Effect Of Umbilical Cord Milking Research Articles

The effect of umbilical cord milking in improving hematological and clinical outcome in preterm babies

The effect of umbilical cord milking in improving hematological and clinical outcome in preterm babies

Effect of Umbilical Cord Milking on Selected Maternal and Premature Neonatal Outcomes among Women with Placental Insuffiency

Effect of Umbilical Cord Milking on Selected Maternal and Premature Neonatal Outcomes among Women with Placental Insuffiency

Impact of Umbilical Cord Milking on Hematological Parameters in Preterm Neonates With Placental Insufficiency.

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.

Umbilical Cord Milking in Late Preterm Neonates and its Effects on Haematological and Haemodynamical ParametersA Randomised Controlled Study

Introduction: Delayed Cord Clamping (DCC) is a procedure, in which the cord is clamped after a short delay (30s to 180s) after birth. This improves iron status, reduce chances of anaemia and need for blood transfusion. However, DCC method compromised the success of resuscitation and induced various consequences, especially in neonates in need of emergency resuscitation. Umbilical Cord Milking (UCM), which is likewise a procedure of transporting additional blood from the umbilical cord to the newborn by milking or stripping the umbilical cord toward the baby, is an alternative to this approach. This study was conducted due to a lack of data on the use of umbilical cord milking in late preterm newborns. Aim: To study the effect of UCM on haematological and haemodynamical parameters in late preterm neonates. Materials and Methods: This single centre randomised controlled study was conducted, from November 2017 to August 2019 in the Department of Paediatrics, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. Total 200 late preterm neonates fulfilling the inclusion criteria were randomised into cases (UCM group) and controls (Immediate cord clamping group). In UCM group, just after delivery, umbilical cord was milked towards the baby. In ICC group, cord was clamped and cut immediately. Primary outcomes included Haemoglobin (Hb), Haematocrit (Hct) and haemodynamic parameters (heart rate, respiratory rate and mean blood pressure), were noted at 48 hours of age. Clinical parameters (respiratory distress, need for oxygen, polycythemia and jaundice requiring phototherapy) were also noted. Student's t-test, Chi-square/fisher-exact test were used to find out the significance of study parameters. Results: There was a significant higher Hb in UCM group (19.27±2.64 gm/dL) than Immediate Cord Clamping (ICC) group (16.32±2.09 gm/dL) with p-value=0.012 and higher Hct in UCM group (55.41±5.07%) than the ICC group (48.99±5.57%) with a p-value &lt;0.001. Hence, there was higher placental transfusion in UCM group as shown by higher Hb and Hct in UCM group. There was also higher systolic, diastolic and mean blood pressure in the UCM group as compared to ICC group. Difference for mean arterial blood pressure was about 3 mmHg and was statistically significant (p-value &lt;0.001). Hence, UCM leads to a higher mean arterial pressure at 48 hours of life. Conclusion: Umbilical cord milking provides a greater placental transfusion, as demonstrated by higher Hb, higher Hct, higher blood pressure, and lesser requirement for inotropes and blood transfusions.

Effect of Umbilical Cord Milking on Maternal and Neonatal Outcomes in a Tertiary Care Hospital in South India: A Randomized Control Trial.

Umbilical cord milking (UCM) has been theorized to increase placental blood transfusion then again, the optimal method of cord clamping at birth is still contested. We aimed to analyse the effects of UCM on the neonatal haematological parameters at 72h and 6weeks of age and its association with any adverse effects. In this randomized control trial, mothers ≥ 34weeks were randomized into two arms. Under the intervention group, the cord was milked three times before clamping and cutting whereas the controls had the cord clamped and cut without milking. Haemoglobin and haematocrit levels were measured at 72h. and at 6weeks. A total of 170 mothers were enrolled with 85 subjects in each arm. Baseline characteristics were comparable. In the intervention arm, the mean haemoglobin [18.1 (2.4) g/dL] and haematocrit [54 (7) %] were significantly higher as compared to the control arm [16.4 (2.1) g/dL and 48 (6) %], at 72h of age. There was also significant increase in the mean haemoglobin [11.6 (1.3) g/dL] and haematocrit [34 (4) %] compared to the controls [10.1 (1.1) g/dL and 30 (3) %], at 6weeks. No statistical difference was found in the incidence of PPH and duration of third stage. There was no significant rise in hyperbilirubinaemia, phototherapy requirement and polycythaemia among neonates in the intervention group. Umbilical cord milking is a sound practical approach to raise the haemoglobin and haematocrit levels up to 6weeks thereby decreasing the proportion of anaemic infants.

