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Abstract
BackgroundUmbilical cord milking (UCM) improves blood pressure and urine output, and decreases the need for transfusions in comparison to immediate cord clamping (ICC). The immediate effect of UCM in the first few minutes of life and the impact on neonatal resuscitation has not been described.MethodsWomen admitted to a tertiary care center and delivering before 32 weeks gestation were randomized to receive UCM or ICC. A blinded analysis of physiologic data collected on the newborns in the delivery room was performed using a data acquisition system. Heart rate (HR), SpO2, mean airway pressure (MAP), and FiO2 in the delivery room were compared between infants receiving UCM and infants with ICC.Results41 of 60 neonates who were enrolled and randomized had data from analog tracings at birth. 20 of these infants received UCM and 21 had ICC. Infants receiving UCM had higher heart rates and higher SpO2 over the first 5 minutes of life, were exposed to less FiO2 over the first 10 minutes of life than infants with ICC.ConclusionsUCM when compared to ICC had decreased need for support immediately following delivery, and in situations where resuscitation interventions were needed immediately, UCM has the advantage of being completed in a very short time to improve stability following delivery.Trial Registration ClinicalTrials.gov NCT01434732
Highlights
The 2012 ACOG guidelines recommended delayed cord clamping (DCC) for at least 30 seconds and up to one minute in preterm infants [1]
One hundred nineteen women were approached for consent between February 1, 2011 and January 31, 2013
Two mothers gave consent but their infants were excluded because the team was unaware they were eligible for the study at the time of delivery
Summary
The 2012 ACOG guidelines recommended delayed cord clamping (DCC) for at least 30 seconds and up to one minute in preterm infants [1]. Umbilical cord milking (UCM), in which the unclamped umbilical cord is immediately milked and clamped, results in rapid blood transfer from the placenta to the newborn allowing resuscitation of the premature infant to proceed without delay. Dawson et al described a median heart rate of ,100 bpm at one minute of life in term and preterm neonates [4]. Bhatt et al demonstrated a 50% drop in pulmonary blood flow and an abrupt 40% drop in heart rate (due to cessation of umbilical venous flow from the placenta) in anesthetized fetal lambs receiving immediate cord clamping (ICC) [5]. The immediate effect of UCM in the first few minutes of life and the impact on neonatal resuscitation has not been described
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