Original ArticleUmbilical Cord Milking vs Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants
Section snippets
Methods
This was a retrospective analysis of prospectively collected data from the NRN Generic Database (GDB). The cohort includes infants born between 220/7and 286/7 weeks of gestation in NRN centers from January 1, 2016 to December 31, 2018. Each participating center obtained institutional review board approval for the NRN GDB registry. Based on the study objective to compare the 2 modes of placental transfusion, infants exposed to immediate cord clamping were not included in the analysis. The
Results
Between January 1, 2016 and December 31, 2018, 5332 infants 220/7-286/7 weeks of gestation were born in participating NRN centers and 2514 infants were exposed to placental transfusion. After applying the exclusion criteria, 1834 were included in the final analysis, of which 23.6% (n = 432) were exposed to umbilical cord milking and 76.4% (n = 1402) were exposed to delayed cord clamping (Figure 1). Between 2016 and 2018, delayed cord clamping was the primary mode of placental transfusion in the
Discussion
In this large, contemporary, observational study, umbilical cord milking was not associated with the primary outcome of mortality or severe IVH by 36 weeks of PMA but was associated with higher odds of the secondary outcome of severe IVH. These results are similar to the large randomized trial comparing delayed cord clamping and umbilical cord milking, which favored delayed cord clamping.16 Over the past 3 years in the NRN, delayed cord clamping was the more frequently used mode of placental
Data Statement
Data sharing statement available at www.jpeds.com.
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Cited by (20)
Placental Transfusion in the Newborn
2023, Principles of NeonatologyPerinatal management: Lessons learned from the neonatal research network
2022, Seminars in PerinatologyCitation Excerpt :However, placental transfusion was independently associated with a reduction in the adjusted odds of mortality before 36 weeks’ post-menstrual age (aOR 0.71, 95% CI 0.55 to 0.92). Subsequently, Kumbhat et al directly compared outcomes following two common placental transfusion practices (delayed cord clamping vs. umbilical cord milking) among 1834 infants born before <29 weeks’ gestation.17 There was no difference between groups in the adjusted odds of the primary outcome, a composite of in-hospital mortality by 36 weeks post-menstrual age or severe IVH.
Pathogenesis and prevention of intraventricular hemorrhage
2022, Seminars in PerinatologyCitation Excerpt :Studies have suggested that umbilical cord milking (UCM) is associated with increased risk of IVH in preterm infants. A retrospective study of 1834 infants <29 weeks gestation found that infants receiving UCM had a higher odds ratio of severe IVH compared with those who received DCC (aOR 1.7, 95% CI 1.2 – 2.43).65 Indeed, the PREMOD-2 trial which compared DCC to UCM was prematurely halted due to a signal of harm in the cord milking group.66
Practical procedures for the delivery room resuscitation of micropreemies
2022, Seminars in Fetal and Neonatal MedicineCitation Excerpt :Placental transfusion for preterm infants has improved short-term outcomes, including death and morbidities, as well as long-term outcomes, including neurodevelopment [7,8]. Delayed cord clamping is more widely-practiced than cord milking [9] but there are insufficient numbers of micropreemies in clinical trials or practice to warrant a definitive recommendation for either. On the other hand, while the rapid establishment of respiratory and circulatory stability is crucial for improving outcomes among micropreemies, maneuvers for placental transfusion should not interfere with the resuscitation process and due to the lack of evidence, no specific practice for cord transfusion is recommended here.
How can obstetricians improve outcomes for infants born extremely preterm?
2021, Seminars in PerinatologyCitation Excerpt :Retrospective data from infants born at less than 29 weeks in 2016 to 2017 indicate that delayed cord clamping or umbilical cord milking (an alternative means of achieving placental transfusion) is associated with decreased mortality by 36 weeks’ postmenstrual age (aOR 0.71, 95% CI 0.55 – 0.92) and a decreased need to treat hypotension in the first 24 postnatal hours (aOR 0.66, 95% CI 0.53 – 0.82).89 The observed increased rate of severe intraventricular hemorrhage among extremely preterm infants exposed to umbilical cord milking (aOR 1.70, 95% CI 1.20 – 2.43) renders delayed cord clamping the preferred approach.90 The precise timing of cord clamping to optimize neonatal outcome is not yet known, with a delay of 30 to 60 seconds being the most common recommendation.91
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List of additional members of the Generic Database Subcommittee of the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network is available at www.jpeds.com (Appendix).