Effect of Umbilical Cord Milking vs Delayed Cord Clamping on Venous Hematocrit at 48 Hours in Late Preterm and Term Neonates: A Randomized Controlled Trial

To compare the effect of intact umbilical cord milking (MUC) and delayed cord clamping (DCC) on venous hematocrit at 48 (±6) hours in late preterm and term neonates (350/7- 426/7 wk). Randomized trial. All late preterm and term neonates (350/7 - 426/7 wk) neonates born in the labor room and maternity operation theatre of tertiary care unit were included. We randomly allocated enrolled neonates to MUC group (cord milked four times towards the baby while being attached to the placenta; n=72) or DCC group (cord clamped after 60 seconds; n=72). Primary outcome was venous hematocrit at 48 (±6) hours of life. Additional outcomes were venous hematocrit at 48 (±6) hours in newborns delivered through lower segment caesarean section (LSCS), incidence of polycythemia requiring partial exchange transfusion, incidence of hyperbilirubinemia requiring phototherapy, and venous hematocrit and serum ferritin levels at 6 (±1) weeks of age. The mean (SD) hematocrit at 48 (±6) hours in the MUC group was higher than in DCC group [57.7 (4.3) vs. 55.9 (4.4); P=0.002]. Venous hematocrit at 6 (±1) weeks was higher in MUC than in DCC group [mean (SD), 37.7 (4.3) vs. 36 (3.4); mean difference 1.75 (95% CI 0.53 to 2.9); P=0.005]. Other parameters were similar in the two groups. MUC leads to a higher venous hematocrit at 48 (±6) hours in late preterm and term neonates when compared with DCC.

The effect of umbilical cord milking on cerebral blood flow in very preterm infants: a randomized controlled study.

To compare the effect of umbilical cord milking (UCM) vs. early cord clamping (ECC) on cerebral blood flow (CBF). Preterm infants <31 weeks' gestation were randomized to receive UCM or ECC at birth. Blood flow velocities and resistive & pulsatility indices of middle and anterior cerebral arteries were measured at 4-6 and 10-12 h after birth as an estimate of CBF. Randomization allocated 37 infants to UCM and 36 to ECC. Maternal and antenatal variables were similar. There were no significant differences between groups in middle or anterior CBF velocities and resistive indices at either study time point. CBF variables were not correlated with mean blood pressure, systemic blood flow, or intraventricular hemorrhage. In very preterm infants, UCM compared with ECC was not shown to change CBF indices during the first 12 h of age or correlate with other hemodynamic measures or with intraventricular hemorrhage. ClinicalTrials.gov: NCT01487187.

&lt;p&gt;The Effect of Umbilical Cord Milking Compared with Delayed Cord Clamping in Term Neonates: A Randomized Controlled Trial&lt;/p&gt;

ObjectiveTo study the effect of intact umbilical cord milking (I-UCM) procedure in comparison with the procedure of delayed cord clamping (DCC) in term neonates.Study DesignA randomized controlled trial.SettingDepartment of Obstetrics and Gynecology and Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University.Materials and MethodsThe study was performed from June 2017 to March 2018. Singleton term pregnant women (37–42 weeks’ gestation) were recruited. Neonates were randomized into DCC and I-UCM groups. Umbilical cord was 3 times milked toward the neonate in 25 cm length from umbilical stump which was still attached to the placenta before cutting the cord in I-UCM group. Delay in cord clamping for 60 seconds was performed before the cord cutting in DCC group. Neonatal and maternal outcomes were recorded.ResultsOf 168 neonates included in this trial, 84 cases were randomized into each group. The baseline characteristics of both groups were comparable. No statistical difference was found in terms of the mean of hemoglobin levels in the DCC and I-UCM groups which were 16.9 (±1.6) g/dl and 17.0 (±1.9) g/dl, respectively (P-value 0.75). There was no difference in terms of adverse neonatal and maternal outcomes in both groups.ConclusionBoth I-UCM and DCC revealed a comparable effect on hematologic status without deleterious effects on neonatal and maternal outcomes at the age of 48–72 hours in term neonates.

