Abstract
Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects of UCM in newborns <37 weeks’ gestation. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database for randomized UCM clinical trials with no language restrictions, which we then compared with other strategies. The sample included 2083 preterm infants. The results of our meta-analysis suggest that UCM in premature infants can reduce the risk of transfusion (relative risk (RR)= 0.78 [95% confidence interval (CI),0.67–0.90]) and increase hemoglobin(pooled weighted mean difference (PWMD)= 0.89 g/L[95%CI 0.55–1.22]) and mean blood pressure (PWMD=1.92 mmHg [95% CI 0.55–3.25]). Conversely, UCM seems to increase the risk of respiratory distress syndrome (RR = 1.54 [95% CI 1.03–2.29]), compared to the control groups. In infants born at <33 weeks, UCM was associated with a reduced risk of transfusion (RR= 0.81 [95%CI 0.66–0.99]), as well as higher quantities of hemoglobin (PWMD= 0.91 g/L[95%CI 0.50–1.32]). UCM reduces the risk of transfusion in preterm infants, and increases initial hemoglobin, hematocrit, and mean blood pressure levels with respect to controls.
Highlights
Placental transfusion is the transfer of residual placental blood to the baby during birth and umbilical cord clamping
With regard to meta-analysis by gestational age, in infants born with
The main conclusion of our systematic review is that UCM increases initial hemoglobin and mean blood pressure levels and reduces the risk of transfusion in preterm infants
Summary
Placental transfusion is the transfer of residual placental blood to the baby during birth and umbilical cord clamping. This transfer is part of the physiological transition from fetal to neonatal circulation [1]. A randomized study of DCC versus immediate umbilical cord clamping (ICC) found an 18% increase in blood volume in the DCC group [4]. This is why the benefits and risks derived from the different ways of managing the umbilical cord in infants have been studied. With DCC, the observed effects include an increase in hemoglobin levels, reduced need for transfusion, an increase in iron deposits, and reduced rates of necrotizing enterocolitis [5,6,7]
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