Umbilical Cord Milking versus Delayed Cord Clamping in Infants 28-32 weeks: A Randomized Trial

Thanks to Anup KATHERIA for leafing this important trial and inviting us to participate.

Objectives: To determine whether rate of severe intraventricular hemorrhage (IVH) or death among preterm infants receiving placental transfusion with UCM is non-inferior to DCC. Methods: Design, Setting, Participants: Non-inferiority (1% non-inferiority margin) randomized controlled trial of preterm infants recruited between June 2017 through September 2022 from 19 university and private medical centers in 4 countries. Planned enrollment was 500 per group. Participants were randomized to UCM (N=511) or DCC (N=508). The primary outcome was Grade III/IV IVH or death. Results: Among 1019 infants born 28-32 weeks, all completed the trial from birth through initial hospitalization (mean gestational age 31 weeks, 44% female). For the primary outcome, 7/511 (1.4%) infants randomized to UCM developed severe IVH or died compared to 7/508 (1.4%) infants randomized to DCC (rate difference 0.01%, 95% CI: (-1.4% to 1.4%), p=0.99). Conclusions: In this randomized controlled trial of UCM vs DCC among preterm infants born between 28 and 32 weeks gestation, there was no difference in the rates of severe IVH or death, although we could not demonstrate non-inferiority at a 1% margin. UCM might be a safe alternative to DCC without delaying resuscitation in premature infants born at 28-32 weeks gestational age.

Article Summary: In a randomized controlled trial in preterm infants receiving UCM or DCC there was no difference in the rate of severe IVH or death.

What’s Known on This Subject: Umbilical cord milking is not safe in preterm infants 23-27 weeks due to an increase in severe intraventricular hemorrhage at birth.

What This Study Adds: In preterm infants 28-32 weeks gestation, there was no differences in severe IVH or death comparing UCM vs DCC. UCM appears to be a safe and effective alternative to accomplish placental transfusion in clinical circumstances that might preclude DCC.