Effect of Umbilical Cord Milking on Transition of Preterm Babies during Resuscitation

Effect of Umbilical Cord Milking on Transition of Preterm Babies during Resuscitation

142 The effect of umbilical cord milking on neurodevelopmental outcomes of preterm infants at 36 months of age: a randomized controlled trial

Umbilical cord milking at birth has been reported to have short-term benefits to preterm infants. Long-term neurodevelopmental outcomes need more exploration. To compare the effects of cord milking (CM) vs. early cord clamping (ECC) at birth on neurodevelopmental outcomes at 36 months corrected age. Preterm infants <31 weeks’ gestation who were randomized to receive CM or ECC at birth, were evaluated at 36 months corrected age. Neuro-developmental outcomes were assessed by blinded examiners using Bayley Scales of Infant and Toddler Development (version III). Intention-to-treat was used for primary analyses. Out of the 74 infants included in the original trial, 2 died and 65 (90%) infants were evaluated at 36 months corrected age. Patients’ characteristics were similar in both study groups except for higher hemoglobin concentration on NICU admission (p=0.02) and longer duration of phototherapy (p=0.02) in the CM group (Table 1). The median cognitive, motor or language scores were higher in the CM group but the difference didn’t reach statistical significance (Table 2). Similarly, there were no significant differences in the rates of cerebral palsy, developmental impairment, deafness or blindness though cerebral palsy was higher in the CM group. In this randomised controlled trial, no significant differences in neuro-developmental outcomes at 36 months corrected age, were found between preterm infants who received CM and those who received ECC at birth. The absence of difference may be attributed to the small sample size. Larger trials are needed to evaluate the neuro-developmental outcomes of CM.

Effect of Umbilical Cord Milking on Transition of Preterm Babies During Resuscitation

Effect of Umbilical Cord Milking on Transition of Preterm Babies During Resuscitation

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations.

Our aim was to evaluate the effect of umbilical cord milking on outcomes for preterm multiples. We implemented a policy of cord milking in neonates born at less than 30 weeks' gestation in September 2011. We compared cord milking in multiples with a historical cohort. Multivariable logistic regression models estimated the effect of cord milking on a composite neonatal adverse outcome. Secondary outcomes were hematocrit at birth, need for blood transfusion, and inotrope use. We identified 149 neonates (120 twins, 29 triplets), 51 historical controls, and 98 neonates with cord milking. Cord milking was associated with a lower rate of adverse composite neonatal outcome in univariable analysis (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.15-0.84). However, in multivariable modeling, the effect was not significant (adjusted OR [aOR]: 0.54, 95% CI: 0.23-1.28). Hematocrit was 4.6 unit % (95% CI: 2-7.3) higher in the cord milking group, and cord milking was associated with a lower rate of blood transfusion (aOR: 0.28; 95% CI: 0.1-0.74; p = 0.01). There was no difference in inotrope administration. Umbilical cord milking was not associated with a decrease in composite neonatal adverse outcome. However, we observed an increase in hematocrit and decreased need for blood transfusion in neonates with cord milking.

A Randomized Clinical Trial of Umbilical Cord Milking vs Delayed Cord Clamping in Preterm Infants: Neurodevelopmental Outcomes at 22-26 Months of Corrected Age

To compare the effect of umbilical cord milking vs delayed cord clamping (DCC) on neurodevelopmental and health outcomes in very preterm infants at 22-26 months of corrected age. Neurodevelopmental outcomes at 2 years of age were assessed using the Bayley Scales of Infant Development, third edition, and a standardized neurologic examination. Data regarding pulmonary morbidities, neurosensory impairments, and hospitalizations were obtained by parental interview. Intention-to-treat was used for primary analyses. Of the 197 infants enrolled in the original study there were 15 deaths, 5 in the umbilical cord milking group and 10 in DCC group. Of the remaining infants, 135 (74%) were assessed at 22-26 months of corrected age. Demographics in umbilical cord milking (n = 70) and DCC (n = 65) groups were similar. Infants randomized to umbilical cord milking at birth had significantly higher cognitive and language composite scores, and were less likely to have a cognitive composite score of <85 (4% vs 15%; P = .04). Motor function was similar in both groups. There were no differences in the incidences of mild or moderate to severe neurodevelopmental impairment, hearing or visual impairments, pulmonary morbidities, or rehospitalizations between the 2 groups. Infants randomized to umbilical cord milking had higher language and cognitive scores compared with those randomized to DCC. There was no difference in rates of mild or moderate to severe neurodevelopmental impairment. clinicaltrials.gov: NCT01434732.

