title: Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants.
abstract: OBJECTIVE
  Delayed cord clamping (DCC) is recommended for premature infants to improve blood volume. Most preterm infants are born by cesarean delivery (CD), and placental transfusion may be less effective than in vaginal delivery (VD). We sought to determine whether infants <32 weeks born by CD who undergo umbilical cord milking (UCM) have higher measures of systemic blood flow than infants who undergo DCC.
  
  
  METHODS
  This was a 2-center trial. Infants delivered by CD were randomly assigned to undergo UCM or DCC. Infants delivered by VD were also randomly assigned separately. UCM (4 strippings) or DCC (45-60 seconds) were performed. Continuous hemodynamic measurements and echocardiography were done at site 1.
  
  
  RESULTS
  A total of 197 infants were enrolled (mean gestational age 28 ± 2 weeks). Of the 154 infants delivered by CD, 75 were assigned to UCM and 79 to DCC. Of the infants delivered by CD, neonates randomly assigned to UCM had higher superior vena cava flow and right ventricular output in the first 12 hours of life. Neonates undergoing UCM also had higher hemoglobin, delivery room temperature, blood pressure over the first 15 hours, and urine output in the first 24 hours of life. There were no differences for the 43 infants delivered by VD.
  
  
  CONCLUSIONS
  This is the first randomized controlled trial demonstrating higher systemic blood flow with UCM in preterm neonates compared with DCC. UCM may be a more efficient technique to improve blood volume in premature infants delivered by CD.
authors.affiliation: Neonatal Research Institute and anup.katheria@sharp.com.
authors.forename: Anup C
authors.initials: AC
authors.lastname: Katheria
authors.affiliation: Departments of Pediatrics, and.
authors.forename: Giang
authors.initials: G
authors.lastname: Truong
authors.affiliation: San Diego Perinatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California;
authors.forename: Larry
authors.initials: L
authors.lastname: Cousins
authors.affiliation: Obstetrics, Loma Linda Medical University, Loma Linda, California.
authors.forename: Bryan
authors.initials: B
authors.lastname: Oshiro
authors.affiliation: Neonatal Research Institute and.
authors.forename: Neil N
authors.initials: NN
authors.lastname: Finer
mesh_terms: D002585:Cesarean Section; D003250:Constriction; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010920:Placenta / Q000502:physiology*; D011247:Pregnancy; D014470:Umbilical Cord / Q000601:surgery*