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Objective: To map the available evidence on umbilical cord milking in newborns. Material and Method: Scoping Review based on the protocol proposed by the Joanna Briggs Institute. A search for full-text articles published in MEDLINE, SCOPUS, WOS and CINAHL was carried out using the following keywords: infant, newborn, umbilical cord milking, placental transfusion and umbilical cord blood. Results: The results indicated umbilical cord milking has superior benefits to the immediate cord clamping, among the main ones are higher levels of Hemoglobin, Hematocrit and Serum Ferritin, and reduction of complications in preterm newborns, such as intraventricular hemorrhage and the need for blood transfusion. When compared to delayed cord clamping, it has similar benefits, but milking is considered a faster method of placental blood transfusion. Conclusions: Umbilical cord milking has similar potential to delayed cord clamping. Therefore, it can be an alternative for obstetric nurses and midwives when delayed cord clamping cannot be performed in order to ensure the benefits of placental transfusion to the neonate.
Objetivo: Mapear la evidencia disponible sobre la ordeña del cordón umbilical en recién nacidos. Material y Método: Revisión de Alcance con base en el protocolo propuesto por el Instituto Joanna Briggs. Se realizó una búsqueda de artículos de texto completo publicados en MEDLINE, SCOPUS, WOS y CINAHL utilizando las siguientes palabras clave: lactante, recién nacidos, ordeña cordón umbilical, transfusión placentaria y sangre de cordón umbilical. Resultados: La ordeña del cordón umbilical tiene beneficios superiores al pinzamiento inmediato del cordón, entre los principales se encuentran: mayores niveles de hemoglobina, hematocrito y ferritina sérica y reducción de complicaciones en recién nacidos prematuros, tales como hemorragia intraventricular y necesidad de transfusión sanguínea. En comparación con el pinzamiento tardío del cordón, tiene beneficios similares, pero la ordeña se considera el método más rápido de transfusión de sangre placentaria. Conclusiones: La ordeña del cordón umbilical tiene potencial similar al pinzamiento tardío del cordón, por lo tanto, puede ser una alternativa para enfermeras obstétricas y parteras cuando no se puede realizar el pinzamiento tardío del cordón para asegurar los beneficios de la transfusión placentaria al neonato.
Objetivo: Mapear as evidências disponíveis sobre a ordenha de cordão umbilical em recém-nascidos. Material e Método: Revisão de escopo baseada no protocolo proposto pelo Joanna Briggs Institute. A busca de artigos completos publicados na MEDLINE, SCOPUS, WOS e CINAHL foi realizada utilizando as seguintes palavras-chave: lactente, recém-nascido, ordenha do cordão umbilical, transfusão de placenta e sangue do cordão umbilical. Resultados: Os resultados indicaram que a ordenha do cordão umbilical tem benefícios superiores ao clampeamento imediato do cordão, entre os principais estão: níveis mais elevados de hemoglobina, hematócrito e ferritina sérica e redução de complicações em recém-nascidos pré-termo, como hemorragia intraventricular e necessidade de transfusão sanguínea. Quando comparado ao clampeamento tardio do cordão umbilical, tem benefícios semelhantes, mas a ordenha é considerada um método mais rápido de transfusão de sangue da placenta. Conclusões: A ordenha do cordão umbilical tem potencial semelhante ao clampeamento tardio do cordão umbilical, portanto, pode ser uma alternativa às enfermeiras obstetras e parteiras quando o clampeamento tardio do cordão não pode ser executado a fim de garantir os benefícios da transfusão placentária ao neonato.
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Placental blood transfusion can be achieved by delayed cord clamping and umbilical cord milking.The World Health Organization has proposed delayed cord clamping as the standard care for newborns that do not require resuscitation.In recent years, umbilical cord milking has become an alternative to delayed cord clamping due to the short duration, quick recovery of the fetus after delivery, and similar effect on placental blood transfusion to that of the delayed cord clamping.This study aims to summarize the research results of the two intervention methods, and their potential benefits and risks, aiming to provide references for the optimal umbilical cord cutting.
