title: The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial.
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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1] Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA [2] Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA [3] Harvard Medical School, Boston, MA, USA.
authors.forename: M I
authors.initials: MI
authors.lastname: March
authors.forename: M R
authors.initials: MR
authors.lastname: Hacker
authors.forename: A W
authors.initials: AW
authors.lastname: Parson
authors.forename: A M
authors.initials: AM
authors.lastname: Modest
authors.forename: M
authors.initials: M
authors.lastname: de Veciana
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods / Q000706:statistics & numerical data*; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D003250:Constriction; D005260:Female; D006400:Hematocrit; D006801:Humans; D015994:Incidence; D062071:Infant, Extremely Premature / Q000502:physiology; D007231:Infant, Newborn; D010865:Pilot Projects; D021041:Placental Circulation / Q000502:physiology; D011181:Postnatal Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D014470:Umbilical Cord; D055815:Young Adult