Milking of the Cut Cord during Stabilization of Infants Born Very Premature: A Randomized Controlled Trial

Objective: To investigate the feasibility of cut-umbilical cord milking (C-UCM) during stabilization of preterm infants after birth.

Study design: This was a pilot randomized controlled trial of initial resuscitation. Infants born to eligible, consenting women presenting in preterm labor at <32 weeks' gestation were randomized to receive either the standard practice of delayed cord clamping (DCC) for 30-60 seconds at birth or C-UCM while supporting breathing and following 30 seconds of DCC. The primary outcome was feasibility in terms of percentage recruitment, intervention compliance, safety, and study completion. Short-term clinical outcomes were collected. Analysis was by intention to treat.

Results: Of the 133 pregnant women approached, 93 consented to participate (70%). Fifty infants delivered <32 weeks' gestation were randomized to either C-UCM (25) or DCC (25). Baseline characteristics of infants were similar. All participants completed the study. One infant in the C-UCM group and 5 infants in the DCC group did not receive the allocated intervention. Median (IQR) time to cord milking was 62 (54, 99) seconds and median (IQR) length of the cut-cord milked was 20 (14, 29) cm. C-UCM was not associated with increased adverse effects compared with C-UCM .

Conclusion: Milking of the long-cut cord after 30 seconds of DCC while supporting breathing was feasible and not associated with significant adverse effects. A larger randomized controlled trial is required to assess the efficacy and safety of this approach on clinical outcomes. C-UCM may be especially useful in situations when DCC is not feasible.