Premature Infants Umbilical Cord Milking or Delayed Cord Clamping (PREMOD)

This study was published in Pediatrics.  

ABSTRACT:

Title: Umbilical Cord Milking improves systemic blood flow at cesarean section in premature infants

Background: Despite current recommendations for delayed cord clamping (DCC) for preterms, the majority of whom are born by cesarean section (C/S), studies comparing mode of delivery & DCC suggest that infants born by C/S may receive less placental transfusion compared to vaginal delivery (VD). An alternative to DCC is umbilical cord milking (UCM).

Objective: Test the hypothesis that infants 32 weeks born by C/S who receive UCM will have higher measures of systemic blood flow (SVC flow, RVO) & placental transfusion compared to DCC infants.

Design/Methods: This was a 2 center trial (SMBWN & LLU). Infants at C/S were randomly assigned to receive UCM or DCC. VD were also randomized separately. UCM (4 strippings) or DCC (45 seconds) were performed as previously described. Continuously measured variables (NIRS, eletrical cardiometry, BP) and fECHO were performed at site 1.

Results: 197 infants were enrolled (152 infants by C/S). Results for the C/S group are shown (bold values significant).

Conclusions: To our knowledge this is the first trial to demonstrate increased hemoglobin & improved organ perfusion with UCM compared to DCC for preterm infants delivered by C/S. UCM is an evidence based intervention for preterm infants at C/S.