EFFECT OF DELAYED CORD CLAMPING VERSUS CORD MILKING IN PRETERM INFANTS: A RANDOMIZED CONTROLLED TRIAL
DOI:
https://doi.org/10.55374/jseamed.v2i1.20Keywords:
Delayed cord clamping, Umbilical cord milkingAbstract
Background:Delayed cord clamping (DCC) is currently recommended for preterm infants to improve blood volume and decrease the rate of blood transfusion. Umbilical cord milking (CM) had similar advantages without interrupting neonatal resuscitation. However, the differences in neonatal outcomes between DCC and CM are not well elucidated. Objective:To compare neonatal outcomes between DCC and CM among preterm infants. Method:Infants born at 25-34 weeks of gestation were randomly allocated to one of two groups; group 1 received DCC for 60 seconds whereas group 2 received CM. Initial hemoglobin value was measured, while blood pressure and urine output were monitored. Neonatal complications and the rate of blood transfusion were recorded. Results: Twenty-two infants were enrolled in each group. No differences were observed regarding sex, gestational age, birth weight, mode of delivery, Apgar scores and rate of resuscitation between groups. The initial hemoglobin level of the DCC group [median 17.1 (13.1, 21.3) g/dL] did not differ from that of the CM group [median 17.1 (14.0, 22.5) g/dL], p=0.963. During the first 24 hours, no significant differences were observed regarding blood pressure and urine output between the groups. No differences were found in the rates of hypothermia, hyperbilirubinemia, intraventricular hemorrhage, necrotizing enterocolitis and rate of blood transfusion. Conclusion:We demonstrated no different effects on neonatal outcomes between DCC and CM among preterm infants. CM can be applied as an alternative to DCC especially in emergency situations. However, larger studies are warranted to determine the effects and safety of CM among preterm infants.
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References
Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev.2012;8:CD003248. DOI: https://doi.org/10.1002/14651858.CD003248.pub3
Ultee CA, van der Deure J, Swart J, Lasham C, van Baar AL. Delayed cord clamping in preterm infants delivered at 34-36 weeks' gestation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2008;93:F20-3. DOI: https://doi.org/10.1136/adc.2006.100354
Oh W, Fanaroff AA, Carlo WA, Donovan EF, McDonald SA, Poole WK; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Effects of delayed cord clamping in very-low-birth-weight infants. J Perinatol 2011 Apr;31 Suppl 1:S68-71. DOI: https://doi.org/10.1038/jp.2010.186
Ranjit T, Nesargi S, Rao PN, Sahoo JP, Ashok C, Chandrakala BS, et al. Effect of early versus delayed cord clamping on hematological status of preterm infants at 6 wk of age. Indian J Pediatr 2015;82:29-34. DOI: https://doi.org/10.1007/s12098-013-1329-8
Kugelman A, Borenstein-Levin L, Riskin A, Chistyakov I, Ohel G, Gonen R, et al. Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study. Am J Perinatol 2007;24:307-15. DOI: https://doi.org/10.1055/s-2007-981434
Meyer MP, Mildenhall L. Delayed cord clamping and blood flow in the superior vena cava in preterm infants: an observational study. Arch Dis Child Fetal Neonatal Ed 2012;97:F484-6. DOI: https://doi.org/10.1136/adc.2010.199703
Sommers R, Stonestreet BS, Oh W, Laptook A, Yanowitz TD, Raker C, et al. Hemodynamic effects of delayed cord clamping in premature infants. Pediatrics 2012;129:e667-72. DOI: https://doi.org/10.1542/peds.2011-2550
Rabe H, Wacker A, Hülskamp G, Hörnig-Franz I, Schulze-Everding A, Harms E, et al. A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatr 2000;159:775-7. DOI: https://doi.org/10.1007/PL00008345
Rabe H, Reynolds G, Diaz-Rossello J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology 2008;93:138-44. DOI: https://doi.org/10.1159/000108764
Hofmeyr GJ, Bolton KD, Bowen DC, Govan JJ. Periventricular/intraventricular haemorrhage and umbilical cord clamping. Findings and hypothesis. S Afr Med J 1988;73:104-6.
Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of Intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial.Pediatrics 2006;117:1235-42. DOI: https://doi.org/10.1542/peds.2005-1706
Raju TN, Singhal N. Optimal timing for clamping the umbilical cord after birth. Clin Perinatol 2012;39:889-900. DOI: https://doi.org/10.1016/j.clp.2012.09.006
Raju TN. Timing of umbilical cord clamping after birth for optimizing placental transfusion. Curr Opin Pediatr. 2013;25:180-7. DOI: https://doi.org/10.1097/MOP.0b013e32835d2a9e
Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, Okada T, et al. Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks’ gestation: a randomized controlled trial. Arch Dis Child Fetal Neonatal Ed 2008;93:F14-9. DOI: https://doi.org/10.1136/adc.2006.108902
Hosono S, Mugishima H, Fujita H, Hosono A, Okada T, Takahashi S, et al. Blood pressure and urine output during the first 120 h of life in infants born at less than 29 weeks' gestation related to umbilical cord milking. Arch Dis Child Fetal Neonatal Ed 2009;94:F328-31. DOI: https://doi.org/10.1136/adc.2008.142935
Takami T, Suganami Y, Sunohara D, Kondo A, Mizukaki N, Fujioka T, et al. Umbilical cord milking stabilizes cerebral oxygenation and perfusion in infants born before 29 weeks of gestation. J Pediatr 2012;161:742-7. DOI: https://doi.org/10.1016/j.jpeds.2012.03.053
March MI, Hacker MR, Parson AW, Modest AM, de Veciana M. The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial. J Perinatol. 2013;33:763-7. DOI: https://doi.org/10.1038/jp.2013.70
Patel S, Clark EA, Rodiguez CE, Metz TD, Abbaszadeh M, Yoder BA. Effect of umbilical cord milking on morbidity and survival in extremely low gestational age neonates. Am J Obstet Gynecol 2014;211:519.e1-7. DOI: https://doi.org/10.1016/j.ajog.2014.05.037
Katheria A, Blank D, Rich W, Finer N. Umbilical cord milking improves transition in premature infants at birth. PLoS One 2014;9:e94085. DOI: https://doi.org/10.1371/journal.pone.0094085
Alan S, Arsan S, Okulu E, Akin IM, Kilic A, Taskin S, et al. Effects of umbilical cord milking on the need for packed red blood cell transfusions and early neonatal hemodynamic adaptation in preterm infants born ≤1500 g: A prospective, randomized, controlled trial. J Pediatr Hematol Oncol 2014;36:e493-8. DOI: https://doi.org/10.1097/MPH.0000000000000143
Katheria AC, Leone TA, Woelkers D, Garey DM, Rich W, Finer NN. The effects of umbilical cord milking on hemodynamics and neonatal outcomes in premature neonates. J Pediatr 2014;164:1045-1050. DOI: https://doi.org/10.1016/j.jpeds.2014.01.024
Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: Neonatal resuscitation: 2015 American Heart Association Guideline Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S543-60. DOI: https://doi.org/10.1161/CIR.0000000000000267
Rabe H, Jewison A, Alvarez RF, Crook D, Stilton D, Bradley R, et al; Brighton Perinatal Study Group. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol. 2011;117(2 Pt 1):205-11. DOI: https://doi.org/10.1097/AOG.0b013e3181fe46ff
Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics. 2015;136:61-9. DOI: https://doi.org/10.1542/peds.2015-0368
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