Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

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

Journal of Perinatology volume 33, pages 763–767 (2013)Cite this article

Subjects

Abstract

Objective:

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).

Result:

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).

Conclusion:

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Hosono S, Ohno T, Kimoto H, Shimizu M, Harada K . Morbidity and mortality of infants born at the threshold of viability: ten year’s experience in a single neonatal intensive care unit, 1991-2000. Pediatr Int 2006; 48: 33–39.

    Article  Google Scholar 

  2. Stockman JA, Graeber JE, Clark DA, McClellan K, Garcia JF, Kavey RE . Anemia of prematurity: determinants of the erythropoietin response. J Pediatr. 1984; 105: 786–792.

    Article  Google Scholar 

  3. Ohls RK . The use of erythropoietin in neonates. Clin Perinatol. 2000; 27: 681–696.

    Article  CAS  Google Scholar 

  4. Haiden N, Schwindt J, Cardona F, Berger A, Klebermass K, Wald M et al. Effects of a combined therapy of erythropoietin, iron, folate, and vitamin B12 on the transfusion requirements of extremely low birth weight infants. Pediatrics 2006; 118: 2004–2013.

    Article  Google Scholar 

  5. Ross MP, Christensen RD, Rothstein G, Koenig JM, Simmons MA, Noble NA et al. A randomized trial to develop criteria for administering erythrocyte transfusions to anemic preterm infants 1 to 3 months of age. J Perinatol 1989; 9: 246–253.

    CAS  PubMed  Google Scholar 

  6. Padbury JF . Placental Transfusion In Rudolph’s Pediatrics. McGraw Hill Medical: New York, NY, USA (2003) pp 163–164.

  7. 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: 138–144.

    Article  Google Scholar 

  8. 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)).

  9. Aladagandy N, McHugh S, Aitchison TC, Wardrop CA, Holland B . Infant’s blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics 2006; 117: 93–98.

    Article  Google Scholar 

  10. Strauss RG, Mock DM, Johnson KJ, Cress GA, Burmeister LF, Zimmerman MB et al. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion 2008; 48: 658–665.

    Article  Google Scholar 

  11. Oh W, Fanaroff AA, Carlo WA, Donovan EF, McDonald SA, Poole WK et al. Effects of delayed cord clamping in very-low-birth-weight infants. J Perinatol 2011; 31 (Suppl 1): S68–S71.

    Article  Google Scholar 

  12. Kinmond S, Aitchison TC, Holland BM, Jones JG, Turner TL, Wardrop CA . Umbilical cord clamping and preterm infants: a randomized trial. BMJ 1993; 306: 172–175.

    Article  CAS  Google Scholar 

  13. 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 (5): 307–315.

    Article  Google Scholar 

  14. 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: 1235–1242.

    Article  Google Scholar 

  15. Rabe H, Wacker A, Hulskamp G, Hornig-Franz I, Schulze-Everding A, Harms E et al. A randomized controlled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatr 2000; 159: 775–777.

    Article  CAS  Google Scholar 

  16. Utlee 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 randomized controlled trial. Arch Dis Child Fetal Neonatal Ed 2008; 93: F20–F23.

    Article  Google Scholar 

  17. Rabe H, Jewison A, Alvarez RF, Crook D, Stilton D, Bradley R et al. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates. Obstet Gynecol 2011; 117: 205–211.

    Article  Google Scholar 

  18. 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: 580–584.

    Article  CAS  Google Scholar 

  19. American College of Obstetricians and Gynecologists. Committee Opinion No. 543:Timing of umbilical cord clamping after birth. Obstet Gynecol 2012; 120: 1522–1526.

    Article  Google Scholar 

  20. 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 less than 29 weeks’ gestation: a randomized control trial. Arch Dis Child Fetal Neonatal Ed 2007; 10: 1136.

    Google Scholar 

  21. 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–F331.

    Article  CAS  Google Scholar 

  22. 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 gestation. J Pediatr. 2012; 161 (4): 742–747.

    Article  Google Scholar 

  23. Pocock S . Group sequential methods in the design and analysis of clinical trials. Biometrika 1977; 62: 191–199.

    Article  Google Scholar 

Download references

Acknowledgements

This work was conducted with support from Harvard Catalyst. The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05 and financial contributions from the Harvard University and its affiliated academic health-care centers.

Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    M I March

  2. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    M I March, M R Hacker & A M Modest

  3. Harvard Medical School, Boston, MA, USA

    M I March & M R Hacker

  4. Hampton Roads Ob/Gyn Center, Norfolk, VA, USA

    A W Parson

  5. Eastern Virginia Medical School, Norfolk, VA, USA

    M de Veciana

Authors
  1. M I March
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M R Hacker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A W Parson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A M Modest
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M de Veciana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M I March.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

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.

Supplementary Information accompanies the paper on the Journal of Perinatology website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

March, M., Hacker, M., Parson, A. et al. The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial. J Perinatol 33, 763–767 (2013). https://doi.org/10.1038/jp.2013.70

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2013.70

Keywords

This article is cited by

Search

Advanced search

Quick links