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A Randomized Controlled Trial of Intact Cord Milking versus Immediate Cord Clamping in Term Infants Born by Elective Cesarean Section
Objective We evaluated whether intact umbilical cord milking (UCM) is more effective than immediate cord clamping (ICC) in enhancing placental transfusion after elective cesarean delivery.
Study Design In a randomized trial, volume of placental transfusion was assessed by Δ hematocrit (Hct) between neonatal cord blood and capillary heel blood at 48 hours of age, corrected for the change in body weight.
Results There were no significant differences in cord blood mean Hct values at birth (UCM, 44.5 ± 4.8 vs. ICC, 44.9 ± 4.2%, p = 0.74). Conversely, at 48 hours of age, the UCM group had significantly higher capillary heel Hct values (UCM, 53.7 ± 5.9 vs. ICC, 49.8 ± 4.6%, p < 0.001), supporting a higher placental transfusion volume (Δ Hct, UCM 9.2 ± 5.2 vs. ICC 4.8 ± 4.7, p < 0.001), despite comparable neonatal body weight decrease (UCM, −7.3 vs. ICC, −6.8%, p = 0.77).
Conclusion Higher Δ Hct between cord blood at birth and capillary heel blood at 48 hours of age, corrected for the change in body weight, suggests that intact UCM is an efficacious and safe procedure to enhance placental transfusion among neonates born via elective cesarean delivery.
Clinical Trial Registration ClinicalTrials.gov, www.clinicaltrials.gov, NCT03668782.
Keywordsneonatal anemia - elective cesarean section - newborns - umbilical cord milking - placental transfusion
Received: 29 May 2019
Accepted: 16 August 2019
Article published online:
10 October 2019
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- 1 Zhou YB, Li HT, Zhu LP, Liu JM. Impact of cesarean section on placental transfusion and iron-related hematological indices in term neonates: a systematic review and meta-analysis. Placenta 2014; 35 (01) 1-8
- 2 Yao AC, Hirvensalo M, Lind J. Placental transfusion-rate and uterine contraction. Lancet 1968; 1: 380-383
- 3 AHA/AAP neonatal resuscitation guidelines 2010: summary of major changes and comment on its utility in resource-limited settings. Accessed September 4, 2019 at: https://www.newbornwhocc.org/pdf/NRP2010-Changes.pdf
- 4 Ceriani Cernadas JM, Carroli G, Pellegrini L. et al. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics 2006; 117 (04) e779-e786
- 5 Lukowski AF, Koss M, Burden MJ. et al. Iron deficiency in infancy and neurocognitive functioning at 19 years: evidence of long-term deficits in executive function and recognition memory. Nutr Neurosci 2010; 13 (02) 54-70
- 6 Katheria AC, Lakshminrusimha S, Rabe H, McAdams R, Mercer JS. Placental transfusion: a review. J Perinatol 2017; 37 (02) 105-111
- 7 Kleinberg F, Dong L, Phibbs RH. Cesarean section prevents placenta-to-infant transfusion despite delayed cord clamping. Am J Obstet Gynecol 1975; 121 (01) 66-70
- 8 Ceriani Cernadas JM, Carroli G, Pellegrini L. et al. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics 2006; 117 (04) e779-e786
- 9 Hosono S, Mugishima H, Fujita H. 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 randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2008; 93 (01) F14-F19
- 10 Erickson-Owens DA, Mercer JS, Oh W. Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial. J Perinatol 2012; 32 (08) 580-584
- 11 Colozzi AE. Clamping of the umbilical cord; its effect on the placental transfusion. N Engl J Med 1954; 250 (15) 629-632
- 12 Jaiswal P, Upadhyay A, Gothwal S. et al. Comparison of two types of intervention to enhance placental redistribution in term infants: randomized control trial. Eur J Pediatr 2015; 174 (09) 1159-1167
- 13 Upadhyay A, Gothwal S, Parihar R. et al. Effect of umbilical cord milking in term and near term infants: randomized control trial. Am J Obstet Gynecol 2013; 208 (02) 120.e1-120.e6
- 14 Rabe H, Jewison A, Alvarez RF. 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): 205-211
- 15 Strauss J, Adamsons Jr K, James LS. Renal function of normal full-term infants in the first hours of extrauterine life: I. Infants delivered naturally and given a placental transfusion. Am J Obstet Gynecol 1965; 91: 286-290
- 16 McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; 9 (07) CD004074
- 17 Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA 2007; 297 (11) 1241-1252
- 18 Luchtman-Jones L, Schwartz AL, Wilson DB. Hematologic problems in the fetus and neonate. In: Martin RJ, Fanaroff AA, Walsh C. eds. Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant, 8th ed. Philadelphia, PA: Mosby-Elsevier; 2006: 1287
- 19 Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999; 103 (01) 6-14
- 20 McAdams RM, Fay E, Delaney S. Whole blood volumes associated with milking intact and cut umbilical cords in term newborns. J Perinatol 2018; 38 (03) 245-250
- 21 Farrar D, Airey R, Law GR, Tuffnell D, Cattle B, Duley L. Measuring placental transfusion for term births: weighing babies with cord intact. BJOG 2011; 118 (01) 70-75
- 22 Kakkilaya V, Pramanik AK, Ibrahim H, Hussein S. Effect of placental transfusion on the blood volume and clinical outcome of infants born by cesarean section. Clin Perinatol 2008; 35 (03) 561-570
- 23 Bora R, Akhtar SS, Venkatasubramaniam A, Wolfson J, Rao R. Effect of 40-cm segment umbilical cord milking on hemoglobin and serum ferritin at 6 months of age in full-term infants of anemic and non-anemic mothers. J Perinatol 2015; 35 (10) 832-836
- 24 Siddall RS, Crissey RR, Knapp WL. Effect on cesarean section babies of stripping or milking of the umbilical cords. Am J Obstet Gynecol 1952; 63 (05) 1059-1064
- 25 Hostetter M, Lister G, Siegel N. Rudolph's Pediatrics. New York, NY: McGraw Hill Medica; 2003
- 26 Upadhyay A, Gothwal S, Parihar R. et al. Effect of umbilical cord milking in term and near term infants: randomized control trial. Am J Obstet Gynecol 2013; 208 (02) 120.e1-120.e6
- 27 Al-Wassia H, Shah PS. Efficacy and safety of umbilical cord milking at birth: a systematic review and meta-analysis. JAMA Pediatr 2015; 169 (01) 18-25