were similar in APGAR scores, vasopressor use, intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). Conclusion: Compared to ICC, DCC and UCM appear to be more beneficial to VLBW neonates without apparent adverse risks.
Highlights
Current recommendations by the American College of Obstetrician and Gynecologists (ACOG) encourage the use of delayed umbilical cord clamping (DCC) in all premature neonates as a means of placental transfusion because of its significant associated benefits [1]
All groups were similar in APGAR scores, vasopressor use, intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC)
The incidence of bronchopulmonary dysplasia at 28 days of life was similar in all three groups, but the incidence of chronic lung disease (CLD) at 36 weeks of corrected gestational age was lower in umbilical cord milking (UCM) and Delayed cord clamping (DCC) group than in immediate cord clamping (ICC) group
Summary
Current recommendations by the American College of Obstetrician and Gynecologists (ACOG) encourage the use of delayed umbilical cord clamping (DCC) in all premature neonates as a means of placental transfusion because of its significant associated benefits [1]. Despite substantial evidence that placental transfusion by delayed cord clamping improves transitional circulation, decreases the need for blood transfusion, and lowers the incidence of necrotizing enterocolitis (NEC) and intraventricular hemorrhage (IVH) in preterm neonates, there appears to be reluctance to adopt DCC. This may be due to concern about delayed neonatal resuscitation until the cord is clamped and cut [2]. To avoid this delay, the study of two distinct approaches to immediate resuscitation efforts that preserve placental transfusion was examined. Conclusion: Compared to ICC, DCC and UCM appear to be more beneficial to VLBW neonates without apparent adverse risks
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