Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born less than 29 weeks' gestation: a randomized controlled trial

Abstract

Objective: To investigate the effects of umbilical cord milking on the need for red blood cell transfusion and morbidity in very preterm infants.

Patients and Methods: 40 singleton infants born between 24 and 28 weeks′ gestation were randomly assigned to having their umbilical cord clamped either immediately or after umbilical cord milking. Twenty had immediate umbilical cord clamping (control group) and remaining 20 had umbilical cord milking (milked group), which involved vigorous milking of approximately 20 cm of the umbilical cord towards the umbilicus two to three times before clamping the cord. The primary outcome measures were the probability of not needing transfusion, determined by using Kaplan-Meier analysis, and the total number of red cell blood transfusions. The secondary outcome variables were hemoglobin value and blood pressure at admission.

Results: There were no significant differences in gestational age and birth weight between the two groups. The milked group was more likely to have not needed red cell transfusion (p=0.02) and had a decreased number of red blood cell transfusions (1.7 ± 3.0 in the milked vs. 4.0 ± 4.2 in the control; p=0.02). The initial hemoglobin value was higher in the milked group (16.5 ± 1.4g/dl in the milked vs. 14.1 & [plusmn] 1.6 g/dl in the control; p<0.01). The mean blood pressure at admission was significantly higher in the milked group (34 ± 9 mmHg in the milked vs. 28 ± 8 mmHg in the control; p=0.03). There was no significant difference in the mortality rate between the groups. The shorter duration of ventilation or supplement oxygen was observed in the milked group compared with the control group. No polycythemia was observed in either groups and there was no significant difference in the risk of intraventricular hemorrhage between the groups.

Conclusion: Milking the umbilical cord is a safe procedure to reduce the requirements for red blood cell transfusions, and the need for both circulatory and respiratory supports in very preterm infants.