Umbilical Cord Milking Versus Delayed Cord Clamping and Associations With In-Hospital Outcomes Among Extremely Premature Infants

Abstract [from journal]

Objective: To compare in-hospital outcomes after umbilical cord milking versus delayed cord clamping among infants <29 weeks' gestation.

Study design: Multicenter retrospective study of infants born <29 weeks' gestation from 2016 to 2018 without congenital anomalies who received active treatment at delivery and were exposed to UCM or DCC. The primary outcome was mortality or severe (grade III or IV) intraventricular hemorrhage (IVH) by 36 weeks postmenstrual age (PMA). Secondary outcomes assessed at 36 weeks PMA were mortality, severe IVH, any IVH or mortality, and a composite of mortality or major morbidity. Outcomes were assessed using multivariable regression, incorporating mortality risk factors identified a priori, confounders, and center. A prespecified, exploratory analysis evaluated severe IVH in two GA strata, 22-246/7 and 25-286/7 weeks.

Results: Among 1,834 infants, 23.6% were exposed to UCM and 76.4% to DCC. The primary outcome, mortality or severe IVH, occurred in 21.1% of infants: 28.3% exposed to UCM and 19.1% exposed to DCC, with an adjusted odds ratio that was similar between groups (aOR 1.45, 95% CI 0.93, 2.26). UCM exposed infants had higher odds of severe IVH (19.8% UCM vs. 11.8% DCC, aOR 1.70 95% CI 1.20, 2.43), as did the 25-286/7 week stratum (14.8% UCM vs. 7.4% DCC, aOR 1.89 95% CI 1.22, 2.95). Other secondary outcomes were similar between groups.

Conclusion: This analysis of extremely preterm infants suggests that DCC is the preferred practice for placental transfusion, as UCM exposure was associated with an increase in the adverse outcome of severe IVH.