Umbilical Cord Milking in Late Preterm Neonates and its Effects on Haematological and Haemodynamical Parameters- A Randomised Controlled Study

Abstract

Introduction: Delayed Cord Clamping (DCC) is a procedure, in which the cord is clamped after a short delay (30 s to 180 s) after birth. This improves iron status, reduce chances of anaemia and need for blood transfusion. However, DCC method compromised the success of resuscitation and induced various consequences, especially in neonates in need of emergency resuscitation. Umbilical Cord Milking (UCM), which is likewise a procedure of transporting additional blood from the umbilical cord to the newborn by milking or stripping the umbilical cord toward the baby, is an alternative to this approach. This study was conducted due to a lack of data on the use of umbilical cord milking in late preterm newborns. Aim: To study the effect of UCM on haematological and haemodynamical parameters in late preterm neonates. Materials and Methods: This single centre randomised controlled study was conducted, from November 2017 to August 2019 in the Department of Paediatrics, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. Total 200 late preterm neonates fulfilling the inclusion criteria were randomised into cases (UCM group) and controls (Immediate cord clamping group). In UCM group, just after delivery, umbilical cord was milked towards the baby. In ICC group, cord was clamped and cut immediately. Primary outcomes included Haemoglobin (Hb), Haematocrit (Hct) and haemodynamic parameters (heart rate, respiratory rate and mean blood pressure), were noted at 48 hours of age. Clinical parameters (respiratory distress, need for oxygen, polycythemia and jaundice requiring phototherapy) were also noted. Student’s t-test, Chi-square/fisher-exact test were used to find out the significance of study parameters. Results: There was a significant higher Hb in UCM group (19.27±2.64 gm/dL) than Immediate Cord Clamping (ICC) group (16.32±2.09 gm/dL) with p-value=0.012 and higher Hct in UCM group (55.41±5.07%) than the ICC group (48.99±5.57%) with a p-value <0.001. Hence, there was higher placental transfusion in UCM group as shown by higher Hb and Hct in UCM group. There was also higher systolic, diastolic and mean blood pressure in the UCM group as compared to ICC group. Difference for mean arterial blood pressure was about 3 mmHg and was statistically significant (p-value <0.001). Hence, UCM leads to a higher mean arterial pressure at 48 hours of life. Conclusion: Umbilical cord milking provides a greater placental transfusion, as demonstrated by higher Hb, higher Hct, higher blood pressure, and lesser requirement for inotropes and blood transfusions.

Keywords

• iron deficiency anaemia
• neonatal complications
• placental transfusion