Umbilical Cord Milking Improves Transition in Premature Infants at Birth

BACKGROUND: Umbilical 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. METHODS: Women 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), SpO(2), mean airway pressure (MAP), and FiO(2) in the delivery room were compared between infants receiving UCM and infants with ICC. RESULTS: 41 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 SpO(2) over the first 5 minutes of life, were exposed to less FiO(2) over the first 10 minutes of life than infants with ICC. CONCLUSIONS: UCM 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