Wednesday 7 September 2022
An NIH-funded study suggests the technique may be more effective than standard treatment.
Treatment to move blood from the umbilical cord into a newborn’s body can improve the overall health of infants classified as non-vigorous: limp, pale, and with minimal breathing, suggests a study funded by the National Institutes of Health. The procedure, known as umbilical cord milking, involves gently squeezing the cord between the thumb and forefinger and slowly pushing the blood into the abdomen. Compared to non-vigorous infants receiving standard treatment of immediate umbilical cord clamping, infants undergoing umbilical cord milking were less likely to need cardiac and respiratory support, less likely to have low oxygen in the brain, and more likely to have higher levels of hemoglobin, a substance that indicates the presence of red blood cells.
The study was led by Anup C. Katheria, MD, of the Sharp Mary Birch Hospital for Women and Newborns in San Diego and colleagues from institutions in the United States, Canada and Poland. It appears in the American Journal of Obstetrics and Gynecology.
“The study results provide evidence that umbilical cord milking for non-vigorous full-term and short-term infants may be a safe and effective alternative to immediate umbilical cord clamping,” said Michele Walsh, MD, of the NIH’s. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study.
Standard practice for non-vigorous babies is to immediately lock and cut the umbilical cord so that the baby can be resuscitated quickly. Many researchers are concerned, however, that this may deprive them of the necessary blood and worsen their outcome. Non-vigorous babies are at risk for complications such as low oxygen levels in the brain, cerebral palsy, and stroke. In the present study, the authors sought to determine whether umbilical cord milking for non-vigorous infants could provide similar benefits to delayed umbilical cord locking in less time.
The current recommendation for vigorous full-term infants is to delay clamping and cutting of the umbilical cord for at least 30-60 seconds after birth. This allows the umbilical cord blood to enter the baby’s circulation. Compared to infants undergoing immediate umbilical cord clamping, term infants undergoing delayed clamping have higher hemoglobin and iron levels. Preterm infants undergoing delayed umbilical cord clamping need less blood transfusions, are less likely to have hemorrhage within the brain, and are less likely to have necrotizing enterocolitis, a life-threatening deterioration of the intestine.
Non-vigorous infants in the study were randomly assigned to undergo umbilical cord milking or immediate clamping. For the cable milking, the suppliers present milked 20 centimeters of cable for two seconds, then repeated this procedure three times. Of more than 16,000 babies born after 35-42 weeks of pregnancy and screened in 10 institutions, 1,730 were included in the analysis.
For the primary outcome of the study – admission to a neonatal intensive care unit – the researchers found no significant differences between the two groups. However, the researchers found several significant differences between the two groups for the study’s secondary outcomes. On average, the umbilical cord milking group had a higher hemoglobin level than the immediate milking group. Of the milking group, 61% required cardiac and respiratory support, compared with 71% of the milking group. Moderate to severe hypoxic ischemic encephalopathy – low blood oxygen levels in the brain – occurred in 1.5% of the milking group, compared with 3% of the blocking group.
About Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD): NICHD leads research and training to understand human development, improve reproductive health, improve the lives of children and adolescents, and optimize everyone’s skills. For more information, visit https://www.nichd.nih.gov.
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Catherine A, et al. Umbilical cord milking in non-vigorous infants: a cluster randomized crossover study. American Journal of Obstetrics and Gynecology.