RT Journal Article SR Electronic T1 Cord milking versus immediate clamping in preterm infants: a randomised controlled trial JF Archives of Disease in Childhood - Fetal and Neonatal Edition JO Arch Dis Child Fetal Neonatal Ed FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP F145 OP F150 DO 10.1136/archdischild-2018-314757 VO 104 IS 2 A1 El-Naggar, Walid A1 Simpson, David A1 Hussain, Arif A1 Armson, Anthony A1 Dodds, Linda A1 Warren, Andrew A1 Whyte, Robin A1 McMillan, Douglas YR 2019 UL http://fn.bmj.com/content/104/2/F145.abstract 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.