Umbilical Cord Milking vs Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants

Authors

Neha Kumbhat, University of California, San Diego and Rady Children’s Hospital, La Jolla, CA
Barry Eggleston, RTI International, Research Triangle Park, NC
Alexis S. Davis, Stanford University, Stanford, CA
Sara B. DeMauro, Children’s Hospital of Philadelphia, Philadelphia, PA
Krisa P. Van Meurs, Stanford University, Stanford, CA
Elizabeth E. Foglia, Children’s Hospital of Philadelphia, Philadelphia, PA
Satyan Lakshminrusimha, University of California, Davis, Sacramento, CA
Michele C. Walsh, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH
Kristi L. Watterberg, University of New Mexico Health Sciences Center, Albuquerque, NM
Myra H. Wyckoff, University of Texas, Southwestern Medical Center, Dallas, TX
Abhik Das, RTI International, Rockville, MD
Sara C. Handley, Children’s Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
Generic Database Subcommittee of the NICHD Neonatal Research Network

Document Type

Article

Publication Date

5-1-2021

Abstract

OBJECTIVE: To compare in-hospital outcomes after umbilical cord milking vs delayed cord clamping among infantsgestation.

STUDY DESIGN: Multicenter retrospective study of infants born(grade III or IV) intraventricular hemorrhage (IVH) by 36 weeks of postmenstrual age (PMA). Secondary outcomes assessed at 36 weeks of PMA were mortality, severe IVH, any IVH or mortality, and a composite of mortality or major morbidity. Outcomes were assessed using multivariable regression, incorporating mortality risk factors identified a priori, confounders, and center. A prespecified, exploratory analysis evaluated severe IVH in 2 gestational age strata, 22-24

RESULTS: Among 1834 infants, 23.6% were exposed to umbilical cord milking and 76.4% to delayed cord clamping. The primary outcome, mortality or severe IVH, occurred in 21.1% of infants: 28.3% exposed to umbilical cord milking and 19.1% exposed to delayed cord clamping, with an aOR that was similar between groups (aOR 1.45, 95% CI 0.93, 2.26). Infants exposed to umbilical cord milking had higher odds of severe IVH (19.8% umbilical cord milking vs 11.8% delayed cord clamping, aOR 1.70 95% CI 1.20, 2.43), as did the 25-28

CONCLUSIONS: This analysis of extremely preterm infants suggests that delayed cord clamping is the preferred practice for placental transfusion, as umbilical cord milking exposure was associated with an increase in the adverse outcome of severe IVH.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT00063063.

Publisher

Mosby

Publication Title

The Journal of pediatrics

ISSN

1097-6833

Volume

232

First Page

87

Last Page

94

DOI

10.1016/j.jpeds.2020.12.072

Recommended Citation

Kumbhat N, Eggleston B, Davis AS, DeMauro SB, Van Meurs KP, Foglia EE, Lakshminrusimha S, Walsh MC, Watterberg KL, Wyckoff MH, Das A, Handley SC; Generic Database Subcommittee of the National Institute of Child Health and Human Development Neonatal Research Network. Umbilical Cord Milking vs Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants. J Pediatr. 2021 May;232:87-94.e4. doi: 10.1016/j.jpeds.2020.12.072. Epub 2021 Jan 5. PMID: 33417919; PMCID: PMC8084979.