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Neurodevelopmental outcomes of very preterm infants who received cord milking at birth: a randomized controlled trial

European Journal of Pediatrics volume 181, pages 4215–4220 (2022)Cite this article

Abstract

Umbilical cord milking improves postnatal adaptation and short-term outcomes of very preterm infants compared to early cord clamping. Little is known about the impact of umbilical cord milking on long-term neurodevelopmental outcomes. The objective of this study is to compare the effects of intact umbilical cord milking (UCM) vs. early cord clamping (ECC) at birth on neurodevelopmental outcomes at 36 months’ corrected age. Preterm infants < 31 weeks’ gestation who were randomized at birth to receive three time milking of their attached cord or ECC (< 10 s) were evaluated at 36 months’ corrected age. Neurodevelopmental outcomes were assessed by blinded examiners using Bayley Scales of Infant and Toddler Development (version III). Analysis was by intention to treat. Out of the 73 infants included in the original trial, 2 died and 65 (92%) infants were evaluated at 36 months’ corrected age. Patient characteristics and short-term outcomes were similar in both study groups. There were no significant differences in the median cognitive, motor or language scores or in the rates of cerebral palsy, developmental impairment, deafness, or blindness between study groups.

Conclusion: Neurodevelopmental outcomes at 36 months’ corrected age of very preterm infants who received UCM were not shown to be significantly different from those who received ECC at birth.

Trial registration: ClinicalTrials.gov: NCT01487187

What is Known:

• Compared to early cord clamping, umbilical cord milking improves postnatal adaptation and short-term outcomes of very preterm infants compared to early cord clamping.

• Little is known about the impact of umbilical cord milking on neurodevelopmental outcomes.

What is New:

• Neurodevelopmental outcomes at 3 years of age were not significantly different in very preterm infants who received cord milking vs. those who received early cord clamping at birth.

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Fig. 1

Data availability

Data generated or analyzed during this study are included in this article. Data reported in this paper may be requested through a data use agreement. Further enquiries can be directed to the corresponding author.

Abbreviations

BPD:

Bronchopulmonary dysplasia

DCC:

Delayed cord clamping

ECC:

Early cord clamping

IVH:

Intraventricular hemorrhage

NDI:

Neurodevelopmental impairment

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

PDA:

Patent ductus arteriosus

ROP:

Retinopathy of prematurity

UCM:

Umbilical cord milking

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Funding

This project was supported by grants from both the Nova Scotia Health Research Foundation (PSO-EST-2013–9023 EGMS 1813) and the IWK Research Foundation (1008052). No honorarium or other form of payment was given to anyone to produce this manuscript.

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, IWK Health Centre, Dalhousie University, 5850/5980 University Ave., PO Box 9700, Halifax, NS, B3K 6R8, Canada

    Walid El-Naggar, Douglas McMillan, Robin Whyte, Michael Vincer & C. David Simpson

  2. Division of Cardiology, Department of Pediatrics, Dalhousie University, Halifax, Canada

    Arif Hussain & Andrew Warren

  3. Department of Obstetrics & Gynecology, Dalhousie University, Halifax, Canada

    Anthony Armson & Michael Vincer

  4. Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Canada

    Linda Dodds

Authors
  1. Walid El-Naggar
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  2. Douglas McMillan
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  3. Arif Hussain
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  4. Anthony Armson
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  5. Linda Dodds
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  6. Andrew Warren
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  7. Robin Whyte
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  8. Michael Vincer
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  9. C. David Simpson
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Contributions

• WE-N designed the study and obtained Research Ethics Board (REB) approval. He was instrumental in performing echocardiographic studies, review of data, and manuscript preparation.

• DBM was involved in study design, obtaining REB approval, and manuscript approval.

• AH was involved in reading and interpreting echocardiography studies, data review, and manuscript approval.

• AA assisted in study design, obtaining REB approval, and manuscript approval.

• LD assisted in study design, sample size calculation, randomization process preparation, REB approval, and manuscript approval.

• AW assisted in study design, REB approval, and manuscript approval.

• RW assisted in study design, REB approval, and manuscript approval.

• MV was the Medical Director of the Perinatal Follow-Up Program and was responsible for the collection of outcome data. He assisted in data analysis and approval of the final manuscript.

• DS assisted in conducting echocardiography studies, data review, analysis, and manuscript approval.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Walid El-Naggar.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the local Research Ethics Board of the IWK Health Centre (Project # 1002554), and written informed consent was obtained antenatally from all women who participated in the trial.

Competing interests

The authors declare no competing interests.

Disclaimer

The funders had no roles in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication. We confirm the independence of the study researchers from the funders; and we confirm that all authors, external and internal, had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the analysis.

Additional information

Communicated by Daniele De Luca

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El-Naggar, W., McMillan, D., Hussain, A. et al. Neurodevelopmental outcomes of very preterm infants who received cord milking at birth: a randomized controlled trial. Eur J Pediatr 181, 4215–4220 (2022). https://doi.org/10.1007/s00431-022-04638-x

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  • DOI: https://doi.org/10.1007/s00431-022-04638-x

Keywords

  • Early cord clamping
  • Umbilical cord milking
  • Long-term neurodevelopmental outcomes
  • Preterm infants