Abstract
BackgroundData is still lacking about the expediency of umbilical cord milking (UCM) in preterm neonates born to mothers with placental insufficiency (PI).ObjectiveTo study the effect of UCM in preterm neonates who had ante-natal evidence of placental insufficiency on peripheral blood cluster of differentiation 34 (CD34) percentage, hematological indices, and clinical outcomes.MethodsPreterm neonates, <34 weeks' gestation, born to mothers with evidence of placental insufficiency that underwent UCM (PI+UCM group) were compared with historical controls whose umbilical stumps were immediately clamped [PI+ICC (immediate cord clamping) group] in a case-control study. Peripheral blood CD34 percentage as a measure of hematopoietic stem cell transfusion was the primary outcome. Early and late-onset anemia; polycythemia; frequency of packed red blood cells (PRBCs) transfusion during NICU stay; peak total serum bilirubin (TSB); incidence of phototherapy, admission rectal temperature; first 24 h hypothermia and hypoglycemia; episodes of hypotension and need for volume expander boluses and inotropic support during the first 24 h of age; duration of oxygen therapy; bronchopulmonary dysplasia (BPD); severe intra-ventricular hemorrhage (IVH); necrotizing enterocolitis (NEC); culture-proven late-onset sepsis; length of hospital stay; and in-hospital mortality were secondary outcomes.ResultsIn preterm infants with placental insufficiency, umbilical cord milking was associated with greater peripheral blood CD34 percentage, hemoglobin levels initially and at postnatal age of 2 months, alongside significantly shorter duration of oxygen therapy compared with ICC group. Frequency of packed RBCs transfusion during hospital stay was comparable. Neonates in UCM group had a greater peak TSB level during admission with significantly higher need for phototherapy initiation compared with ICC. Logistic regression, adjusted for gestational age, revealed that UCM resulted in greater CD34 percentage, higher initial hemoglobin level, higher peak serum bilirubin, significant increase of phototherapy initiation, and higher hemoglobin level at 2 months.ConclusionsUCM in preterm neonates born to mothers with placental insufficiency was feasible and resulted in greater CD34 percentage, higher initial hemoglobin level, higher peak serum bilirubin, significant increase of phototherapy initiation, and higher hemoglobin level at 2 months.
Highlights
Placental transfusion is a transfer of residual placental blood to a newborn after birth till the time of umbilical cord clamping and cutting
Neonates in the placental insufficiency and umbilical cord milking (PI+umbilical cord milking (UCM)) arm had significantly lower birth weights with higher rates of birth weights
Peripheral blood Cluster of differentiation 34 (CD34) percentage was significantly higher in the PI+UCM group compared with that in PI+Immediate cord clamping (ICC) group [median (IQR) of 1.05 (0.70–1.50) vs. 0.35 (0.2–0.5), p < 0.0001]
Summary
Placental transfusion is a transfer of residual placental blood to a newborn after birth till the time of umbilical cord clamping and cutting. Three recent meta-analyses revealed that placental transfusion, compared with ICC, was associated with reduced incidence of mortality, IVH, and need for blood transfusions for infants born preterm [1–3]. This additional blood volume may exert its beneficial effects by enhancing neonatal iron-rich cell volume [4], improving cardiovascular hemodynamics [5], and transferring progenitor stem cells that may replace damaged cells and ameliorate immunocompetence [6]. Previous studies showed that UCM in preterm infants provides cardiovascular stability as evidenced by greater systemic blood flow, higher left diastolic function, and improved cerebral perfusion compared to ICC [10, 11]. Data is still lacking about the expediency of umbilical cord milking (UCM) in preterm neonates born to mothers with placental insufficiency (PI)
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