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Response to Dr. Kumar’s letter

Journal of Perinatology volume 39, pages 597–598 (2019)Cite this article

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We would like to thank Dr. Kumar for his comments about our paper. We agree that the non-blinded trials with subjective binary outcomes are more likely at risk for observer bias. As suggested, we will consider using time to start positive pressure ventilation as a continuous variable in future studies. However, finding a difference of few seconds in an initiation of resuscitation is likely be statistically significant but may be clinically insignificant. Moreover, we did not find any differences in the resuscitation efforts, outcomes of resuscitation, Apgar scores, and short-term outcomes with umbilical cord milking (UCM) suggesting this procedure is safe in depressed neonates. The paper referenced by Dr Kumar regrading a potential harmful effect of excessive volume in asphyxiated myocardium is an opinion in a review article, not a conclusion from a human study [1]. As suggested by Dr. Kumar, a study on effects of UCM in depressed neonates using hemodynamic assessment is important. However, we did not find a difference in the use of inotropes with UCM in our cohort of depressed neonates. Recently, two more human studies have shown that the UCM in depressed infants is not only safe, but may also be beneficial [2, 3]. A study by Katheria et al. has shown that the UCM is safe and may decrease the need for resuscitation in term neonates who had acidosis and were depressed at birth [2]. In a more recent randomized clinical trial from India, Mohan et al. reported that the UCM is safe in preterm neonates who are depressed at birth and required resuscitation [3]. The depressed preterm infants who received UCM had a higher mean arterial pressure at 6 and 24 h of life and a higher hemoglobin and ferritin at 6 weeks [3].

Infants with culture positive early onset sepsis were excluded as this a confounding variable for the short term outcomes.

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Authors and Affiliations

  1. Lata Mangeshkar Medical College, Nagpur, Maharashtra, India

    Meenakshi Girish

  2. Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Zubair H Aghai

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  1. Meenakshi Girish
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  2. Zubair H Aghai
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Correspondence to Meenakshi Girish.

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Girish, M., Aghai, Z.H. Response to Dr. Kumar’s letter. J Perinatol 39, 597–598 (2019). https://doi.org/10.1038/s41372-019-0326-9

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