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Randomised controlled trial
Cord milking at delivery improves the iron status of term infants at 6 weeks
  1. William Oh
  1. Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
  1. Correspondence to Dr William Oh
    Department of Pediatrics, Women and Infants Hospital, 101 Dudley street, Providence, RI 02905, USA; woh{at}

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Placental transfusion achieved by delayed cord clamping or cord milking has generated considerable interest in recent years. Hutton et al1 have shown that delayed-cord clamping in term infants increased iron storage and reduced the incidence of iron deficiency anaemia. With the exception of a higher incidence of polycythaemia, no significant adverse effects were observed. The findings suggest that delayed-cord clamping may serve as an effective no-cost intervention to reduce the incidence of iron deficiency state in infancy particularly in areas with high prevalence of iron deficiency state.2 It has also been proposed that increased iron storage may enhance the neurodevelopmental status of children because iron is an essential element of growth and development.3

The aim of the current study was to gather evidence for improved iron storage following cord milking in term infants at 6 weeks of age.


This was a randomised controlled trial enrolling 100 term, or near term, infants in the cord milking group, and 100 infants as the controls. Cord milking was carried out as described by Hosono et al.4 Primary endpoints were haemoglobin and serum ferritin levels at 6 weeks of age.


Haemoglobin and serum ferritin levels were significantly higher in the cord milking group when compared with control: 11.9±1.5 (g/dl with SD) vs 10.8±0.9 and 355.9±182.6 vs 177.5±135.8 µg/l, respectively, at 6 weeks.


The study was relatively well designed with an appropriate power calculation and a high follow-up rate (87%). However, its finding is not new, as shown by Hutton's meta-analysis.1 This research does show that cord milking achieved a similar haematological and iron storage status as in delayed-cord clamping, and can be used as an alternative strategy to achieve placental transfusion in term infants.

In preterm infants, placental transfusion by delayed cord clamping or cord milking results in improved blood pressure during the first day, lower incidence of late onset sepsis and necrotising enterocolitis and reduced needs for blood transfusion during the neonatal period.5 These studies also showed no significant increase in the incidence of untoward side effects such as hypothermia, hypoglycaemia, polycythaemia and hyperbilirubinaemia. However, none of the studies addressed these side effects as primary outcomes, raising the issue of inadequate power to establish the safety of the intervention. There is also suggestive evidence that higher iron supply in preterm infants is associated with improved neurodevelopmental outcome.6 Nonetheless, the association is based on analysis of neurodevelopmental outcome as secondary variable.

The American College of Obstetricians and Gynecology (ACOG) recently published a committee statement7 recommending that cord clamping be delayed up to 60 s in preterm infants. The statement stopped short of recommending such intervention in term infants for the lack of solid evidence for the benefits.

The work by Upadhyay et al may add further credence to the ACOG's recommendation that placental transfusion as a no-cost intervention may be beneficial for term infants.


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  • Competing interests None.

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