Umbilical cord milking appears safe in preterm infants
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Key takeaways:
- Preterm infants born between 28 and 32 weeks' gestation reacted well to a treatment to move blood into their body.
- Few alternatives exist for infants born prior to 28 weeks’ gestation.
Umbilical cord milking — when blood is pushed through an unclamped umbilical cord toward the infant — appeared to be safe in preterm infants born between 28 and 32 weeks’ gestation, according to a study published in Pediatrics.
Umbilical cord milking (UCM) has also been endorsed as an alternative to delayed cord clamping (DCC), allowing resuscitation to begin promptly, but it has not been well studied, according to Anup Katheria, MD, director of the Neonatal Research Institute at the Sharp Mary Birch Hospital for Women & Newborns in San Diego.
“Previously, it had been found that UCM is not safe in preterm infants aged 23 to 27 weeks due to an increase in severe intraventricular hemorrhage at birth,” Katheria told Healio. “However, there are many infants born prematurely greater than 27 weeks that may benefit from either UCM or DCC, and it was important to study the safety in infants 28 to 32 weeks’ gestational age.”
A standard DCC procedure usually takes 30 to 180 seconds, but cord milking takes about 20 seconds, which the researchers said reduces delay for infants who need immediate assistance, such as respiratory support. Most studies that do not show differences are not truly able demonstrate that that two interventions are similar or safe, Katheria added.
“The lack of a difference often occurs in small studies, which can be misinterpreted as safe,” Katheria said. “A large noninferiority study is designed to demonstrate safety and or equivalence. Since cord milking is easier to do and could be done in babies that need resuscitation, it seemed ideally suited to study.”
In the study, 1,019 infants (mean gestational age, 31 weeks; 44% girls) were randomly assigned to umbilical cord milking (n = 511) or delayed cord clamping (n = 508). In each group, 1.4% of the infants experienced severe intraventricular hemorrhage (IVH) or died (rate difference, 0.01%; 95% CI, –1.4% to 1.4%). The researchers called this primary finding — as well as the difference in any grade IVH, hemoglobin at 4 hours old, and any exploratory outcome — not significant.
The results are “reassuring,” Katheria told Healio.
“Although we surprisingly could not demonstrate noninferiority at a 1% margin, our results are supportive that these two interventions may be similar,” Katheria said. “Among preterm infants born at 28 to 32 weeks’ gestational age, UCM may be a safe and easily implemented alternative to DCC for premature infants who require resuscitation. The study continues to follow long-term neurodevelopmental outcomes through 2 years of age, which are ongoing and will be reported upon completion.”
Katheria and colleagues are still working on a neurodevelopmental follow-up for the entire cohort of newborns. He noted that there is a lack of good alternatives for premature infants younger than the studied age.
“There is still no good alternative to infants that are below 28 weeks,” Katheria said. “To date, no studies of providing resuscitation during delayed cord clamping have shown any benefit. There is a need for the ideal respiratory support while infants are receiving delayed cord clamping.”
In a related commentary, Roger F. Soll, MD, H. Wallace Professor of Neonatology at the University of Vermont Larner College of Medicine, noted that the findings in the study align with recommendations that say UCM is a “reasonable alternative” to DCC in this age group.
“Although the study seems to support these recommendations, it is worth taking a step back to understand the underpinning of the trial and our approach to UCM,” Soll wrote. “There are lessons we learned from our evolving approach to respiratory management in the delivery room, where less invasive approaches to support are clearly gaining ground.”
References:
Katheria A, et al. Pediatrics. 2023;doi:10.1542/peds.2023-063113.
Soll RF, et al. Pediatrics. 2023;doi:10.1542/peds.2023-063505.
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Katheria A, et al. Pediatrics. 2023;doi:10.1542/peds.2023-063113.
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