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Randomized Controlled Trial
. 2023 Dec 1;152(6):e2023063113.
doi: 10.1542/peds.2023-063113.

Umbilical Cord Milking Versus Delayed Cord Clamping in Infants 28 to 32 Weeks: A Randomized Trial

Anup Katheria  1 , Jeff Szychowski  2 , Waldemar A Carlo  2 , Akila Subramaniam  2 , Frank Reister  3 , Jochen Essers  3 , Farha Vora  4 , Courtney Martin  4 , Georg M Schmölzer  5 , Brenda Law  5 , Eugene Dempsey  6 , Keelin O'Donoghue  6 , Joseph Kaempf  7 , Mark Tomlinson  7 , Kevin Fulford  8 , Bergen Folsom  8 , Simon Karam  9 , Rachael Morris  9 , Toby Yanowitz  10 , Stacy Beck  10 , Erin Clark  11 , Tara DuPont  11 , Manoj Biniwale  12 , Rangasamy Ramanathan  12 , Shazia Bhat  13 , Matthew Hoffman  13 , Nitin Chouthai  14 , Fayez Bany-Mohammed  15 , Janardhan Mydam  16 , Vivek Narendran  17 , Fiona Wertheimer  12 , Yvonne Gollin  1 , Yvonne Vaucher  18 , Kathy Arnell  1 , Michael Varner  11 , Gary Cutter  2 , Nicole Wilson  2 , Wade Rich; RRT; Neil Finer  1
Affiliations
Randomized Controlled Trial

Umbilical Cord Milking Versus Delayed Cord Clamping in Infants 28 to 32 Weeks: A Randomized Trial

Anup Katheria et al. Pediatrics. .

Abstract

Objectives: To determine whether rate of severe intraventricular hemorrhage (IVH) or death among preterm infants receiving placental transfusion with UCM is noninferior to delayed cord clamping (DCC).

Methods: Noninferiority randomized controlled trial comparing UCM versus DCC in preterm infants born 28 to 32 weeks recruited between June 2017 through September 2022 from 19 university and private medical centers in 4 countries. The primary outcome was Grade III/IV IVH or death evaluated at a 1% noninferiority margin.

Results: Among 1019 infants (UCM n = 511 and DCC n = 508), all completed the trial from birth through initial hospitalization (mean gestational age 31 weeks, 44% female). For the primary outcome, 7 of 511 (1.4%) infants randomized to UCM developed severe IVH or died compared to 7 of 508 (1.4%) infants randomized to DCC (rate difference 0.01%, 95% confidence interval: (-1.4% to 1.4%), P = .99).

Conclusions: In this randomized controlled trial of UCM versus DCC among preterm infants born between 28 and 32 weeks' gestation, there was no difference in the rates of severe IVH or death. UCM may be a safe alternative to DCC in premature infants born at 28 to 32 weeks who require resuscitation.

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Conflict of interest statement

Dr Katheria reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. No other disclosures were reported.

Figures

Figure 1
Figure 1
CONSORT diagram: Screening, randomization and enrollment of study participants (including prior reported infants).
Figure 2.
Figure 2.
Forest plot of primary and secondary outcomes
See this image and copyright information in PMC

Comment in

References

    1. Perlman JM, Wyllie J, Kattwinkel J, Wyckoff MH, Aziz K, Guinsburg R, et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015;132(16 suppl 1):S204–S241. - PubMed
    1. WHO Guidelines Approved by the Guidelines Review Committee. Guidelines on Basic Newborn Resuscitation. Geneva: World Health Organization.; 2012.
    1. Katheria AC. Neonatal Resuscitation with an Intact Cord: Current and Ongoing Trials. Children (Basel, Switzerland). 2019;6(4). - PMC - PubMed
    1. Patel S, Clark EA, Rodriguez CE, Metz TD, Abbaszadeh M, Yoder BA. Effect of umbilical cord milking on morbidity and survival in extremely low gestational age neonates. American journal of obstetrics and gynecology. 2014;211(5):519 e511–517. - PubMed
    1. Schmid MB, Reister F, Mayer B, Hopfner RJ, Fuchs H, Hummler HD. Prospective risk factor monitoring reduces intracranial hemorrhage rates in preterm infants. Deutsches Arzteblatt international. 2013;110(29–30):489–496. - PMC - PubMed

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