Delayed Cord Clamping Effects, with or without Umbilical Cord Milking, on Premature Infant Hemodynamic Circulation: A Randomized Control Trial

Abstract

Introduction: Delayed cord clamping (DCC) results in decreased incidence of intraventricular hemorrhage (IVH) by increasing the systemic blood flow which is assessed by measuring superior vena cava (SVC) flow, right ventricular (RV) output and left ventricular (LV) output. Umbilical cord milking (UCM) is an alternative placental transfusion method with higher levels of systemic blood flow. We intend to explore if UCM can augment DCC benefits.
Objectives: To compare placental transfusion hemodynamic effects between 3 techniques: DCC, DCC with UCM before clamping (DCM-B), and DCC with UCM after cord clamping (DCM-A).
Methods: Premature infants at 28-33 weeks GA born at Thammasat University Hospital were randomized by placental transfusion methods. Vital signs were recorded, and blinded echocardiography was performed to evaluate hemodynamic circulation within 24 hours of age.
Results: One hundred and twenty infants were divided into 3 groups. No significant differences in incidence of intraventricular hemorrhage (IVH) were observed between groups and no severe IVH had occurred. DCC group had higher SVC flow (150.9 ± 81.1 mL/kg/min), RV output (271.3 ± 110.4 mL/kg/min), and LV output (232.4 ± 81.6 mL/kg/min) in comparison to DCM-B and DCM-A group but were not statistically significant.
Conclusions: Our study showed DCC with or without UCM had no significant variations in hemodynamic effects and may benefit preterm infants. DCC combined with UCM appeared to be safe with none of the participants developing severe IVH.