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Objective:To investigate the correlation between the dynamic changes of the superior mesenteric artery (SMA) blood flow after umbilical cord milking (UCM)detected and feeding tolerance in premature infants.Methods:This was a prospective study a total of 88 premature infants delivered in Shanghai Jiading Maternal and Child Health Care Hospital from June 2018 to February 2020 were randomly divided into UCM group(45 cases) and early cord clamping group (ECC group, 43 cases). SMA blood flow indexes 15 min before the first feeding (prefeed) and 60 min after the first feeding (post-feed) were detected using the GE Voluson 730 Ultrasound Machine, including the peak systolic velocity (PSV), time-averaged mean velocity (TAMV), pulsatility index (PI) and resistance index (RI). The gestational age, birth weight, the weight at discharge, SMA blood flow indexes, time to achieve enteral nutrition, length of stay and incidence of complications between the two groups were analyzed using t test, Chi- square test or Fisher′ s exact test. Results:(1)There were no significant differences in the gestational age, birth weight, the mother′s hemoglobin before deliver, and the incidence of complications between UCM group and ECC group (all P>0.05). (2) Except for RI, all SMA blood flow indexes were higher in UCM group than those of ECC group.However, only prefeed TAMV[(24.74±11.47) cm/s vs.(20.24±7.71) cm/s], post-feed TAMV[(42.11±15.74 )cm/s vs.(28.31±9.99) cm/s] and TAMV change before and after feeding [(13.89-20.86) cm/s vs.(5.31-10.82) cm/s]were detected to be significantly higher in UCM group than those of ECC group (all P<0.05). (3) Multivariable linear regression analysis showed that the gestational age, birth weight, PSV elevation and PI reduction were negatively correlated with the length of adequate feeding (all P<0.05). (4) The time to achieve enteral nutrition[(11.75±7.36) d vs.(13.38±8.12) d] and the incidence of feeding intolerance [13.3% (6/45 cases) vs.20.9%(9/43 cases)] were lower in UCM group than those of ECC group, although no significant differences were detected (all P>0.05). Conclusions:UCM increases the hemoglobin level in premature infants, which is beneficial to feeding tolerance of premature infants by improving SMA blood flow.
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OBJECTIVES@#To study the influence of umbilical cord milking versus delayed cord clamping on the early prognosis of preterm infants with a gestational age of <34 weeks.@*METHODS@#PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Data, Weipu Database, and SinoMed were searched for randomized controlled trials on umbilical cord milking versus delayed cord clamping in preterm infants with a gestational age of <34 weeks published up to November 2021. According to the inclusion and exclusion criteria, two researchers independently performed literature screening, quality evaluation, and data extraction. Review Manger 5.4 was used for Meta analysis.@*RESULTS@#A total of 11 articles were included in the analysis, with 1 621 preterm infants in total, among whom there were 809 infants in the umbilical cord milking group and 812 in the delayed cord clamping group. The Meta analysis showed that compared with delayed cord clamping, umbilical cord milking increased the mean blood pressure after birth (weighted mean difference=3.61, 95%CI: 0.73-6.50, P=0.01), but it also increased the incidence rate of severe intraventricular hemorrhage (RR=1.83, 95%CI: 1.08-3.09, P=0.02). There were no significant differences between the two groups in hemoglobin, hematocrit, blood transfusion rate, proportion of infants undergoing phototherapy, bilirubin peak, and incidence rates of complications such as periventricular leukomalacia and necrotizing enterocolitis (P>0.05).@*CONCLUSIONS@#Compared with delayed cord clamping, umbilical cord milking may increase the risk of severe intraventricular hemorrhage in preterm infants with a gestational age of <34 weeks; however, more high-quality large-sample randomized controlled trials are needed for further confirmation.
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Female , Humans , Infant , Infant, Newborn , Pregnancy , Cerebral Hemorrhage , Constriction , Gestational Age , Infant, Premature , Prognosis , Umbilical Cord/physiology , Umbilical Cord ClampingABSTRACT
Objective:To study the early effects of intact-umbilical cord milking (I-UCM) and cut-umbilical cord milking (C-UCM) for the prevention of anemia of prematurity in preterm infants.Method:From January 2019 to October 2019, C-section delivered infants with gestational age <34 weeks were randomly assigned into I-UCM group and C-UCM group. Hematological parameters at different timepoints after birth, iron status, incidence of anemia within 7 d after birth, blood transfusions, transcutaneous bilirubin levels and the total duration of phototherapy were collected and analyzed.Result:A total of 60 cases were enrolled, including 30 in I-UCM group and 30 in C-UCM group. I-UCM group had significant higher levels of hemoglobin (Hb), hematocrit (Hct) and serum iron on admission ( P<0.05). Comparing with C-UCM group, Hb and Hct were significantly higher in I-UCM group at 7 d and 14 d after birth ( P<0.05). Lower prevalence of anemia within 1 week [3.3% (1/30) vs. 33.3% (10/30), P<0.05] and less blood transfusions during hospitalization [13.3% (4/30) vs. 56.7% (17/30)] were noted in I-UCM group. No statistically significant differences existed between the two groups in phototherapy duration and the peak bilirubin levels ( P>0.05). Conclusion:I-UCM can provide more placental transfusion at birth to increase Hb levels and iron storage to prevent and reduce anemia in preterm infants.
