scholarly journals Milking of the Umbilical Cord in Term and Late Preterm Infants

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Stefano Basile ◽  
Sara Pinelli ◽  
Elisabetta Micelli ◽  
Marta Caretto ◽  
Pierluigi Benedetti Panici
Keyword(s):  
Preterm Infants ◽  
Umbilical Cord ◽  
Time Frame ◽  
Late Preterm ◽  
Delayed Cord Clamping ◽  
Late Preterm Infants ◽  
Positive Effects ◽  
Cord Clamping ◽  
Number Of Patients ◽  
Umbilical Cord Milking

Introduction. Umbilical cord milking is a procedure in which clamped or unclamped umbilical cord is grasped, and blood is pushed (“stripped”) two to four times towards the newborn, in a rapid time frame, usually within 20 seconds. The target of umbilical cord milking is to provide infants with their whole potential blood volume—of which they are deprived when early cord clamping is carried out—completing placental transfusion in a shorter time than delayed cord clamping. The aim of this narrative review is to analyse the literature regarding umbilical cord milking in term and late-preterm infants and to assess all possible benefits and limits of this procedure in clinical practice, especially in comparison to immediate and delayed cord clamping.Methods. We analysed literature data concerning maternal, as well as neonatal, outcomes for term and late-preterm (gestational age ≥ 34 weeks) newborns who received umbilical cord milking.Results. Most studies show comparable benefits for both umbilical cord milking and delayed cord clamping, especially in terms of haematological parameters when compared to immediate cord clamping. Umbilical cord milking may be a feasible procedure also for newborns requiring resuscitation.Conclusions. Literature data concerning positive effects of umbilical cord milking are encouraging and suggest that umbilical cord milking may be a quick and effective method to provide placental transfusions to depressed infants. However, the lack of standardised procedures and the variation in evaluated outcomes as well as the limited number of patients enrolled in trials, along with the retrospective nature of some of them, prevent recommending umbilical cord milking as a routine procedure.

scholarly journals Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping

2022 ◽  
Author(s):  
Inmaculada Lara-Cantón ◽  
Shiraz Badurdeen ◽  
Janneke Dekker ◽  
Peter Davis ◽  
Calum Roberts ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Preterm Infants ◽  
Left Ventricular ◽  
Late Preterm ◽  
Arterial Oxygen ◽  
Reference Ranges ◽  
Delayed Cord Clamping ◽  
Late Preterm Infants ◽  
Cord Clamping ◽  
Neonatal Transition

Abstract Blood oxygen in the fetus is substantially lower than in the newborn infant. In the minutes after birth, arterial oxygen saturation rises from around 50–60% to 90–95%. Initial respiratory efforts generate negative trans-thoracic pressures that drive liquid from the airways into the lung interstitium facilitating lung aeration, blood oxygenation, and pulmonary artery vasodilatation. Consequently, intra- (foramen ovale) and extra-cardiac (ductus arteriosus) shunting changes and the sequential circulation switches to a parallel pulmonary and systemic circulation. Delaying cord clamping preserves blood flow through the ascending vena cava, thus increasing right and left ventricular preload. Recently published reference ranges have suggested that delayed cord clamping positively influenced the fetal-to-neonatal transition. Oxygen saturation in babies with delayed cord clamping plateaus significantly earlier to values of 85–90% than in babies with immediate cord clamping. Delayed cord clamping may also contribute to fewer episodes of brady-or-tachycardia in the first minutes after birth, but data from randomized trials are awaited. Impact Delaying cord clamping during fetal to neonatal transition contributes to a significantly earlier plateauing of oxygen saturation and fewer episodes of brady-and/or-tachycardia in the first minutes after birth. We provide updated information regarding the changes in SpO2 and HR during postnatal adaptation of term and late preterm infants receiving delayed compared with immediate cord clamping. Nomograms in newborn infants with delayed cord clamping will provide valuable reference ranges to establish target SpO2 and HR in the first minutes after birth.

Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants

2015 ◽  
Vol 70 (11) ◽  
pp. 683-684
Author(s):  
Anup C. Katheria ◽  
Giang Truong ◽  
Larry Cousins ◽  
Bryan Oshiro ◽  
Neil N. Finer
Keyword(s):  
Preterm Infants ◽  
Umbilical Cord ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Umbilical Cord Milking

scholarly journals Benefits of umbilical cord milking versus delayed cord clamping on neonatal outcomes in preterm infants: A systematic review and meta-analysis

PLoS ONE ◽  
2018 ◽  
Vol 13 (8) ◽  
pp. e0201528 ◽  
Author(s):  
Nobuhiko Nagano ◽  
Makoto Saito ◽  
Takahiro Sugiura ◽  
Fumiko Miyahara ◽  
Fumihiko Namba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Umbilical Cord ◽  
Meta Analysis ◽  
Neonatal Outcomes ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Umbilical Cord Milking

scholarly journals Umbilical cord milking in preterm infants: a systematic review and meta-analysis

2020 ◽  
Vol 105 (6) ◽  
pp. 572-580
Author(s):  
Haribalakrishna Balasubramanian ◽  
Anitha Ananthan ◽  
Vaibhav Jain ◽  
Shripada C Rao ◽  
Nandkishor Kabra
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Umbilical Cord ◽  
Meta Analysis ◽  
Intraventricular Haemorrhage ◽  
Reference List ◽  
Delayed Cord Clamping ◽  
Neurodevelopmental Outcomes ◽  
Cord Clamping ◽  
Umbilical Cord Milking

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.

Effects of Placental Transfusion on Late Preterm Infants Admitted to a Mother Baby Unit

2021 ◽  
Author(s):  
Arpitha Chiruvolu ◽  
Reshma George ◽  
Karen C. Stanzo ◽  
Cassandra M. Kindla ◽  
Sujata Desai
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Guideline Implementation ◽  
Hospital Length ◽  
Late Preterm ◽  
Hospital Length Of Stay ◽  
Delayed Cord Clamping ◽  
Late Preterm Infants ◽  
Cord Clamping ◽  
Key Points

Objective Well-appearing late preterm infants admitted to a mother baby unit may benefit from either delayed cord clamping (DCC) or umbilical cord milking (UCM). However, there are concerns of adverse effects of increased blood volume such as polycythemia and hyperbilirubinemia. The purpose of this study is to examine the short-term effects of placental transfusion on late preterm infants born between 350/7 and 366/7 weeks of gestation.Study Design In this pre- and postimplementation retrospective cohort study, we compared late preterm infants who received placental transfusion (161 infants, DCC/UCM group) during a 2-year period after guideline implementation (postimplementation period: August 1, 2017 to July 31, 2019) to infants who had immediate cord clamping (118 infants, ICC group) born during a 2-year period before implementation (preimplementation period: August 1, 2015 to July 31, 2017).Results The mean hematocrit after birth was significantly higher in the DCC/UCM group. Fewer infants had a hematocrit <40% after birth in the DCC/UCM group compared with the ICC group. The incidence of hyperbilirubinemia needing phototherapy, neonatal intensive care unit (NICU) admissions, or readmissions to the hospital for phototherapy was similar between the groups. Fewer infants in the DCC/UCM group were admitted to the NICU primarily for respiratory distress. Symptomatic polycythemia did not occur in either group. Median hospital length of stay was 3 days for both groups.Conclusion Placental transfusion (DCC or UCM) in late preterm infants admitted to a mother baby unit was not associated with increased incidence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admissions, or readmissions to the hospital for phototherapy.Key Points

scholarly journals Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants

PEDIATRICS ◽  
2015 ◽  
Vol 136 (1) ◽  
pp. 61-69 ◽  
Author(s):  
A. C. Katheria ◽  
G. Truong ◽  
L. Cousins ◽  
B. Oshiro ◽  
N. N. Finer
Keyword(s):  
Preterm Infants ◽  
Umbilical Cord ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Umbilical Cord Milking
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