Umbilical cord milking versus delayed cord clamping in term infants: a systematic review and meta-analysis

ObjectiveTo conduct a systematic review and meta-analysis of the efficacy and safety of umbilical cord milking in preterm infants.DesignRandomised controlled trials comparing umbilical cord milking with delayed cord clamping/immediate cord clamping in preterm infants were identified by searching databases, clinical trial registries and reference list of relevant studies in November 2019. Fixed effects model was used to pool the data on various clinically relevant outcomes.Main outcome measuresMortality and morbidities in preterm neonates.ResultsNineteen studies (2014 preterm infants) were included. Five studies (n=922) compared cord milking with delayed cord clamping, whereas 14 studies (n=1092) compared milking with immediate cord clamping. Cord milking, as opposed to delayed cord clamping, significantly increased the risk of intraventricular haemorrhage (grade III or more) (risk ratio (RR): 1.95 (95% CI 1.01 to 3.76), p=0.05). When compared with immediate cord clamping, cord milking reduced the need for packed RBC transfusions (RR:0.56 (95% CI 0.43 to 0.73), p<0.001). There was limited information on long-term neurodevelopmental outcomes. The grade of evidence was moderate or low for the various outcomes analysed.ConclusionUmbilical cord milking, when compared with delayed cord clamping, significantly increased the risk of severe intraventricular haemorrhage in preterm infants, especially at lower gestational ages. Cord milking, when compared with immediate cord clamping, reduced the need for packed RBC transfusions but did not improve clinical outcomes. Hence, cord milking cannot be considered as placental transfusion strategy in preterm infants based on the currently available evidence.

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Assessment of effectiveness of delayed cord clamping and umbilical cord milking in early term and preterm infants

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183840 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2071

Author(s):

Mahendra K. Jain ◽

Nidhi Bhedru ◽

Anubhuti Jain

Keyword(s):

Umbilical Cord ◽

Randomized Study ◽

Delayed Cord Clamping ◽

Term Infants ◽

Early Term ◽

Cord Clamping ◽

Significant Difference ◽

Insignificant Difference ◽

Nicu Admission ◽

Umbilical Cord Milking

Background: Early cord clamping and cutting of the umbilical cord is widely practiced as part of the management of labor; it could deprive the neonate of about a quarter of its blood volume and iron. This thesis is aimed at comparing effects of delayed cord clamping versus umbilical cord milking at birth in preterm and early term infants.Methods: This single centered randomized study was conducted in Department of Pediatrics and data collection was done on the basis of the preterm and early term infants delivered by vaginal or cesarean delivery in Department of Gynecology, Geetanjali Medical College and Hospital, Udaipur during period of January 2016 to January 2017. Total of 120 infants were included in the study.Results: Statistically it has been analyzed that in both pre-term and early term infants who underwent DDC and UCM, there was insignificant difference in level of hemoglobin (Hb), haematocrit (HCT), blood sugar, bilirubin level (TSB) and temperature of body. On the other hand, significant difference was observed in weight and cord pH of neonates of both groups. There is also insignificant difference in terms of NICU admission for RDS, sepsis, phototherapy, need of oxygen, saline boluses, PRBC transfusion, polycythemia.Conclusions: Thus, overall it was observed that there is insignificant difference in delayed cord clamping and umbilical cord milking group. Thus, both are found to be equally effective in improving hematologic parameters.

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Pemerahan dan penundaan penjepitan tali pusat terhadap kadar hemoglobin bayi baru lahir

Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery) ◽

10.26699/jnk.v5i3.art.p195-200 ◽

2018 ◽

Vol 5 (3) ◽

pp. 195-200

Author(s):

Ahmaniyah Ahmaniyah ◽

Kamilah Hidajati ◽

Ari Suwondo

Keyword(s):

Treatment Group ◽

Umbilical Cord ◽

Vascular System ◽

Sampling Technique ◽

Deficiency Anemia ◽

Control Group ◽

Delayed Cord Clamping ◽

Term Infants ◽

Cord Clamping ◽

Umbilical Cord Milking

The incidence of iron deficiency anemia in term infants from 0-6 months is 40.8%. Efforts to reduce anemia in infants and toddlers is by ensuring the baby gets blood from the placenta through the umbilical cord. Labor occurs when oxygen shifts from the heart to the lungs 8-10% of the fetal period to 50% in neonates. Immediate cord clamping vascular resistance from the disconnected placenta which results in the increased of resistance of the baby's vascular system and eliminates about 1/4 of the volume of blood and iron in the neonate. The time of cutting the umbilical cord is a determining factor for placental transfusion to the baby. Delay cord clamping and umbilical cord milking are expected to provide iron reserves in infant. The aim of this study was to determine the differences in umbilical cord milking and delayed cord clamping. The design used experimental study with posttest-Only Control Group. The sampling technique used simple random sampling differs into treatment group and control group. The treatment group was umbilical cord milking and the control group was delayed cord clamping. The highest average of Hb levels in the umbilical cord milking group was 17.3mmHg and the delayed cord clamping group was 15.75 mmHg. Difference test on umbilical cord milking group and delayed cord clamping group used independent T-test obtained P <0.05 (p = 0,001). It is recommended that midwives used umbilical cord milking as an alternative action in providing midwifery care to newborns when clamping and cutting the umbilical cord. It was proven that there were differences in the haemoglobin levels of newborns between the umbilical cord milking group and delayed cord clamping group.

