Cardiac and cerebral hemodynamics with umbilical cord milking compared with early cord clamping: A randomized cluster crossover trial

Abstract

Objective: A large, randomized cluster cross-over trial (N = 1730) comparing intact umbilical cord milking (UCM) to early cord clamping (ECC) in non-vigorous near-term/term newborns demonstrated a reduction in cardiorespiratory interventions at birth and less moderate to severe hypoxic ischemic encephalopathy. We evaluated changes in cerebral tissue oxygenation (StO₂), pulse oximetry (SpO₂), pulse rate and fraction of inspired oxygen (FiO₂) during the first 10 min of life in a subset of infants enrolled in the parent trial.

Study design: Infants enrolled in the Milking in Non-Vigorous Infants trial that had StO₂ monitoring at birth were included in the sub-study conducted at 3 hospitals the US and Canada. A near-infrared spectroscopy sensor, pulse oximeter and electrocardiogram electrodes were placed. Pulse rate, StO₂, SpO₂, and FiO₂ were collected for the first 10 min after birth. Longitudinal models were used to compare effects of UCM and ECC.

Results: Thirty-four infants had StO₂ data. Fifteen of these infants received UCM and 19 had ECC. Infants receiving UCM had similar heart rates, SpO₂, and StO₂ values, but were exposed to less FiO₂ over the first 10 min of life than infants with ECC (0.26 ± 0.12 vs. 0.81 ± 0.05 at 10 min).

Conclusion: Non-vigorous term/near term infants who received UCM at birth required lower FiO₂ after delivery when compared to infants who umbilical cords were clamped soon after birth while achieving similar peripheral and cerebral oxygenation. Cord milking may be a potential option for placental transfusion in non-vigorous near term/term infants when delayed cord clamping cannot be performed.

Trial registration: ClinicalTrials.gov NCT03621956.

Keywords: Early cord clamping; Hypoxic ischemic encephalopathy; Oxygen, delayed cord clamping.