The Effect of Umbilical Cord Milking on Hemodynamic Status of Preterm Infants: A Randomized Controlled Trial

Abstract BACKGROUND: Delayed cord clamping may be difficult to perform in extremely preterm infants. The effects of the alternative, cord milking, have not been fully evaluated. OBJECTIVES: To determine whether cord milking (CM) at birth improves systemic blood flow and short term outcomes, as compared with immediate cord clamping (ICC). DESIGN/METHODS: Babies born to eligible, consenting women presenting in preterm labor between 24 and 31 weeks' gestation were randomized to receive CM or ICC. Echocardiography was performed at 4-6 and 10-12 hours after birth. The primary outcome was systemic blood flow as represented by echo-derived superior vena cava (SVC) flow. Neonatal care staff, echogardiographer and interpreter were blind to the randomization. Analysis was by intention to treat. RESULTS: A total of 73 eligible infants were randomized (37 to CM and 36 to ICC) during the study period (November 2011-2014). There were no statistically significant differences in maternal demographic and antenatal variables. Mean (SD) gestational age was 26.1 (11) weeks and mean (SD) birth weight was 1025 (308) g. 38% of infants were born by vaginal delivery. No significant differences were found between groups in SVC flow, cardiac outputs or neonatal morbidities [table1]. CONCLUSION: There were no statistically significant differences in functional cardiac outcomes, mortality or morbidity between preterm infants who received CM and those who received ICC. Larger trials are needed to establish the best practice in managing the umbilical cord at birth in extremely preterm infants.

Effect of Umbilical Cord Milking on Morbidity and Survival in Extremely Low Gestational Age Neonates

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Umbilical cord milking and hematological parameters in moderate to late preterm neonates: A randomized controlled trial

To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age in late preterm neonates. Randomized controlled trial. A tertiary care center of Northern India during 2013-14. 200 moderate to late preterm neonates randomly allocated to early cord clamping or umbilical cord milking group (100 in each). In milking group, 25 cm length of cord was milked towards the baby thrice after separating (within 30 s) it from placenta. Hemoglobin and serum ferritin at 6 weeks of age. Mean (SD) serum ferritin [428.9 (217.6) vs. 237.5 (118.6) ng/mL; P< 0.01] and hemoglobin [12.1 (1.5) vs. 10.4 (1.2) gm/dL; P<0.01] at 6 weeks were significantly higher in umbilical cord milking group. In early neonatal period, hemodynamic and hematological parameters were not significantly different. Higher incidence of jaundice with higher phototherapy rates (33% vs. 9%; P<0.01) were noted in umbilical cord milking group. In preterm neonates, umbilical cord milking at birth enhances iron stores at 6 weeks of age. Higher phototherapy rates with this intervention are a matter of concern.

Efficacy and safety of umbilical cord milking at birth: a systematic review and meta-analysis.

Umbilical cord milking (UCM) is suggested to improve neonatal outcomes. To perform a systematic review and meta-analysis of the efficacy and safety of UCM in full-term and preterm neonates. A systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrials.gov database, and the reference list of retrieved articles from 1940 to 2014. Randomized clinical trials comparing UCM with other strategies of handling the umbilical cord at birth in full-term and preterm infants. Seven of the 18 initially identified studies were selected. Two reviewers independently extracted data and assessed the risk for bias in included trials using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Neonatal mortality before discharge from the hospital. We included 7 randomized clinical trials involving 501 infants. Infants with a gestational age of less than 33 weeks allocated to UCM compared with control conditions showed no difference in the risk for mortality (risk ratio [RR], 0.75 [95% CI, 0.35 to 1.64]; risk difference [RD], -0.02 [95% CI, -0.09 to 0.04]), hypotension requiring volume expanders (RR, 0.71 [95% CI, 0.41 to 1.25]; RD, -0.09 [95% CI, -0.22 to 0.05]), or inotrope support (RR, 0.77 [95% CI, 0.51 to 1.17]; RD, -0.10 [95% CI, -0.25 to 0.05]). Higher initial levels of hemoglobin (mean difference, 2.0 [95% CI, 1.3-2.7] g/dL) and hematocrit (mean difference, 4.5% [95% CI, 1.5%-7.4%]) were identified in the UCM groups. We found a reduced risk for oxygen requirement at 36 weeks (RR, 0.42 [95% CI, 0.21 to 0.83]; RD, -0.14 [95% CI, -0.25 to -0.04]) and for intraventricular hemorrhage of all grades (RR, 0.62 [95% CI, 0.41 to 0.93]; RD, -0.12 [95% CI, -0.22 to -0.02]) in infants assigned to UCM. Among infants with a gestational age of at least 33 weeks, UCM was associated with higher hemoglobin levels in the first 48 hours in 224 infants (mean difference, 1.2 [95% CI, 0.8-1.5] g/dL) and at 6 weeks of life in 170 infants (mean difference, 1.1 [95% CI, 0.7-1.5] g/dL). Umbilical cord milking was associated with some benefits and no adverse effects in the immediate postnatal period in preterm infants (gestational age, <33 weeks); however, further studies are warranted to assess the effect of UCM on neonatal and long-term outcomes.

