1061 Long term effects of milking of cut umbilical cord in very preterm neonates: a randomised controlled trial in Southern India

AimsMilking of umbilical cord is a method of placental transfusion, suggested by some as an alternative to delayed cord clamping in neonates. It has the potential benefit of avoiding delay in initiation of resuscitation required in preterm neonates, especially when facility for delayed cord clamping and simultaneous resuscitation near the mother, are not available in resource limited settings. We aimed to evaluate if death and disability were reduced at 12 months of corrected age when milking of cut umbilical cord was done in very preterm neonates born between 27 and 32 weeks period of gestation. Secondary objectives were the effect of cut cord milking on APGAR score, hematocrit levels, requirement of phototherapy, incidence of cranial ultrasound abnormalities and duration of respiratory support and hospital stay.MethodsAn open labelled randomized controlled trial was done on neonates born between 27 and 32 weeks period of gestation in a tertiary care hospital in Southern India, after necessary approvals from the Institutional Ethics Committee. Exclusion Criteria were monochorionic diamniotic twins, intrauterine growth restriction, hydrops fetalis and major congenital anomalies. Randomization was done using computer generated random numbers. In the intervention group, umbilical cord, cut 30 cm long at birth, was milked three times for 10–20 seconds, after initial resuscitation measures. Early cord clamping was done without milking in the controls. Primary outcome was composite death and disability at one year of age. Amiel Tison (AT) angles, Trivandrum development screening chart (TDSC), development assessment scale for Indian infants (DASII) and detailed neurologic evaluation were used to evaluate the neuro-developmental outcome.ResultsOf the 218 neonates screened between 1 April 2018 and 1 April 2021, 179 could be evaluated finally. Milking was done in 93 neonates and 86 acted as controls. Composite of death and disability at one year was significantly lower in the intervention group (odds ratio 2.136; 95%CI, 1.006-4.533; p value =0.046). Among the other variables, significant association was observed with death (odds ratio 4.7; 95%CI, 1.65-13.2; p=0.002), abnormal cranial ultrasound findings at 28 days (odds ratio:0.310;95% CI: 0.093-1.03 at P value = 0.046) and need for ventilator support (OR 0.075, 95% CI, 0.318 -1.043 at P value= 0.047). No adverse outcome was observed due to milking.ConclusionCut umbilical cord milking was found to significantly improve the survival and neurodevelopmental outcome in very preterm neonates in our study. These potential benefits that look promising and relevant in resource limited setting, however need to be further validated by large multicentric trials, before cut cord milking can be recommended as the standard of care in umbilical cord management.