title: The effects of umbilical cord milking on hemodynamics and neonatal outcomes in premature neonates.
abstract: OBJECTIVE
  To determine whether umbilical cord milking (UCM) improves systemic blood flow and reduces neonatal morbidities compared with immediate cord clamping (ICC).
  
  
  METHODS
  Women admitted to a tertiary care center and delivering before 32 weeks' gestation were randomized to receive UCM or ICC. Three blinded serial echocardiograms were performed in the first 2 days of the infant's life. The primary outcome was measured systemic blood flow (superior vena cava flow) at each time point.
  
  
  RESULTS
  Of the 60 neonates who were enrolled and randomized, 30 were assigned to cord milking and 30 to ICC. Neonates randomized to cord milking had greater measures of superior vena cava flow and right ventricular output in the first 6 hours and 30 hours of life. Neonates receiving UCM also had greater serum hemoglobin, received fewer blood transfusions, fewer days on oxygen therapy, and less frequent use of oxygen at 36 weeks' corrected postmenstrual age.
  
  
  CONCLUSIONS
  We demonstrate greater systemic blood flow with UCM in preterm neonates compared with ICC. Future large prospective trials are needed to determine whether UCM reduces intraventricular hemorrhage and other long-term morbidities.
authors.affiliation: Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA. Electronic address: anup.katheria@sharp.com.
authors.forename: Anup C
authors.initials: AC
authors.lastname: Katheria
authors.affiliation: Division of Neonatology, Department of Pediatrics, Colombia University, New York, NY.
authors.forename: Tina A
authors.initials: TA
authors.lastname: Leone
authors.affiliation: Division of Perinatology, Department of Obstetrics, University of California San Diego, San Diego, CA.
authors.forename: Doug
authors.initials: D
authors.lastname: Woelkers
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Garey
authors.affiliation: Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA.
authors.forename: Wade
authors.initials: W
authors.lastname: Rich
authors.affiliation: Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA; Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA.
authors.forename: Neil N
authors.initials: NN
authors.lastname: Finer
mesh_terms: D001783:Blood Flow Velocity; D002302:Cardiac Output; D003250:Constriction; D004452:Echocardiography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D018743:Perinatal Care / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method; D018617:Ultrasonography, Doppler, Pulsed; D014470:Umbilical Cord; D014683:Vena Cava, Superior / Q000502:physiology*