625: Effect of umbilical cord milking on morbidity and survival in preterm neonates from multiple gestations

625: Effect of umbilical cord milking on morbidity and survival in preterm neonates from multiple gestations

Umbilical Cord Milking Improves Transition in Premature Infants at Birth

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

Effect of Umbilical Cord Milking in Term and Near Term Infants

Two measures to prevent anemia in infants are delayed cord clamping (DCC) and umbilical cord milking (UCM), both of which allow transfer of additional blood volume and hemoglobin (Hgb) from the placenta to the newborn. Umbilical cord milking and DCC generate comparable increases in Hgb in premature babies, but data are lacking for the effect of UCM in full-term neonates. This single-center, randomized controlled trial was designed to investigate the effect of UCM compared with early cord clamping on hematologic parameters at 6 weeks of age among term and near-term neonates. Infants were more than 34 weeks 6 days’ gestation and delivered by low uterine segment transverse cesarean or vaginal delivery. In the UCM group, the cord was cut at ∼25 cm of length from umbilical stump within 30 seconds of birth. The umbilical cord was raised and milked from the cut end toward the infant 3 times at 10 cm/s and then clamped 2 to 3 cm from the umbilical stump. In controls, the cord was clamped within 30 seconds near the umbilicus and cut without milking. The 2 groups received routine postnatal care. Primary outcomes were Hgb and serum ferritin levels at 6 weeks postnatally. Secondary outcomes included clinical parameters in the first 48 hours; presence of respiratory distress, jaundice requiring phototherapy, polycythemia, and jitteriness in 48 hours; and Hgb, packed cell volume at 12 and 48 hours and bilirubin level at 48 hours. Group means of continuous normally distributed data were compared using an unpaired Student t test. Categorical data were compared using a χ2/Fisher exact test. Of 700 births, 200 neonates met inclusion criteria, and 100 were randomized to each group; 171 (120 term and 51 near-term) completed the study. Baseline demographic characteristics of the groups were comparable. At 6 weeks, the mean ferritin and Hgb levels in the UCM group were 355.9 ± 182.6 μg/L and 11.9 ± 1.5 g/dL, respectively, and 177.5 ± 13.8 μg/L and 10.8 ± 0.9 g/dL in the controls (P < 0.05). Similar results were observed in term and near-term infants analyzed separately. Mean Hgb and hematocrit at 12 and 48 hours were significantly higher in the intervention group (P = 0.0001). Mean blood pressures at 30 minutes, 12 hours, and 48 hours were significantly higher, but within reference range, in the UCM group. The 2 groups did not differ significantly in heart rate, respiratory rate, and serum bilirubin. None of the newborns required neonatal intensive care unit admission or phototherapy, and none had polycythemia. Mean bilirubin levels at 48 hours were 7.4 and 6.6 mg/dL in the UCM and control groups, respectively (P > 0.05). No significant differences were found when near-term babies were examined for adverse outcomes. Umbilical cord milking is safe and increases Hgb and iron levels at 6 weeks, without significant adverse effects. Umbilical cord milking can be used routinely or when cord clamping cannot be delayed. Studies with longer follow-up are needed to assess the sustainability of the advantage in Hgb and ferritin later in infancy. Another study is needed to compare UCM with DCC in term babies.