Umbilical cord milking safer than delayed cord clamping for preterm infants born after 28 weeks

USA: A recent study published in the journal Pediatrics has suggested that umbilical cord milking (UCM) may be a safe alternative to delayed cord clamping (DCM) in premature infants born at 28 to 32 weeks who require resuscitation.

Umbilical cord milking is a treatment to move blood from the umbilical cord into an infant's body. It involves gently squeezing the cord between the thumb and forefinger and pushing the blood into the newborn’s abdomen.

The new findings suggest that concerns raised by a 2019 study of infants born before 28 weeks—which concluded that umbilical cord milking might increase the risk of bleeding inside the brain—do not apply to preterm infants born after 28 weeks. 

The standard procedure, delaying cord clamping while blood naturally flows into the infant’s body, takes 30 to 180 seconds. However, cord milking, takes about 20 seconds, reducing delay for infants who need immediate assistance, such as respiratory support. Both procedures allow for the umbilical cord blood to reach the infant’s body before clamping, reducing the risk of anaemia and other complications seen among infants receiving immediate cord clamping and cutting.

The study was conducted by Anup Katheria, M.D., of the Sharp Mary Birch Hospital for Women & Newborns in San Diego, and colleagues in the United States, Canada and Europe. It was supported by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

More than 1,000 infants were randomly assigned either to umbilical cord milking or delayed cord clamping. Rates of severe intraventricular haemorrhage (bleeding inside the brain) and/or death did not differ significantly between the two groups (just over 1%). Moreover, the rates of overall intraventricular hemorrhage were also similar between the groups (approximately 12%). The researchers will follow all the infants in the study for two years to observe longer term outcomes. 

Key findings were as follows:

• Among 1019 infants (UCM n = 511 and DCC n = 508), all completed the trial from birth through initial hospitalization (mean gestational age 31 weeks, 44% female).
• For the primary outcome, 1.4% of infants randomized to umbilical cord milking developed severe intraventricular haemorrhage or died compared to 1.4% of infants randomized to delayed cord clamping (rate difference 0.01%).

"In this randomized controlled trial of UCM versus DCC among preterm infants born between 28 and 32 weeks’ gestation, we found no difference in the rates of severe IVH or death," the researchers wrote.

"UCM may be a safe alternative to DCC in premature infants born at 28 to 32 weeks who require resuscitation," they concluded. 

Reference:

"Umbilical Cord Milking Versus Delayed Cord Clamping in Infants 28 to 32 Weeks: A Randomized Trial," was published in the journal Pediatrics.