Download PDF
Am J Perinatol 2022; 39(01): 031-036
DOI: 10.1055/s-0040-1713350
Original Article

Effects of Umbilical Cord Milking on Anemia in Preterm Infants: A Multicenter Randomized Controlled Trial

Yu-jie Xie
1   Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical College, Shanghai, People's Republic of China
,
Jia-li Xiao
2   Department of Neonatology, Jiaxing Maternity & Child health Care Hospital, Jiaxing, People's Republic of China
,
Juan-juan Zhu
1   Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical College, Shanghai, People's Republic of China
,
Yi-wen Wang
1   Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical College, Shanghai, People's Republic of China
,
Bei Wang
3   Department of Obstetrics, Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical College, Shanghai, People's Republic of China
,
Li-juan Xie
1   Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical College, Shanghai, People's Republic of China
› Author Affiliations Funding This study received its financial support from Shanghai Hospital Development Center (grant number SHDC12016217).
› Further Information
    Permissions and Reprints

Abstract

Objective This study aimed to investigate whether umbilical cord milking (UCM) prevents and controls anemia in preterm infants, as compared with immediate cord clamping (ICC).

Study Design Pregnant women delivering at <34 weeks' gestation in four hospitals were randomly assigned to undergo UCM or ICC from July 2017 to June 2019. Hematological parameters and iron status were collected and analyzed as primary outcomes at 24 hours, 1 week, 2 weeks, and 6 months after delivery.

Results Neonates receiving UCM had significant higher levels of hemoglobin (Hb), hematocrit, and serum iron (p < 0.05). Lower prevalence of anemia and lower need for transfusions were noted in UCM group. Although UCM was associated with prolonged duration of phototherapy, the maximum levels of bilirubin were similar between two groups (p > 0.05).

Conclusion UCM is an effective intervention to help preterm infants experience less anemia with the potential to increase blood volume, as seen by higher Hb levels and more enhanced iron stores.

Keywords

umbilical cord milking - anemia - placental transfusion

Note

This trial was approved by the Institutional Ethical Review Board and written informed consent was obtained from the parents before the time of delivery.




Publication History

Received: 28 February 2020

Accepted: 11 May 2020

Article published online:
03 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Hirata M, Kusakawa I, Ohde S, Yamanaka M, Yoda H. Risk factors of infant anemia in the perinatal period. Pediatr Int (Roma) 2017; 59 (04) 447-451
    CrossrefPubMedGoogle Scholar
  • 2 Kc A, Målqvist M, Rana N, Ranneberg LJ, Andersson O. Effect of timing of umbilical cord clamping on anaemia at 8 and 12 months and later neurodevelopment in late preterm and term infants; a facility-based, randomized-controlled trial in Nepal. BMC Pediatr 2016; 16: 35-39
    CrossrefPubMedGoogle Scholar
  • 3 Carter RC, Jacobson JL, Burden MJ. et al. Iron deficiency anemia and cognitive function in infancy. Pediatrics 2010; 126 (02) e427-e434
    CrossrefPubMedGoogle Scholar
  • 4 Mercer JS, Erickson-Owens DA. Rethinking placental transfusion and cord clamping issues. J Perinat Neonatal Nurs 2012; 26 (03) 202-217 , quiz 218–219
    CrossrefPubMedGoogle Scholar
  • 5 Katheria AC, Lakshminrusimha S, Rabe H, McAdams R, Mercer JS. Placental transfusion: a review. J Perinatol 2017; 37 (02) 105-111
    CrossrefPubMedGoogle Scholar
  • 6 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 (08) CD003248
    PubMedGoogle Scholar
  • 7 Fogarty M, Osborn DA, Askie L. et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 2018; 218 (01) 1-18
    CrossrefPubMedGoogle Scholar
  • 8 Perrone B, Ghirardello S. ; “Italian Survey on Placental Transfusion Group”. Placental transfusion strategies in Italy: A nationwide survey of tertiary-care delivery wards. Am J Perinatol 2017; 34 (07) 722-728
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Royal College of Obstetricians and Gynaecologists, Scientific Advisory Committee. Clamping of the umbilical cord and placental transfusion, scientific impact paper no. 14, 2015. Accessed February 27, 2015 at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/sip14/
    PubMedGoogle Scholar
  • 10 Katheria A, Reister F, Essers J, Mendler M, Hummler H, Subramaniam A. et al. Association of umbilical cord milking vs delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants. JAMA 2019; 322 (19) 1877-1886
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 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
    CrossrefPubMedGoogle Scholar
  • 13 Xie LJ, Zhang YH. Eearly effects of umbilical cord milking on preterm infants. Chin J Perinat Med. 2015; 18 (01) 35-37
    PubMedGoogle Scholar
  • 14 Sweet DG, Carnielli V, Greisen G. et al. European consensus guidelines on the management of respiratory distress syndrome - 2016 update. Neonatology 2017; 111 (02) 107-125
    CrossrefPubMedGoogle Scholar
  • 15 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
    CrossrefPubMedGoogle Scholar
  • 16 Kumar B, Upadhyay A, Gothwal S, Jaiswal V, Joshi P, Dubey K. Umbilical cord milking and hematological parameters in moderate to late preterm neonates: a randomized controlled trial. Indian Pediatr 2015; 52 (09) 753-757
    CrossrefPubMedGoogle Scholar
  • 17 Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics 2015; 136 (01) 61-69
    CrossrefPubMedGoogle Scholar
  • 18 Katheria A, Blank D, Rich W, Finer N. Umbilical cord milking improves transition in premature infants at birth. PLoS One 2014; 9 (04) e94085
    CrossrefPubMedGoogle Scholar
  • 19 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
    CrossrefPubMedGoogle Scholar
  • 20 von Lindern JS, Lopriore E. Management and prevention of neonatal anemia: current evidence and guidelines. Expert Rev Hematol 2014; 7 (02) 195-202
    CrossrefPubMedGoogle Scholar
  • 21 dos Santos AM, Guinsburg R, de Almeida MF. et al; Brazilian Network on Neonatal Research. Red blood cell transfusions are independently associated with intra-hospital mortality in very low birth weight preterm infants. J Pediatr 2011; 159 (03) 371-376.e1 , 3
    CrossrefPubMedGoogle Scholar
  • 22 Lozoff B, Wolf AW, Jimenez E. Iron-deficiency anemia and infant development: effects of extended oral iron therapy. J Pediatr 1996; 129 (03) 382-389
    CrossrefPubMedGoogle Scholar
  • 23 Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol 2006; 13 (03) 158-165
    CrossrefPubMedGoogle Scholar
  • 24 Mercer JS, Erickson-Owens DA, Deoni SCL. et al. Effects of delayed cord clamping on 4-month ferritin levels, brain myelin content, and neurodevelopment: a randomized controlled trial. J Pediatr 2018; 203: 266-272.e2
    CrossrefPubMedGoogle Scholar
  • 25 McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Evid Based Child Health 2014; 9 (02) 303-397
    CrossrefPubMedGoogle Scholar
  • 26 Linderkamp O. Placental transfusion: determinants and effects. Clin Perinatol 1982; 9 (03) 559-592
    CrossrefPubMedGoogle Scholar
  • 27 Christensen RD, Baer VL, Gerday E. et al. Whole-blood viscosity in the neonate: effects of gestational age, hematocrit, mean corpuscular volume and umbilical cord milking. J Perinatol 2014; 34 (01) 16-21
    CrossrefPubMedGoogle Scholar