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Umbilical Cord Milking in Infants Born at <37 Weeks of Gestation: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9041071 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1071

Author(s):

Inmaculada Ortiz-Esquinas ◽

Juan Gómez-Salgado ◽

Julián Rodriguez-Almagro ◽

Ángel Arias-Arias ◽

Ana Ballesta-Castillejos ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Clinical Trials ◽

Preterm Infants ◽

Umbilical Cord ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Mean Blood Pressure ◽

Cord Clamping ◽

Umbilical Cord Milking

Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects of UCM in newborns <37 weeks’ gestation. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database for randomized UCM clinical trials with no language restrictions, which we then compared with other strategies. The sample included 2083 preterm infants. The results of our meta-analysis suggest that UCM in premature infants can reduce the risk of transfusion (relative risk (RR)= 0.78 [95% confidence interval (CI),0.67–0.90]) and increase hemoglobin(pooled weighted mean difference (PWMD)= 0.89 g/L[95%CI 0.55–1.22]) and mean blood pressure (PWMD=1.92 mmHg [95% CI 0.55–3.25]). Conversely, UCM seems to increase the risk of respiratory distress syndrome (RR = 1.54 [95% CI 1.03–2.29]), compared to the control groups. In infants born at <33 weeks, UCM was associated with a reduced risk of transfusion (RR= 0.81 [95%CI 0.66–0.99]), as well as higher quantities of hemoglobin (PWMD= 0.91 g/L[95%CI 0.50–1.32]). UCM reduces the risk of transfusion in preterm infants, and increases initial hemoglobin, hematocrit, and mean blood pressure levels with respect to controls.

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Does Delayed Cord Clamping Improve Long-Term (≥4 Months) Neurodevelopment in Term Babies? A Systematic Review and a Meta-Analysis of Randomized Clinical Trials

Frontiers in Pediatrics ◽

10.3389/fped.2021.651410 ◽

2021 ◽

Vol 9 ◽

Author(s):

Serena Xodo ◽

Luigi Xodo ◽

Giovanni Baccarini ◽

Lorenza Driul ◽

Ambrogio P. Londero

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Hematological Parameters ◽

Pooled Analysis ◽

Delayed Cord Clamping ◽

Term Infants ◽

Cord Clamping

Background: Recently, the literature suggested that placental transfusion facilitated by delayed cord clamping (DCC), besides having benefits on hematological parameters, might improve the infants' brain development.Objective: The present review primarily evaluates the Ages and Stages Questionnaire (ASQ) total score mean difference (MD) at long-term follow-up (≥4 months) comparing DCC (>90 or >180 s) to early cord clamping (ECC). Secondary aims consisted of evaluating the ASQ domains' MD and the results obtained from other methods adopted to evaluate the infants' neurodevelopment.Methods: MEDLINE, Scopus, Cochrane, and ClinicalTrials.gov databases were searched (up to 2nd November 2020) for systematic review and meta-analysis. All randomized controlled trials (RCTs) of term singleton gestations received DCC or ECC. Multiple pregnancies, pre-term delivery, non-randomized studies, and articles in languages other than English were excluded. The included studies were assessed for bias and quality. ASQ data were pooled stratified by time to follow up.Results: This meta-analysis of 4 articles from 3 RCTs includes 765 infants with four-month follow-up and 672 with 12 months follow-up. Primary aim (ASQ total score) pooled analysis was possible only for 12 months follow-up, and no differences were found between DCC and ECC (MD 1.1; CI 95: −5.1; 7.3). DCC approach significantly improves infants' communication domains (MD 0.6; CI 95: 0.1; 1.1) and personal-social assessed (MD 1.0; CI 95: 0.3; 1.6) through ASQ at 12 months follow-up. Surprisingly, the four-month ASQ personal social domain (MD −1.6; CI 95: −2.8; −0.4) seems to be significantly lower in the DCC group than in the ECC group.Conclusions: DCC, a simple, non-interventional, and cost-effective approach, might improve the long-term infants' neurological outcome. Single-blinding and limited studies number were the main limitations. Further research should be performed to confirm these observations, ideally with RCTs adopting standard methods to assess infants' neurodevelopment.Trial registration: NCT01245296, NCT01581489, NCT02222805, NCT01620008, IRCT201702066807N19, and NCT02727517

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