Umbilical Cord Milking Reduces Duration of Inotrope Support in Preterm Infants Less than 32 Weeks of Gestation, Born with Cesarean Section in Comparison to Delayed Cord Clamping

Objective: Very preterm infants commonly need inotrope support. We aimed to demonstrate that umbilical cord milking (UCM)would reduce the need for inotropes in preterm infants born with cesarean section in comparison to delayed cord clamping (DCC).Study Design: We compared the need of inotrope support, in a pilot randomized controlled trial, among preterm infants<32 weeks’ gestation receiving UCM (n = 25) in comparison to those who underwent DCC (n = 24).Results: Baseline maternal and newborn characteristics were similar. There was a significant reduction in the total duration ofinotrope support (P = 0.004) and total duration of respiratory support (P = 0.021) in babies undergoing UCM when comparedto those undergoing DCC. Trend toward reduction in incidence of hemodynamically significant patent ductus arteriosus andintraventricular hemorrhage was noted in UCM group.Conclusion: UCM significantly improved respiratory and hemodynamic stability in preterm infants <32 weeks’ gestation withoutassociated complications.

Very Early (<2 h) Versus Early (12 h) Administration of Caffeine Citrate for Reducing Need for Mechanical Ventilation within 24 h of Life in Preterm Infants on Continuous Positive Airway Pressure

Background and Objective: In the caffeine for apnea of prematurity (CAP) trial, post hoc analyses have discovered reductionsin respiratory and neurologic morbidities associated with earlier caffeine initiation (within 3 days). This study aims to compare theeffects of early (<2 h) and late (12 h) initiation of caffeine in preterm neonates on continuous positive airway pressure (CPAP).Study Design: A total of 36 neonates <32 weeks gestational age were randomized to receive intravenous caffeine citrate(20 mg/kg) before 2 h (early n = 19) or at 12 h of age (late n = 17). This was a pilot randomized controlled trial to determine thepower needed to reduce the need for endotracheal intubation by 24 h of age. Other outcomes included the duration of respiratorysupport, duration of oxygen therapy, need for vasopressors, incidence of intraventricular hemorrhage, patent ductus arteriosusneeding treatment, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, sepsis, and mortality.Results: There was no difference in the need for intubation (P = 0.615) or vasopressors (P = 0.455) by 24 h of age. Statisticallysignificant reduction was noted in the total duration of CPAP support (P = 0.003). However, total duration of respiratory support(P = 0.425), total duration of mechanical ventilation days (P = 0.237), and oxygen days (P = 0.145) were favoring early caffeinegroup, which were not statistically significant. None of the babies in both the groups had apnea of prematurity. There was nodifference in other outcomes.Conclusion: This pilot study demonstrated the feasibility of conducting such a trial in very preterm neonates. We found thatearly caffeine administration was associated with statistically significant reduction in the duration of non-inWvasive respiratorysupport. Larger studies are needed to determine whether early caffeine reduces intubation, intraventricular hemorrhage, durationof respiratory support, and related long-term outcomes.