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Background: Perinatal iron deficiency has received little attention in the past. Umbilical cord milking is a type of placental transfusion, they serve to potentially enhance neonatal blood volume and consequently the iron stores after birth. Among the neonates, the preterm infants are sick and vulnerable babies who are already deprived of iron stores. The aim of this study was to evaluate the effect of cord milking on ferritin values amongst preterm neonates.Methods: This is a hospital based randomized control trial which included the babies born at 29-36 weeks of gestation. The babies were randomized to two intervention groups; cord milking and delayed cord clamping group. Detailed clinical history taken, including details of labour and clinical examination. Blood samples were analysed for ferritin as required at 6 weeks of post-natal age.Results: Neonates under cord milking group had higher ferritin values (249.04'21.93 ng/mL) as compared to those neonates under delayed cord clamping group (179.66'32.94 ng/mL) and this was statistically very significant (p= <0.001).Conclusions: In preterm neonates, umbilical cord milking results in improved iron status as shown by higher ferritin values at 6 weeks of life. UCM can be a used as placental transfusion strategy in preterm neonates for improving iron status and preventing anemia of prematurity.
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Anemia of prematurity is one of the most common and serious problems affecting quality of life and survival of premature infants.Recent studies have found that delayed cord clamping or umbilical cord milking may prevent and control anemia of prematurity by providing a placental transfusion and elevating hemoglobin concentration.This review is a summary of current evidence on the effects of different umbilical cord handling on premature infants with anemia,with potential benefits and adverse effects discussed.
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Background: Delayed umbilical cord clamping is an effective strategy and particularly relevant for infants living in low-resource settings with less access to iron-rich foods and thus are at greater risk of anaemia. Objective: To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on haematological parameters (serum ferritin & hemoglobin) at birth and at 72 hours in term neonates. Methods: This was an Open Label Randomized Controlled Trial conducted at Suvidha Mother and Child Nursing Home Talab Tillo Jammu over a period of 6 months. A total of 68 babies born at > 37 weeks of gestation were randomized in three groups, group I UCM alone (n=28) , Group II DCC alone (n=23) and Group III both UCC and DCC (n=17) using simple randomization technique . In milking group, Umbilical cord was milked 4 times towards the baby at a speed of 10 cm / sec . In Delayed Cord Clamping group cord was clamped and cut 2-3 cm distance from the umbilical stump after 3 minutes of birth. In Group III both procedures were done simultaneously. Statistical analysis: ANOVAwas used to compare mean difference of outcome between three intervention arms. Two tailed Pvalue of <0.05 was taken as significant. SPSS version 20.0 was used for data analysis Results: The baseline characteristics were mostly comparable in the all the groups. Maximum increase in Haemoglobin and PCV was seen in group II i.e delayed cord clamping . Mean haemoglobin and heamatocrit (PCV) levels at 72 hours of life neonates in group II (17.7g% and 55.4 ) and group III (17.3g% and 54) were comparable . Conclusion: Both the interventions i.e Delayed cord clamping performed alone or in combination with umbilical cord milking had comparable effect on hematological status in term neonates
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Objective To investigate the effects of different umbilical cord ligation methods on anemia and jaundice in preterm infants with a gestational age less than 32 weeks.Methods A total of 135 preterm infants with a gestational age less than 32 weeks were recruited and randomly divided into the umbilical cord milking group,the delayed cord clamping group and the immediate cord clamping group,with 45 cases in each group.Comparisons among three groups were performed on hemoglobin,hematocrit at 1 h and 1 week after birth,and bilirubin peak,total time of phototherapy,the incidence of anemia,pathologic jaundice as well as polycythemia before discharge.Results Finally 40 cases in the umbilical cord milking group,42 cases in the delayed cord clamping group and 38 cases in the immediate cord clamping group were recruited.Compared with the immediate cord clamping group,Hb(g/L)and hematocrit(％) levels were significantly higher in the umbilical cord milking group and the delayed cord clamping group(P＜0.05),the anemia rate was significantly lower in umbilical cord milking group and the delayed cord clamping group(P＜0.05).However,there were no statistical differences in Hb(g/L) and hematocrit(％) levels as well as ane mia rate between the umbilical cord milking group and the delayed cord clamping group (P＞0.05).There were no significant differences among three groups in bilirubin peak,total time of phototherapy and the incidence of pathologic jaundice as well as polycythemia.Conclusion Umbilical cord milking and delayed cord clamping can both reduce the anemia rate,but not increase the risk of pathological jaundice.Umbilical cord milking can be preferred method for preterm infants with a gestational age less than 32 weeks and asphyxia.
