Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial.
OBJECTIVE
To compare two strategies to enhance placento-fetal blood transfusion in preterm neonates before 33 weeks of gestation.


METHODS
We recruited women at risk for singleton preterm deliveries. All delivered before 33 completed weeks of gestation. In this single-center trial, women were randomized to either standard treatment (clamping the cord for 30 seconds after delivery) or repeated (four times) milking of the cord toward the neonate. Exclusion criteria included inadequate time to obtain consent before delivery, known congenital abnormalities of the fetus, Rhesus sensitization, or fetal hydrops.


RESULTS
Of 58 neonates included the trial, 31 were randomized to cord clamping and 27 were randomized to repeated milking of the cord. Mean birth weight was 1,263±428 g in the clamping group and 1,235±468 g in the milking group, with mean gestational age of 29.2±2.3 weeks and 29.5±2.7 weeks, respectively. Mean hemoglobin values for each group at 1 hour after birth were 17.3 g/L for clamping and 17.5 g/L for milking (P=.71). There was no significant difference in number of neonates undergoing transfusion (clamping group, 15; milking group, 17; P=.40) or the median number of transfusions within the first 42 days of life (median [range]: clamping group 0 [0-7]; milking group 0 [0-20]; P=.76).


CONCLUSIONS
Milking the cord four times achieved a similar amount of placento-fetal blood transfusion compared with delaying clamping the cord for 30 seconds.


BACKGROUND
National Research Register UK, www.nihr.ac.uk/Pages/default.aspx, N0051177741.


METHODS
I.
From the Brighton and Sussex University Hospitals, Department of Neonatology, Brighton, United Kingdom; the Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom; and the Brighton and Sussex University Hospitals, Department of Obstetrics, Brighton, United Kingdom.
Heike
H
Rabe
Amanda
A
Jewison
Ramon
R
Fernandez Alvarez
David
D
Crook
Denise
D
Stilton
Robert
R
Bradley
Desmond
D
Holden
D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001810:Blood Volume; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005312:Fetal Blood; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D021041:Placental Circulation; D011247:Pregnancy; D055815:Young Adult
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