Effects of umbilical cord milking versus delayed cord clamping on systemic blood flow in intrauterine growth-restricted neonates: A randomized controlled trial

Chaitra Angadi; Poonam Singh; Yash Shrivastava; Mayank Priyadarshi; Suman Chaurasia; Jaya Chaturvedi; Sriparna Basu

doi:10.1007/s00431-023-05105-x

Effects of umbilical cord milking versus delayed cord clamping on systemic blood flow in intrauterine growth-restricted neonates: A randomized controlled trial

Eur J Pediatr. 2023 Sep;182(9):4185-4194. doi: 10.1007/s00431-023-05105-x. Epub 2023 Jul 13.

Authors

Chaitra Angadi¹, Poonam Singh², Yash Shrivastava³, Mayank Priyadarshi¹, Suman Chaurasia¹, Jaya Chaturvedi⁴, Sriparna Basu¹

Affiliations

¹ Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
² Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India. drpoonamujn@gmail.com.
³ Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
⁴ Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

PMID: 37439849
DOI: 10.1007/s00431-023-05105-x

Abstract

Recommendations for umbilical cord management in intrauterine growth-restricted (IUGR) neonates are lacking. The present randomized controlled trial compared hemodynamic effects of umbilical cord milking (UCM) with delayed cord clamping (DCC) in IUGR neonates > 28 weeks of gestation, not requiring resuscitation. One hundred seventy IUGR neonates were randomly allocated to intact UCM (4 times squeezing of 20 cm intact cord; n = 85) or DCC (cord clamping after 60 s; n = 85) immediately after delivery. The primary outcome variable was superior vena cava (SVC) blood flow at 24 ± 2 h. Secondary outcomes assessed were anterior cerebral artery (ACA) and superior mesenteric artery (SMA) blood flow indices, right ventricular output (RVO), regional cerebral oxygen saturation (CrSO₂) and venous hematocrit at 24 ± 2 h, peak total serum bilirubin (TSB), incidences of in-hospital complications, need and duration of respiratory support, and hospital stay. SVC flow was significantly higher in UCM compared to DCC (111.95 ± 33.54 and 99.49 ± 31.96 mL/kg/min, in UCM and DCC groups, respectively; p < 0.05). RVO and ACA/SMA blood flow indices were comparable whereas CrSO₂ was significantly higher in UCM group. Incidences of polycythemia and jaundice requiring phototherapy were similar despite significantly higher venous hematocrit and peak TSB in UCM group. The need for non-invasive respiratory support was significantly higher in UCM group though the need and duration of mechanical ventilation and other outcomes were comparable.

Conclusions: UCM significantly increases SVC flow, venous hematocrit, and CrSO₂ compared to DCC in IUGR neonates without any difference in other hemodynamic parameters and incidences of polycythemia and jaundice requiring phototherapy; however, the need for non-invasive respiratory support was higher with UCM.

Trial registration: Clinical trial registry of India (CTRI/2021/03/031864).

What is known: • Umbilical cord milking (UCM) increases superior vena cava blood flow (SVC flow) and hematocrit without increasing the risk of symptomatic polycythemia and jaundice requiring phototherapy in preterm neonates compared to delayed cord clamping (DCC). • An association between UCM and intraventricular hemorrhage in preterm neonates < 28 weeks of gestation is still being investigated.

What is new: • Placental transfusion by UCM compared to DCC increases SVC flow, regional cerebral oxygenation, and hematocrit without increasing the incidence of symptomatic polycythemia and jaundice requiring phototherapy in intrauterine growth-restricted neonates. • UCM also increases the need for non-invasive respiratory support compared to DCC.

Keywords: Cerebral blood flow; Delayed cord clamping; Intrauterine growth restriction; Neonate; Superior vena cava blood flow; Umbilical cord milking.