Effects of Umbilical Cord Milking on Term Infants Delivered by Cesarean Section

Abstract

Objective Umbilical cord milking (UCM) is an efficient way to achieve optimal placental transfusion in term infants born by cesarean section (CS). However, it is not frequently performed due to concern for short-term adverse effects of increased blood volume, such as polycythemia and hyperbilirubinemia. The aim of this study is to evaluate the short-term effects of UCM on term infants delivered by CS. Study Design We conducted a pre- and postimplementation cohort study comparing term infants delivered by CS who received UCM five times (141 infants, UCM group) during a 6-month period (August 1, 2017 to January 31, 2018) to those who received immediate cord clamping (ICC) during the same time period (105 infants, postimplementation ICC) and during a 3-month period (October1, 2016 to December 31, 2016) prior to the implementation of UCM (141 infants, preimplementation ICC). Results Mothers were older in UCM group compared with both ICC groups. There were no significant differences in other maternal or neonatal characteristics. Although this study was not powered to detect differences in outcomes, the occurrence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admissions, or readmissions for phototherapy was similar between the groups. Conclusion UCM intervention was not associated with increased incidence of phototherapy or symptomatic polycythemia in term infants delivered by CS.

Effects of Placental Transfusion on Late Preterm Infants Admitted to a Mother–Baby Unit

“…10 Our previous study established the feasibility and safety of UCM in term infants delivered by cesarean section. 20 In a previously published randomized controlled trial, term infants who received DCC/UCM demonstrated lower residual placental volume and higher hemoglobin levels at 24 to 48 hours of life without an increase in hyperbilirubinemia or symptomatic polycythemia. 2 At 4 months of age, these infants had higher ferritin levels and increased brain myelin in the internal capsule and other early maturing brain regions associated with motor, visual, and sensory processing/function.…”

“…10 Our previous study established the feasibility and safety of UCM in term infants delivered by cesarean section. 20…”

“…For the purpose of this study, a convenience sample of 100 late preterm infants born between 35 0/7 and 36 6/7 weeks of gestation in each group was deemed appropriate on the basis of our previous study. 20 This sample size was feasible with a 2-year study period for each arm. Continuous data were presented as mean and standard deviation if parametrically distributed or median and range if nonparametric and categorical variables as counts (percent).…”

Umbilical Cord Milking in Newborns: Scoping Review

“…The cord was then released at the placental end and allowed to refill with blood for a brief 1 to 3 seconds pause between each milking motion (12, 14, 18-24, 27, 29-36, 39-41, 42, 43, 45-49, 53, 58, 66, 69, 74, 76-78) . In general, the entire procedure was completed in not more than 30 s. After this, the umbilical cord was clamped and cut at 2-3 cm from the umbilicus and the infant taken to the warmer for routine newborn care (20,23,26,35,43,48,50,61,69,74,77) .…”

Umbilical cord milking-benefits and risks

“…Several randomized controlled trials have demonstrated preterm infants delivered by C-section undergoing UCM vs. DCC had better systemic blood flow, blood pressure, hemoglobin levels, and urine output in the first 72 h of life ( 33 – 35 ). UCM has been found to be feasible in term infants born by C-section and did not result in higher incidence of phototherapy, symptomatic polycythemia, NICU hospitalizations, or readmissions for phototherapy ( 36 ). UCM may be a good alternative in elective C-section to optimize placental transfusion ( 37 ).…”