Research
Obstetrics
Effect of umbilical cord milking in term and near term infants: randomized control trial

Presented as a poster at the annual meeting of the Pediatric Academic Societies, Boston, MA, April 28 through May 1, 2012, and at the 18th State Conference of the National Neonatology Forum of India (Kerala Neocon), Kerala, India, Feb. 18-19, 2012.
https://doi.org/10.1016/j.ajog.2012.10.884Get rights and content

Objective

The objective of the study was to investigate the effect of umbilical cord milking as compared with early cord clamping on hematological parameters at 6 weeks of age among term and near term neonates.

Study Design

This was a randomized control trial. Eligible neonates (>35 weeks' gestation) were randomized in intervention and control groups (100 each). Neonates of both groups got early cord clamping (within 30 seconds). The cord of the experimental group was milked after cutting and clamping at 25 cm from the umbilicus, whereas in control group cord was clamped near (2-3 cm) the umbilicus and not milked. Both groups got similar routine care. Unpaired Student t and Fisher exact tests were used for statistical analysis.

Results

Baseline characteristics were comparable in the 2 groups. Mean hemoglobin (Hgb) (11.9 [1.5] g/dL and mean serum ferritin 355.9 [182.6] μg/L) were significantly higher in the intervention group as compared with the control group (10.8 [0.9] g/dL and 177.5 [135.8] μg/L), respectively, at 6 weeks of age. The mean Hgb and hematocrit at 12 hours and 48 hours was significantly higher in intervention group (P = .0001). The mean blood pressure at 30 minutes, 12 hours, and 48 hours after birth was significantly higher but within normal range. No significant difference was observed in the heart rate, respiratory rate, polycythemia, serum bilirubin, and need of phototherapy in the 2 groups.

Conclusion

Umbilical cord milking is a safe procedure and it improved Hgb and iron status at 6 weeks of life among term and near term neonates.

Section snippets

Materials and Methods

This study was designed as a single-center, randomized, controlled trial, conducted from April 2010 to September 2011 in the Departments of Pediatrics and Obstetrics at a teaching hospital in North India. Two investigators (A.U. and S.G.) approached expectant mothers and their spouses (parents), explained the study, and obtained the written consent before the birth of the baby.

We included all infants of more than 34 weeks 6 days of completed gestation, delivered either by low uterine segment

Patient characteristics

A total of 700 babies were delivered during the period. Five hundred babies were excluded for different reasons (Figure 1). Two hundred neonates fulfilled the inclusion criteria and were randomized to intervention and control group (100 in each group).

Trial compliance

The mean ferritin and mean Hgb at 6 weeks was higher in the intervention

Comment

Our study demonstrated that the milking of extra blood from about 25 cm of umbilical cord, 3 times into the baby, leads to higher Hgb and serum ferritin after 6 weeks of birth. We also demonstrated relatively higher blood pressure (although within normal range) over an initial period of 48 hours in milked group. Although this might not have been clinically significant in term healthy infants, a gain of 4 mm Hg may be important in hypotensive babies because of hypovolemia. When we analyzed the

Conclusions

Umbilical cord milking is a safe procedure and it improves Hgb and iron status at 6 weeks in term and near term infants, without causing significant increase in respiratory distress, polycythemia, and jaundice.

Acknowledgment

A special thanks to Mr Upendra Kumar Sharma, laboratory technician (LLRM Medical College, Meerut) for his cooperation with the hematological tests.

References (16)

  • National Family Health Survey III (2005-2006): Nutrition in India

  • T. Walter

    Impact of iron deficiency on cognition in infancy and childhood

    Eur J Clin Nutr

    (1993)
  • A.E. Colozzi

    Clamping of the umbilical cord: its effect on the placental transfusion

    N Engl J Med

    (1954)
  • S.J. McDonald et al.

    Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes

    Cochrane Database Syst Rev

    (2008)
  • J.L. Methew

    Timing of umbilical cord clamping in term and preterm deliveries and infant and maternal outcome: a systematic review of randomized controlled trials

    Ind Paediatr

    (2011)
  • S. Hosono et al.

    Effect of haemoglobin on transfusion and neonatal adaptation in extremely low birth weight infants

    Pediatr Int

    (2008)
  • S. Hosono et al.

    Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born less than 29 weeks' gestation: a randomized controlled trial

    Arch Dis Child Neonatal Fetal Educ

    (2008)
  • H. Rabe et al.

    Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial

    Obstet Gynecol

    (2011)
There are more references available in the full text version of this article.

Cited by (90)

  • Umbilical cord milking in nonvigorous infants: a cluster-randomized crossover trial

    2023, American Journal of Obstetrics and Gynecology
    Citation Excerpt :

    UCM has been shown to improve heart rate, blood pressure, urine output, cerebral oxygenation, hemoglobin levels, and prevent anemia in term or near-term infants.14–16 No harm from UCM has been noted in any study among term/near-term infants.12,14–23 Unlike DCC, UCM can achieve significant placental transfusion without significantly delaying resuscitation and be completed almost as quickly as ECC.24

  • Prevention of postpartum hemorrhage in vaginal deliveries

    2023, European Journal of Obstetrics and Gynecology and Reproductive Biology
  • A 20-cm cut umbilical cord milking may not benefit the preterm infants < 30 week's gestation: A randomized clinical trial

    2022, Journal of the Formosan Medical Association
    Citation Excerpt :

    In the present study, we found no significant difference in the rate of pRBC transfusion before the 21st day of life between the 20-cm C-UCM and ICC groups, as well as hemoglobin and hematocrit levels at admission and the need for administration of volume expander within 24 h of life. This finding was similar to the reports by Ümmühan et al., Simonin et al., and Hasan et al.,8–10 whereas three other studies reported the opposite.5–7 A possible reason for this discrepancy is that the length of the umbilical cord milked in the present study was shorter than that in previous studies, which was the purpose of this study.

  • Perinatal care for the extremely preterm infant

    2022, Seminars in Fetal and Neonatal Medicine
    Citation Excerpt :

    UCM consists of gentle stripping of the umbilical cord from the placental end toward the infant, usually in a time frame of 20–30 s and then clamping the cord [121,132]. While UCM is usually performed before clamping the umbilical cord (intact UCM), milking after clamping and cutting of the umbilical cord (cut UCM) has also been reported [133]. UCM has been considered as an alternative to DCC in such situations for term or late preterm infants when DCC could be difficult to implement in infants who require immediate resuscitation at birth [134,135].

View all citing articles on Scopus

The authors report no conflict of interest.

Cite this article as: Upadhyay A, Gothwal S, Parihar R, et al. Effect of umbilical cord milking in term and near term infants: randomized control trial. Am J Obstet Gynecol 2013;208:120.e1-6.

View full text