title: Effect of umbilical cord milking on morbidity and survival in extremely low gestational age neonates.
abstract: OBJECTIVE
  Delayed umbilical cord clamping benefits extremely low gestational age neonates (ELGANs) but has not gained wide acceptance. We hypothesized that milking the umbilical cord (MUC) would avoid resuscitation delay but improve hemodynamic stability and reduce rates for composite outcome of severe intraventricular hemorrhage, necrotizing enterocolitis, and/or death before discharge.
  
  
  METHODS
  We implemented a joint neonatal/maternal-fetal quality improvement process for MUC starting September 2011. The MUC protocol specified that infants who were born at <30 weeks of gestation undergo MUC 3 times over a duration of <30 seconds at delivery. Obstetric and neonatal data were collected until discharge. We compared the MUC group to retrospective ELGAN cohort delivered at our center between January 2010 and August 2011. Analysis was intention-to-treat.
  
  
  RESULTS
  We identified 318 ELGANs: 158 eligible for MUC and 160 retrospective control neonates. No adverse events were reported with cord milking. There was no difference in neonatal resuscitation, Apgar scores, or admission temperature. Hemodynamic stability was improved in the MUC group with higher mean blood pressures through 24 hours of age, despite less vasopressor use (18% vs 32%; P < .01). The initial hematocrit value was higher (50% vs 45%; P < .01), and red cell transfusions were fewer (57% vs 79%; P < .01) in MUC vs control infants. Presence of the composite outcome was significantly less in MUC vs the historic control infants (22% v 39%; odds ratio, 1.81; 95% confidence interval, 1.06-3.10). There were also reductions in intraventricular hemorrhage, necrotizing enterocolitis, and death before hospital discharge.
  
  
  CONCLUSIONS
  MUC improves early hemodynamic stability and is associated with lower rates of serious morbidity and death among ELGANs.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: Shrena.Patel@hsc.utah.edu.
authors.forename: Shrena
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Erin A S
authors.initials: EA
authors.lastname: Clark
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Rodriguez
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Torri D
authors.initials: TD
authors.lastname: Metz
authors.affiliation: Department of Nursing, University of Utah Health Sciences Center, Salt Lake City, UT.
authors.forename: Minda
authors.initials: M
authors.lastname: Abbaszadeh
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D000328:Adult; D001034:Apgar Score; D001794:Blood Pressure; D001831:Body Temperature; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002821:Chorioamnionitis / Q000453:epidemiology; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006400:Hematocrit; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D014470:Umbilical Cord; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents
keywords: delayed cord clamping; extremely low gestational age neonates (ELGANs); intraventricular hemorrhage; mortality rate; necrotizing enterocolitis; umbilical cord milking