Delayed umbilical cord clamping better than cord milking in preterm infants: JAMA

Delhi: Umbilical cord milking compared with delayed umbilical cord clamping is associated with a significantly higher rate of severe intraventricular hemorrhage (bleeding into the brain's fluid-filled cavities) in preterm infants born at less than 32 weeks, according to a recent study in JAMA journal. However, women in both groups experienced a similar rate of the composite outcome of death or severe intraventricular hemorrhage.

Umbilical cord milking is the practice of gently squeezing the cord and pushing the contents into the newborn's abdomen before umbilical cord clamping. Unlike cord milking, a delay in clamping allows time for the blood to flow naturally from the cord into the abdomen before clamping and cutting the cord.

Some studies in preterm infants have found that delayed cord clamping reduces the chances of anemia and appears to benefit cognitive development in early childhood. However, the extra time needed for delayed cord clamping may also delay the start of the respiratory support often needed for the infants' underdeveloped lungs.

"Recent trials have demonstrated the benefits of cord management by delayed cord clamping or umbilical cord milking for both preterm and term infants. A Cochrane review of studies involving preterm infants found a 28% reduction in in-hospital deaths associated with delayed cord clamping. In term infants, higher iron values during the first year of life and better neurodevelopmental outcome up to 4 years, especially in boys, have been reported," Heike Rabe and Ola Andersson from Sweden wrote in an accompanying editorial.

The evidence led the WHO to publish recommendations to delay cord milking and cutting for at least 60 seconds for preterm infants and 1 to 3 minutes for term infants to allow for placental transfusion to take place.

Anup Katheria, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California, and colleagues conducted the present study to determine the difference in rates of death or severe intraventricular hemorrhage in preterm infants receiving placental transfusion with umbilical cord milking vs delayed umbilical cord clamping.

The study enrolled women at less than 32 weeks of pregnancy at risk for preterm birth. When the women went into early labor, their infants were assigned at random to umbilical cord milking or delayed cord clamping for 60 seconds. For safety reasons, obstetricians could opt out of either procedure and immediately clamp the cord.

Researchers planned to enroll 1,500 infants, with 750 assigned at random to each group. Before the study was halted, 474 infants were randomized, with 236 assigned to cord milking and 238 assigned to delayed clamping.

Read Also: Delayed Clamping of umbilical cord later saves preterm babies lives

Key findings of the study include:

• Twelve percent (29/236) of the umbilical cord milking group died or developed severe intraventricular hemorrhage compared with 8% (20/238) of the delayed umbilical cord clamping group (risk difference, 4%).


• Although there was no statistically significant difference in death, severe intraventricular hemorrhage was statistically significantly higher in the umbilical cord milking group than in the delayed umbilical cord clamping group (8% [20/236] vs 3% [8/238], respectively; risk difference, 5%).


• The test for interaction between gestational age strata and treatment group was significant for severe intraventricular hemorrhage only; among infants born at 23 to 27 weeks’ gestation, severe intraventricular hemorrhage was statistically significantly higher with umbilical cord milking than with delayed umbilical cord clamping (22% [20/93] vs 6% [5/89], respectively; risk difference, 16%).

The study, "Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants," is published in the JAMA journal.

DOI:10.1001/jama.2019.16004