The effects of umbilical cord milking on hemodynamics and neonatal outcomes in premature neonates

Anup C Katheria; Tina A Leone; Doug Woelkers; Donna M Garey; Wade Rich; Neil N Finer

doi:10.1016/j.jpeds.2014.01.024

The effects of umbilical cord milking on hemodynamics and neonatal outcomes in premature neonates

J Pediatr. 2014 May;164(5):1045-1050.e1. doi: 10.1016/j.jpeds.2014.01.024. Epub 2014 Feb 20.

Authors

Anup C Katheria¹, Tina A Leone², Doug Woelkers³, Donna M Garey⁴, Wade Rich⁵, Neil N Finer⁶

Affiliations

¹ Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA. Electronic address: anup.katheria@sharp.com.
² Division of Neonatology, Department of Pediatrics, Colombia University, New York, NY.
³ Division of Perinatology, Department of Obstetrics, University of California San Diego, San Diego, CA.
⁴ Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA.
⁵ Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA.
⁶ Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA; Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA.

PMID: 24560179
DOI: 10.1016/j.jpeds.2014.01.024

Abstract

Objective: To determine whether umbilical cord milking (UCM) improves systemic blood flow and reduces neonatal morbidities compared with immediate cord clamping (ICC).

Study design: Women admitted to a tertiary care center and delivering before 32 weeks' gestation were randomized to receive UCM or ICC. Three blinded serial echocardiograms were performed in the first 2 days of the infant's life. The primary outcome was measured systemic blood flow (superior vena cava flow) at each time point.

Results: Of the 60 neonates who were enrolled and randomized, 30 were assigned to cord milking and 30 to ICC. Neonates randomized to cord milking had greater measures of superior vena cava flow and right ventricular output in the first 6 hours and 30 hours of life. Neonates receiving UCM also had greater serum hemoglobin, received fewer blood transfusions, fewer days on oxygen therapy, and less frequent use of oxygen at 36 weeks' corrected postmenstrual age.

Conclusions: We demonstrate greater systemic blood flow with UCM in preterm neonates compared with ICC. Future large prospective trials are needed to determine whether UCM reduces intraventricular hemorrhage and other long-term morbidities.

Trial registration: ClinicalTrials.gov NCT01434732.

Publication types

Randomized Controlled Trial

MeSH terms

Blood Flow Velocity
Cardiac Output
Constriction
Echocardiography
Female
Humans
Infant, Newborn
Infant, Premature / physiology*
Male
Perinatal Care / methods*
Prospective Studies
Single-Blind Method
Ultrasonography, Doppler, Pulsed
Umbilical Cord*
Vena Cava, Superior / physiology*

Associated data

ClinicalTrials.gov/NCT01434732