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Objective: To investigate the impact of umbilical cord milking on hemoglobin, bilirubin and cardiac function in premature newborns, and the significance of prevention of anemia. Methods: A randomized controlled trial was performed in Maternal and Child Health Hospital of Shanghai Jiading from July to November 2017 on neonates born0.05). Conclusion: Umbilical cord milking can increase the hemoglobin level to premature infants and reduce the incidence of anemia at discharge, and it does not increase the risk of cardiac insufficiency and hyperbilirubinemia. This practice has been shown to be simple and safe.
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PURPOSE: To evaluate the safety and feasibility of delayed cord clamping compared with umbilical cord milking in premature infants less than 32 weeks of gestation. METHODS: This study was performed by 1:2 case-control match. Infants received delayed cord clamping (DCC) for one minute (DCC group, n=10, May 2014-October 2015) were compared with perinatal factors-matching controls, who received umbilical cord milking (CM, CM group, n=20, May 2014-October 2015) or who received immediate cord clamping (ICC, ICC group, n=20, January 2008-December 2008). The primary outcome was hematocrit during the first 28 days. Secondary outcomes included delivery room management, selected neonatal morbidities and mortality. RESULTS: Baseline characteristics were comparable in all the three groups. The median hematocrit level at 1st day and 3rd day was significantly higher in the DCC group (54.3±6.2%, 53.6±5.6%) as compared with the CM group (48.0±7.7%, 43.2±7.8%) or ICC group (47.2±7.5%, 45.8±6.3%). The DCC group had reductions in red blood cell transfusion within the first two weeks of life compared to the CM group (10% vs. 50%, P=0.03). The DCC group compared to the CM group had no increment in respiratory intervention in the delivery room and hypothermia on admission. There was no difference between DCC and CM in mortality, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, severe retinopathy of prematurity and sepsis. CONCLUSION: Delayed cord clamping for 1 minute in preterm infants may be a safe and feasible method to increase initial hematocrit and reduce transfusion compared with umbilical cord milking.
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Humans , Infant , Infant, Newborn , Pregnancy , Bronchopulmonary Dysplasia , Case-Control Studies , Constriction , Delivery Rooms , Enterocolitis, Necrotizing , Erythrocyte Transfusion , Hematocrit , Hemorrhage , Hypothermia , Infant, Premature , Methods , Milk , Mortality , Retinopathy of Prematurity , Sepsis , Umbilical CordABSTRACT
ObjectiveTo study the effects of placental transfusion of umbilical cord milking on very low birth weight (VLBW) infants. Methods Fifty-seven VLBW infants born from September 2011 to May 2014 who had umbilical cord milking at birth were selected as experimental group. Sixty-one VLBW infants born from January 2008 to August 2011 who had normal cord clamping at birth were selected as control group. The complications of VLBW infants, blood transfusion, frequency of using pulmonary surfactant (PS), the duration of mechanical ventilation, the duration of oxygen and mortality were compared between two groups.Results The incidence of severe asphyxia, IVH and anemia was signiifcantly lower in experimental group than in control group (P< 0.05). The blood transfusion and transfusion volume, duration of mechanical ventilation, and duration of oxy-gen were signiifcantly lower in experimental group than in control group (P< 0.05).Conclusions Umbilical cord milking can reduce the incidence of severe asphyxia, IVH and anemia. It also can reduce the blood transfusion, the duration of mechanical ventilation, and the duration of oxygen in VLBW infants.
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PURPOSE: To investigate the effects of umbilical cord milking on the level of the hemoglobin, frequency of transfusion, initial adaptation after birth and morbidities in the extremely low birth weight infants (ELBWI). METHODS: Medical records of ELBWI admitted to the Samsung Medical Center Neonatal Intensive Care Unit from November 2007 to October 2010 were reviewed retrospectively. Before June 2009, infants' umbilical cords were clamped immediately (control group, n=39). After that time, umbilical cords were clamped after repeated (two or three times) milking of the cord toward the neonate under the radiant warmer (milking group, n=37). RESULTS: ELBWI with a gestational age of > or =26 weeks presented higher level of hemoglobin at the age of 3 days (16.9+/-2.6 vs. 14.3+/-2.3 g/dL, P=0.008) and 7 days (14.6+/-1.7 vs. 12.6+/-1.8 g/dL, P=0.005), lower frequency of transfusion during the hospital days (2.5+/-0.7 vs. 4.0+/-3.0) and smaller number of neonate undergoing transfusion within the first three weeks of life in the milking group than the control group (30% vs. 70%). There was no significant difference between the two groups in blood pressure and the urine output changes. There was no significant difference in mortality and morbidity, including respiratory distress syndrome, patent ductus arteriosus, bronchopulmonary dysplasia and intraventricular hemorrhage. CONCLUSION: Umbilical cord milking in ELBWI may be a useful method to reduce transfusion in neonates, especially in those of longer than 26 weeks gestation.