Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 8;18(1):155.
doi: 10.1186/s12887-018-1131-x.

Impact of umbilical cord milking and pasteurized donor human milk on necrotizing enterocolitis: a retrospective review

Mehtab K Sekhon  1 , Bradley A Yoder  2
Affiliations

Impact of umbilical cord milking and pasteurized donor human milk on necrotizing enterocolitis: a retrospective review

Mehtab K Sekhon et al. BMC Pediatr. .

Abstract

Background: Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Our objective was to evaluate the impact of an umbilical cord milking protocol (UCM) and pasteurized donor human milk (PDHM) on NEC rates in infants less than 30 weeks gestational age from January 1, 2010 to September 30, 2016. We hypothesized an incremental decrease in NEC after each intervention.

Methods: We performed a retrospective review of 638 infants born less than 30 weeks gestational age. Infants were grouped into three epochs: pre-UCM/pre-PDHM (Epoch 1, n = 159), post-UCM/pre-PDHM (Epoch 2, n = 133), and post-UCM/post-PDHM (Epoch 3, n = 252). The incidence of NEC, surgical NEC, and NEC/death were compared. Logistic regression was used to determine independent significance of time epoch, gestational age, birth weight, and patent ductus arteriosus for NEC, surgical NEC, and death/NEC.

Results: At birth, infants in Epoch 1 were younger than Epoch 2 and 3 (26.8 weeks versus 27.3 and 27.2, respectively, P = 0.036) and smaller (910 g versus 1012 and 983, respectively, P = 0.012). Across epochs, there was a significant correlation between patent ductus arteriosus treatment and NEC rate (P < 0.001, Cochran-Mantel-Haenszel). There was a significant decrease in rates of NEC, surgical NEC, and NEC/death between groups. Logistic regression showed this as significant for rates of NEC and surgical NEC between Epoch 1 and 3. Patent ductus arteriosus was a significant variable affecting the incidence of NEC, but not surgical NEC or death/NEC.

Conclusions: An umbilical cord milking protocol and pasteurized donor human milk availability was associated with decreased rates of NEC and surgical NEC. This suggests an additive effect of these interventions in preventing NEC.

Keywords: Necrotizing enterocolitis; Pasteurized donor human milk; Umbilical cord milking.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Institutional review board approval from the University of Utah was obtained for this study. This committee approved a waiver of consent for this study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient flowchart depicting inclusions and exclusions in each epoch
Fig. 2
Fig. 2
Sequential changes in breast milk (BM) use across time epochs are shown. Any BM use, BM at first feed and BM at discharge (D/C) gradually increased over time. There was a dramatic increase in the use of pasteurized donor human milk (PDHM) in lieu of formula in Epoch 3. Raw data was not available to allow statistical comparisons
Fig. 3
Fig. 3
a. Sequential change in rate of NEC (p = 0.002) and surgical NEC (p = 0.002), between Epochs 1, 2, and 3. b. Changes in all cause death (p = 0.003), death due to NEC (p = 0.070), and combined outcome of death/NEC (p < 0.001). NEC – necrotizing enterocolitis; Epoch 1 – pre-umbilical cord milking and pre-donor human milk; Epoch 2 – post-umbilical cord milking and post-donor human milk; Epoch 3 – post-umbilical cord milking and pre-donor human milk
See this image and copyright information in PMC

References

    1. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364:255–264. doi: 10.1056/NEJMra1005408. - DOI - PMC - PubMed
    1. Schanler RJ, Lau C, Hurst NM, Smith EO. Randomized trial of donor human milk versus preterm formula as substitutes for mothers own milk in the feeding of extremely premature infants. Pediatrics. 2005;116(2):400–406. doi: 10.1542/peds.2004-1974. - DOI - PubMed
    1. Chowning R, Radmacher P, Lewis S, Serke L, Pettit N, Adamkin DH. A retrospective analysis of the effect of human milk on prevention of necrotizing enterocolitis and postnatal growth. J Perinatol. 2016;36:221–224. doi: 10.1038/jp.2015.179. - DOI - PubMed
    1. O’Connor DL, Gibbins S, Kiss A, Bando N, Brennan-Donnan J, Ng E, Campbell DM, Vaz S, Fusch C, Asztalos E, Church P, Kelly E, Ly L, Daneman A, Unger S. Effect of supplemental donor human milk compared with preterm formula on neurodevelopment of very low-birth-weight infants at 18 months: a randomized clinical trial. JAMA. 2016;316(18):1897–1905. doi: 10.1001/jama.2016.16144. - DOI - PubMed
    1. Cristofalo EA, Schanler RJ, Blanco CL, Sullivan S, Trawoeger R, Kiechl-Kohlendorfer U, Dudell G, Rechtman DJ, Lee ML, Lucas A, Abrams S. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr. 2013;163:1592–1595. doi: 10.1016/j.jpeds.2013.07.011. - DOI - PubMed