Milking of the cut cord during stabilization of infants born very premature: a randomized controlled trial
Milking of the cut cord during stabilization of infants born very premature: a randomized controlled trial
Objective: to investigate the feasibility of cut-umbilical cord milking (C-UCM) during stabilization of preterm infants after birth.
Study design: this was a pilot randomized controlled trial of initial resuscitation. Infants born to eligible, consenting women presenting in preterm labor at <32 weeks' gestation were randomized to receive either the standard practice of delayed cord clamping (DCC) for 30-60 seconds at birth or C-UCM while supporting breathing and following 30 seconds of DCC. The primary outcome was feasibility in terms of percentage recruitment, intervention compliance, safety, and study completion. Short-term clinical outcomes were collected. Analysis was by intention to treat.
Results: of the 133 pregnant women approached, 93 consented to participate (70%). Fifty infants delivered <32 weeks' gestation were randomized to either C-UCM (25) or DCC (25). Baseline characteristics of infants were similar. All participants completed the study. One infant in the C-UCM group and 5 infants in the DCC group did not receive the allocated intervention. Median (IQR) time to cord milking was 62 (54, 99) seconds and median (IQR) length of the cut-cord milked was 20 (14, 29) cm. C-UCM was not associated with increased adverse effects compared with C-UCM .
Conclusion: milking of the long-cut cord after 30 seconds of DCC while supporting breathing was feasible and not associated with significant adverse effects. A larger randomized controlled trial is required to assess the efficacy and safety of this approach on clinical outcomes. C-UCM may be especially useful in situations when DCC is not feasible.
El-Naggar, Walid
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Mitra, Souvik
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Abeysekera, Jayani
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Disher, Tim
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Woolcott, Christy
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Hatfield, Tara
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McMillan, Douglas
ab870fba-0c0f-4cb4-9d3a-220fb39b02f2
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
23 December 2024
El-Naggar, Walid
c77c2888-8794-4cf4-8546-babee5668f74
Mitra, Souvik
66762ff9-575c-49b3-bdf7-5b6a746d0164
Abeysekera, Jayani
1b66d48f-c6ee-4bc7-8977-55b3abf68104
Disher, Tim
3096c107-d6ed-441c-9b60-7f9747f2ed74
Woolcott, Christy
0cbc0cce-5b6b-458c-ab66-33def3590475
Hatfield, Tara
400eb6ef-1778-49a7-9adc-d2ae35f5fb81
McMillan, Douglas
ab870fba-0c0f-4cb4-9d3a-220fb39b02f2
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
El-Naggar, Walid, Mitra, Souvik, Abeysekera, Jayani, Disher, Tim, Woolcott, Christy, Hatfield, Tara, McMillan, Douglas and Dorling, Jon
(2024)
Milking of the cut cord during stabilization of infants born very premature: a randomized controlled trial.
The Journal of Pediatrics, 278, [114444].
(doi:10.1016/j.jpeds.2024.114444).
Abstract
Objective: to investigate the feasibility of cut-umbilical cord milking (C-UCM) during stabilization of preterm infants after birth.
Study design: this was a pilot randomized controlled trial of initial resuscitation. Infants born to eligible, consenting women presenting in preterm labor at <32 weeks' gestation were randomized to receive either the standard practice of delayed cord clamping (DCC) for 30-60 seconds at birth or C-UCM while supporting breathing and following 30 seconds of DCC. The primary outcome was feasibility in terms of percentage recruitment, intervention compliance, safety, and study completion. Short-term clinical outcomes were collected. Analysis was by intention to treat.
Results: of the 133 pregnant women approached, 93 consented to participate (70%). Fifty infants delivered <32 weeks' gestation were randomized to either C-UCM (25) or DCC (25). Baseline characteristics of infants were similar. All participants completed the study. One infant in the C-UCM group and 5 infants in the DCC group did not receive the allocated intervention. Median (IQR) time to cord milking was 62 (54, 99) seconds and median (IQR) length of the cut-cord milked was 20 (14, 29) cm. C-UCM was not associated with increased adverse effects compared with C-UCM .
Conclusion: milking of the long-cut cord after 30 seconds of DCC while supporting breathing was feasible and not associated with significant adverse effects. A larger randomized controlled trial is required to assess the efficacy and safety of this approach on clinical outcomes. C-UCM may be especially useful in situations when DCC is not feasible.
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PIIS002234762400547X
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Accepted/In Press date: 18 December 2024
e-pub ahead of print date: 22 December 2024
Published date: 23 December 2024
Identifiers
Local EPrints ID: 497732
URI: http://eprints.soton.ac.uk/id/eprint/497732
ISSN: 0022-3476
PURE UUID: 163462a4-181f-43bd-82b6-0bc1bff7fb9e
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Date deposited: 30 Jan 2025 17:43
Last modified: 22 Aug 2025 02:41
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Contributors
Author:
Walid El-Naggar
Author:
Souvik Mitra
Author:
Jayani Abeysekera
Author:
Tim Disher
Author:
Christy Woolcott
Author:
Tara Hatfield
Author:
Douglas McMillan
Author:
Jon Dorling
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