Placental Resuscitation versus Cord Milking: No Added Benefit for Preterm Newborns, Study Finds

In a clinical trial involving preterm newborns between 23 and 29 weeks gestational age, resuscitation with the placental circulation intact for 3 minutes showed no significant reduction in the combined outcomes of death, severe intraventricular hemorrhage (grades 3 to 4), or bronchopulmonary dysplasia when compared to umbilical cord milking. The findings were published online in JAMA Network Open.

The trial compared intact placental resuscitation, where newborns remain attached to the placenta for three minutes during resuscitation, with umbilical cord milking, a method involving the manual squeezing of the cord to rapidly transfer blood to the infant. Both techniques are designed to maximize the benefits of placental transfusion, which may support cardiovascular stability and oxygen delivery in preterm babies.

Among preterm newborns, delayed cord clamping for 60 seconds has been linked to reduced mortality compared to early clamping. However, the impact of extending cord clamping for longer durations while providing respiratory support remains uncertain.

To address this, Simone Pratesi, University of Florence, Firenze, Italy, and colleagues aimed to evaluate whether resuscitating preterm infants while maintaining placental circulation and delaying cord clamping for an extended period could lead to better outcomes compared to the practice of umbilical cord milking. This approach sought to explore the potential benefits of prolonged placental transfusion during resuscitation in this vulnerable population.

For this purpose, the researchers conducted a randomized clinical trial at eight Italian neonatal intensive care units from April 2016 to February 2023, enrolling preterm newborns between 23 and 29 weeks gestation from singleton pregnancies. Infants were randomly assigned to resuscitation with intact placental circulation for 180 seconds or umbilical cord milking followed by early cord clamping within 20 seconds.

The primary outcome measured was a composite of death, severe intraventricular hemorrhage, and bronchopulmonary dysplasia at 36 weeks postconception.

The following were the key findings of the study:

• The study included 212 mother-newborn dyads, with 209 completing enrollment in the intention-to-treat population. The median gestational age was 27 weeks, and the median birth weight was 900 g.
• Of the enrolled newborns, 105 were assigned to the intact placental circulation group and 104 to the cord milking group.
• The composite outcome of death, severe intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 33% of the intact placental circulation group (35/105) and 38% of the cord milking group (39/104) (odds ratio 0.83).

"The findings showed that resuscitating preterm neonates with intact placental circulation for 180 seconds showed no improvement in the composite outcome of death, severe intraventricular hemorrhage, and bronchopulmonary dysplasia compared to umbilical cord milking," the researchers wrote.

"Further research is needed to assess the potential benefits of placental circulation-based resuscitation in preterm newborns who are not breathing at birth," they concluded.

Reference:

Pratesi S, Ciarcià M, Boni L, et al. Resuscitation With Placental Circulation Intact Compared With Cord Milking: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(12):e2450476. doi:10.1001/jamanetworkopen.2024.50476