Original Article

Journal of Perinatology (2013) 33, 763–767; doi:10.1038/jp.2013.70; published online 18 July 2013

The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial

M I March1,2,3, M R Hacker2,3, A W Parson4, A M Modest2 and M de Veciana5

  1. 1Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
  2. 2Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
  3. 3Harvard Medical School, Boston, MA, USA
  4. 4Hampton Roads Ob/Gyn Center, Norfolk, VA, USA
  5. 5Eastern Virginia Medical School, Norfolk, VA, USA

Correspondence: Dr MI March, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, KS Third Floor, Boston 02215, MA, USA. E-mail: melissamarch@gmail.com

Received 16 January 2013; Revised 27 March 2013; Accepted 23 May 2013
Advance online publication 18 July 2013

This study was previously presented at the Society for Maternal Fetal Medicine’s 31st Annual Meeting, held in San Francisco, CA (‘The Efficacy of Umbilical Cord Milking on the Reduction of Red Blood Cell Transfusion Rates in Infants Born Between 24 and 28 6/7 Weeks Gestation - A Randomized Controlled Trial,’ Abstract ID: 221362) on 7–12 February 2011.





Delayed cord clamping has been shown to decrease the need for transfusion in preterm neonates, but may delay resuscitation. The aim of this study was to determine whether umbilical cord milking compared with immediate cord clamping in extremely preterm deliveries reduces the need for neonatal red blood cell transfusion.

Study design:


Women admitted to a tertiary care center and expected to deliver between 24 to 28 completed weeks of gestation were randomized to cord milking before clamping or immediate cord clamping. The primary outcome was the risk of neonatal transfusion, reported as risk ratio (RR) and 95% confidence interval (CI).



Of 113 women who were enrolled and randomized, 56 were assigned to cord milking with 36 remaining eligible and completing the study and 57 were assigned to the control group with 39 remaining eligible and completing the study. Albeit not statistically significant, neonates in the cord milking group were less likely to require transfusion compared with those in the control group (RR: 0.86; 95% CI: 0.73 to 1.0). Neonates whose cords were milked had higher hematocrits at birth (P=0.004) and were less likely to develop an intraventricular hemorrhage (P=0.0195).



Milking the umbilical cord of a preterm neonate is an easy intervention with the potential to improve perinatal outcomes. Our results suggest that milking of the cord increases the neonate’s initial hematocrit and may lessen the need for transfusion in the neonatal period. The observed reduction in the incidence of intraventricular hemorrhage may have important long-term implications that warrant further study.


umbilical cord milking; preterm delivery; anemia of prematurity