Umbilical cord milking in preterm infants: a systematic review and meta-analysis
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  • Published on:
    Umbilical cord milking is probably better than immediate cord clamping at birth in preterm infants
    • Simone Pratesi, Neonatologist, MD, PhD Careggi University Hospital, Florence, Italy
    • Other Contributors:
      • Carlo Dani, Full Professor of Pediatrics, MD

    Dear Editor,
    we read with great interest the work by Balasubramanian H et al (1). Their systematic review and meta-analysis included 19 randomised controlled trials comparing umbilical cord milking (UCM) with delayed cord clamping (DCC, 5 studies, 922 newborns) and immediate cord clamping (ICC, 14 studies, 1092 newborns) in preterm infants. They concluded that “… cord milking, as compared to delayed cord clamping, significantly increased the risk of severe intraventricular haemorrhage (IVH) in preterm infants <34 weeks gestation”. We believe that this firm conclusion is not supported by the available data: 1) firstly, the gestational age of population in the four analyzed studies ranges from 23 to 31 weeks gestation in three studies (2-4) and from 24 to 32 weeks in one study with no severe IVH reported (5); 2) secondly, at least 20 of the 24 severe IVH events in the UCM group occurred in newborns less than 28 weeks’ gestation (3), while gestational age of newborns with the remaining 4 IVH events is not reported (thus, it actually might be even zero severe IVH in newborns above 27 weeks gestation). Therefore, the increased risk of severe IVH should be referred only to PREMOD 2 infants less than 28 weeks’ gestation (3), and not also extended to infants with 28-33 weeks’ gestation population.
    This metanalysis confirms what we stated in our commentary to PREMOD 2 study (6): UCM procedure demonstrates advantages in comparison to routine practice of ICC at bir...

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    Conflict of Interest:
    None declared.