Umbilical Cord Milking Versus Delayed Cord Clamping in Infants 28 to 32 Weeks: A Randomized Trial

Author:

Katheria Anup1,Szychowski Jeff2,Carlo Waldemar A2,Subramaniam Akila2,Reister Frank3,Essers Jochen3,Vora Farha4,Martin Courtney4,Schmölzer Georg M.5,Law Brenda5,Dempsey Eugene6,O’Donoghue Keelin6,Kaempf Joseph7,Tomlinson Mark7,Fulford Kevin8,Folsom Bergen8,Karam Simon9,Morris Rachael9,Yanowitz Toby10,Beck Stacy10,Clark Erin11,DuPont Tara11,Biniwale Manoj12,Ramanathan Rangasamy12,Bhat Shazia13,Hoffman Matthew13,Chouthai Nitin14,Bany-Mohammed Fayez15,Mydam Janardhan16,Narendran Vivek17,Wertheimer Fiona12,Gollin Yvonne1,Vaucher Yvonne18,Arnell Kathy1,Varner Michael11,Cutter Gary2,Wilson Nicole2,Rich Wade,Finer Neil1,

Affiliation:

1. aNeonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California

2. bUniversity of Alabama at Birmingham, Birmingham, Alabama

3. cDepartment of Pediatrics and Obstetrics, University of Ulm, Ulm, Germany

4. dDepartment of Pediatrics and Obstetrics, Loma Linda University, Loma Linda, California

5. eDepartment of Pediatrics, University of Alberta, Edmonton, Alberta, Canada

6. fDepartment of Pediatrics and Obstetrics, University College Cork, Cork, Ireland

7. gWomen and Children’s Services, Providence St Vincent Medical Center, Portland, Oregon

8. hDepartment of Pediatrics and Obstetrics, Sharp Grossmont Hospital, La Mesa, California

9. iDepartment of Pediatrics and Obstetrics, University of Mississippi Medical CenterJackson, Mississippi

10. jDepartment of Pediatrics and Obstetrics, Magee Women’s Hospital of UPMC, Pittsburgh, Pennsylvania

11. kUniversity of Utah, Department of Pediatrics and Obstetrics, Salt Lake City, Utah

12. lDepartment of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California

13. mDepartment of Pediatrics and Obstetrics, Christiana Care Health System, Newark, Delaware

14. nDepartment of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri

15. oDepartment of Pediatrics, University of California, Irvine, School of Medicine, Orange, California

16. pDepartment of Pediatrics, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois

17. qDepartment of Pediatrics and Obstetrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

18. rDepartment of Pediatrics, University of California at San Diego, San Diego, California

Abstract

OBJECTIVES To determine whether rate of severe intraventricular hemorrhage (IVH) or death among preterm infants receiving placental transfusion with UCM is noninferior to delayed cord clamping (DCC). METHODS Noninferiority randomized controlled trial comparing UCM versus DCC in preterm infants born 28 to 32 weeks recruited between June 2017 through September 2022 from 19 university and private medical centers in 4 countries. The primary outcome was Grade III/IV IVH or death evaluated at a 1% noninferiority margin. RESULTS Among 1019 infants (UCM n = 511 and DCC n = 508), all completed the trial from birth through initial hospitalization (mean gestational age 31 weeks, 44% female). For the primary outcome, 7 of 511 (1.4%) infants randomized to UCM developed severe IVH or died compared to 7 of 508 (1.4%) infants randomized to DCC (rate difference 0.01%, 95% confidence interval: (−1.4% to 1.4%), P = .99). CONCLUSIONS In this randomized controlled trial of UCM versus DCC among preterm infants born between 28 and 32 weeks’ gestation, there was no difference in the rates of severe IVH or death. UCM may be a safe alternative to DCC in premature infants born at 28 to 32 weeks who require resuscitation.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference26 articles.

1. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations;Perlman;Circulation,2015

2. Neonatal resuscitation with an intact cord: current and ongoing trials;Katheria;Children (Basel),2019

3. Effect of umbilical cord milking on morbidity and survival in extremely low gestational age neonates;Patel,2014

4. Prospective risk factor monitoring reduces intracranial hemorrhage rates in preterm infants;Schmid;Dtsch Arztebl Int,2013

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1. Further Insights Into Cord Management;Pediatrics;2023-11-09

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