title: Neurodevelopmental Outcomes at 2 and 3.5 Years for Very Preterm Babies Enrolled in a Randomized Trial of Milking the Umbilical Cord versus Delayed Cord Clamping.
abstract: BACKGROUND
  Guidelines published by the International Liaison Committee for Resuscitation and by the World Health Organization recommend delaying cord clamping at birth as part of routine care for infants.
  
  
  OBJECTIVE
  To study the use of milking of the cord 4 times as an alternative to enhance the redistribution of placental blood into the baby.
  
  
  METHODS
  This is a prospective cohort study of neurodevelopmental assessment by the Bayley III method of very preterm infants who had participated in a trial of delayed cord clamping versus cord milking at birth that was conducted in a neonatal tertiary care hospital. The primary outcomes were differences in cognitive, motor and language development at 2 and 3.5 years. Two-tailed analyses were performed with the x03C7;2 test, Fisher's exact test, t test, Mann-Whitney U test and ANCOVA.
  
  
  RESULTS
  Out of the 58 infants enrolled in the original study, 39 infants (67%) were assessed at 2 years and 29 (50%) at 3.5 years of age. Neurodevelopmental outcomes at 2 and 3.5 years did not significantly differ between the two groups for the three Bayley III composite scores. At 3.5 years there was a trend towards higher scores for girls in the language composite scores (girls: mean = 121.6, SD = 15.22; boys: mean = 101.07, SD = 19.84) and on the motor scale (girls: mean = 124.60, SD = 18.15; boys: mean = 97.86, SD = 17.23).
  
  
  CONCLUSIONS
  In this small number of participants followed up at 2 and 3.5 years of age, milking of the cord 4 times did not have any long-term adverse effect on neurodevelopmental outcome, suggesting that cord milking could be used as an alternative to delayed cord clamping.
authors.affiliation: Academic Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Heike
authors.initials: H
authors.lastname: Rabe
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sawyer
authors.forename: Philip
authors.initials: P
authors.lastname: Amess
authors.forename: Susan
authors.initials: S
authors.lastname: Ayers
mesh_terms: D002657:Child Development; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000517:prevention & control; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D007805:Language Development Disorders / Q000175:diagnosis / Q000517:prevention & control; D008297:Male; D065886:Neurodevelopmental Disorders / Q000175:diagnosis / Q000517:prevention & control*; D009483:Neuropsychological Tests; D063868:Patient Outcome Assessment; D014470:Umbilical Cord; D014944:World Health Organization