Journal article
Umbilical Cord Milking vs Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants
The Journal of pediatrics, Vol.232, pp.87-94.e4
05/2021
DOI: 10.1016/j.jpeds.2020.12.072
PMCID: PMC8084979
PMID: 33417919
Abstract
To compare in-hospital outcomes after umbilical cord milking vs delayed cord clamping among infants <29 weeks of gestation.
Multicenter retrospective study of infants born <29 weeks of gestation from 2016 to 2018 without congenital anomalies who received active treatment at delivery and were exposed to umbilical cord milking or delayed cord clamping. The primary outcome was mortality or severe (grade III or IV) intraventricular hemorrhage (IVH) by 36 weeks of postmenstrual age (PMA). Secondary outcomes assessed at 36 weeks of 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 2 gestational age strata, 22-24
and 25-28
weeks.
Among 1834 infants, 23.6% were exposed to umbilical cord milking and 76.4% to delayed cord clamping. The primary outcome, mortality or severe IVH, occurred in 21.1% of infants: 28.3% exposed to umbilical cord milking and 19.1% exposed to delayed cord clamping, with an aOR that was similar between groups (aOR 1.45, 95% CI 0.93, 2.26). Infants exposed to umbilical cord milking had higher odds of severe IVH (19.8% umbilical cord milking vs 11.8% delayed cord clamping, aOR 1.70 95% CI 1.20, 2.43), as did the 25-28
week stratum (14.8% umbilical cord milking vs 7.4% delayed cord clamping, aOR 1.89 95% CI 1.22, 2.95). Other secondary outcomes were similar between groups.
This analysis of extremely preterm infants suggests that delayed cord clamping is the preferred practice for placental transfusion, as umbilical cord milking exposure was associated with an increase in the adverse outcome of severe IVH.
ClinicalTrials.gov: NCT00063063.
Details
- Title: Subtitle
- Umbilical Cord Milking vs Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants
- Creators
- Neha Kumbhat - University of California San DiegoBarry Eggleston - RTI InternationalAlexis S Davis - Stanford UniversitySara B DeMauro - Children's Hospital of PhiladelphiaKrisa P Van Meurs - Stanford UniversityElizabeth E Foglia - Children's Hospital of PhiladelphiaSatyan Lakshminrusimha - University of California, DavisMichele C Walsh - Case Western Reserve UniversityKristi L Watterberg - University of New MexicoMyra H Wyckoff - The University of Texas Southwestern Medical CenterAbhik Das - RTI InternationalSara C Handley - Leonard Davis Institute of Health EconomicsGeneric Database Subcommittee of the National Institute of Child Health and Human Development Neonatal Research Network
- Contributors
- John M Dagle (Contributor) - University of Iowa, Stead Family Department of Pediatrics
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.232, pp.87-94.e4
- DOI
- 10.1016/j.jpeds.2020.12.072
- PMID
- 33417919
- PMCID
- PMC8084979
- NLM abbreviation
- J Pediatr
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Grant note
- UG1 HD068244 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS UG1 HD087226 / NICHD NIH HHS U24 HD095254 / NICHD NIH HHS UG1 HD087229 / NICHD NIH HHS
- Language
- English
- Date published
- 05/2021
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Biochemistry and Molecular Biology; Neonatology
- Record Identifier
- 9984293073802771
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