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Cord milking versus immediate clamping in preterm infants: a randomised controlled trial
  1. Walid El-Naggar1,
  2. David Simpson1,
  3. Arif Hussain2,
  4. Anthony Armson3,
  5. Linda Dodds4,
  6. Andrew Warren2,
  7. Robin Whyte1,
  8. Douglas McMillan1
  1. 1 Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
  2. 2 Division of Cardiology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
  3. 3 Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada
  4. 4 Perinatal Epidemiology Research Unit, Department of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to Dr Walid El-Naggar, IWK Health Centre, Halifax, NS B3K 6R8, Canada; walid.el-naggar{at}


Objective To investigate whether umbilical cord milking (UCM) at birth improves systemic blood flow and short-term outcomes, as compared with immediate cord clamping (ICC).

Design Randomised clinical trial.

Setting Single tertiary care centre.

Patients Infants born to eligible women presenting in preterm labour between 24 and 31 weeks’ gestation.

Interventions UCM three times at birth or ICC.

Outcome measures Primary outcome included systemic blood flow as represented by echo-derived superior vena cava(SVC) flow at 4–6 hours after birth. The echocardiographer and interpreter were blinded to the randomisation. Secondary outcomes included cardiac output, neonatal morbidities and mortality. Analysis was by intention to treat.

Results A total of 73 infants were randomised (37 to UCM and 36 to ICC). Mean (SD) gestational age was 27 (2) weeks and mean (SD) birth weight was 1040 (283) g. Haemoglobin on admission was higher in the UCM than in the ICC group (16.1 vs 15.0 g/L), p=0.049 (mean difference 1.1, 95% CI 0.003 to 2.2). No statistically significant differences were found between groups in SVC flow at 4–6 hours (88.9±37.8 and 107.3±60.1 mL/kg/min), p=0.13 (mean difference −18.4, 95% CI −41.7 to 5.0 mL/kg/min) or at 10–12 hours of age (102.5±41.8 and 90.6±28.4 mL/kg/min), p=0.17 (mean difference 12.0, 95% CI −4.7 to 28.7 mL/kg/min), cardiac output or neonatal morbidities.

Conclusions Cord milking was not shown to improve functional cardiac outcomes, neonatal morbidity or mortality. More research is needed before routine cord milking can be recommended for very preterm infants.

Trial registration NCT01487187.

  • neonatology
  • resuscitation

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  • Contributors WE-N was involved in the study design, Research Ethics Board (REB) approval, performing echo-cardiography studies, data review and manuscript preparation. DS and AH were involved in conducting and reading and interpreting echocardiography studies, respectively, data review and manuscript reviewing. LD was involved in sample size calculation and randomisation process preparation. AA, LD, AW, RW and DM were involved in the study design, REB approval and manuscript reviewing. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This project was supported by grants from both Nova Scotia Health Research Foundation (PSO-EST-2013-9023 EGMS 1813) and IWK Research Foundation (1008052). No honorarium or other form of payment was given to anyone to produce this manuscript.

  • Competing interests None declared.

  • Patient consent Obtained from the parents/guardian.

  • Ethics approval IWK Health Centre Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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