PT - JOURNAL ARTICLE AU - El-Naggar, Walid AU - Simpson, David AU - Hussain, Arif AU - Armson, Anthony AU - Dodds, Linda AU - Warren, Andrew AU - Whyte, Robin AU - McMillan, Douglas TI - Cord milking versus immediate clamping in preterm infants: a randomised controlled trial AID - 10.1136/archdischild-2018-314757 DP - 2019 Mar 01 TA - Archives of Disease in Childhood - Fetal and Neonatal Edition PG - F145--F150 VI - 104 IP - 2 4099 - http://fn.bmj.com/content/104/2/F145.short 4100 - http://fn.bmj.com/content/104/2/F145.full SO - Arch Dis Child Fetal Neonatal Ed2019 Mar 01; 104 AB - 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.