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.
OBJECTIVE
To investigate the effects of umbilical cord milking on the need for red blood cell (RBC) transfusion and morbidity in very preterm infants.


METHODS
40 singleton infants born between 24 and 28 weeks' gestation were randomly assigned to receive umbilical cord clamped either immediately (control group, n = 20) or after umbilical cord milking (milked group, n = 20). Primary outcome measures were the probability of not needing transfusion, determined by Kaplan-Meier analysis, and the total number of RBC transfusions. Secondary outcome variables were haemoglobin value and blood pressure at admission.


RESULTS
There were no significant differences in gestational age and birth weight between the two groups. The milked group was more likely not to have needed red cell transfusion (p = 0.02) and had a decreased number (mean (SD)) of RBC transfusions (milked group 1.7 (3.0) vs controls 4.0 (4.2); p = 0.02). The initial mean (SD) haemoglobin value was higher in the milked group (165 (14) g/l) than in the controls (141 (16) g/l); p<0.01). Mean (SD) blood pressure at admission was significantly higher in the milked group (34 (9) mm Hg) than in the controls 28 (8) mm Hg; p = 0.03). There was no significant difference in mortality between the groups. The milked group had a shorter duration of ventilation or supplemental oxygen than the control group.


CONCLUSIONS
Milking the umbilical cord is a safe procedure, reducing the need for RBC transfusions, and the need for circulatory and respiratory support in very preterm infants.
Hosono
S
S
Dr S Hosono, Department of Paediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchi Itabashi, Tokyo 173-8610, Japan; hosonos@med.nihon-u.ac.jp.
Mugishima
H
H
Fujita
H
H
Hosono
A
A
Minato
M
M
Okada
T
T
Takahashi
S
S
Harada
K
K
D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D003250:Constriction; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005312:Fetal Blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D019102:Infant, Very Low Birth Weight / Q000502:physiology; D007564:Japan; D010100:Oxygen / Q000627:therapeutic use; D012121:Respiration, Artificial; D016896:Treatment Outcome; D014470:Umbilical Cord
D006454:Hemoglobins; D010100:Oxygen