A Randomized Clinical Trial of Umbilical Cord Milking vs Delayed Cord Clamping in Preterm Infants: Neurodevelopmental Outcomes at 22-26 Months of Corrected Age - 13/12/17

Doi : 10.1016/j.jpeds.2017.10.037

Anup Katheria, MD ^1,^* , Donna Garey, MPH, MD ^1,², Giang Truong, MD ³, Natacha Akshoomoff, PhD ⁴, Jane Steen, RN ¹, Mauricio Maldonado, MD ¹, Debra Poeltler, PhD ¹, Mary Jane Harbert, MD ¹, Yvonne E. Vaucher, MPH, MD ⁵, Neil Finer, MD ^1,⁵
¹ Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA
² Department of Pediatrics, Columbia University, New York, NY
³ Department of Pediatrics, Loma Linda University Medical Center, Loma Linda, CA
⁴ Department of Psychiatry, University of California, San Diego, San Diego, CA
⁵ Department of Pediatrics, University of California, San Diego, San Diego, CA

^*Reprint requests: Anup Katheria, MD, Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, 8555 Aero Dr, Suite 104, San Diego, CA 92123.Neonatal Research InstituteSharp Mary Birch Hospital for Women and Newborns8555 Aero DrSuite 104San DiegoCA92123

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Abstract

Objective

To compare the effect of umbilical cord milking vs delayed cord clamping (DCC) on neurodevelopmental and health outcomes in very preterm infants at 22-26 months of corrected age.

Study design

Neurodevelopmental outcomes at 2 years of age were assessed using the Bayley Scales of Infant Development, third edition, and a standardized neurologic examination. Data regarding pulmonary morbidities, neurosensory impairments, and hospitalizations were obtained by parental interview. Intention-to-treat was used for primary analyses.

Results

Of the 197 infants enrolled in the original study there were 15 deaths, 5 in the umbilical cord milking group and 10 in DCC group. Of the remaining infants, 135 (74%) were assessed at 22-26 months of corrected age. Demographics in umbilical cord milking (n = 70) and DCC (n = 65) groups were similar. Infants randomized to umbilical cord milking at birth had significantly higher cognitive and language composite scores, and were less likely to have a cognitive composite score of <85 (4% vs 15%; P = .04). Motor function was similar in both groups. There were no differences in the incidences of mild or moderate to severe neurodevelopmental impairment, hearing or visual impairments, pulmonary morbidities, or rehospitalizations between the 2 groups.

Conclusions

Infants randomized to umbilical cord milking had higher language and cognitive scores compared with those randomized to DCC. There was no difference in rates of mild or moderate to severe neurodevelopmental impairment.

Trial registration

clinicaltrials.gov NCT01434732.

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Keywords : placental transfusion, resuscitation, neonatal, intraventricular hemorrhage

Abbreviations : Bayley-III, CA, DCC, GMFCS

Plan

Supported by the Thrasher Research Foundation (TRF13157) and the Hervey Family Fund at The San Diego Foundation. The authors declare no conflicts of interest.