Impact of Umbilical Cord Milking on Hematological Parameters in Preterm Neonates With Placental Insufficiency

Evaluation of cord management strategies in intrauterine growth-restricted infants: a systematic review and meta-analysis

Delayed cord clamping (DCC) has been widely adopted in both term and preterm infants to improve neonatal outcomes by increasing blood volume and supporting oxygenation. However, the optimal cord management for intrauterine growth-restricted (IUGR) infants is unclear. To systematically review and meta-analyze the effects of DCC compared to early cord clamping (ECC) in IUGR infants. We followed the PRISMA guidelines for meta-analysis. Six databases were searched for randomized controlled trials (RCTs) and observational studies comparing DCC and ECC in IUGR infants, focusing on neonatal resuscitation measures, hematological parameters, morbidities, and mortality. The Cochrane Collaboration tool and Newcastle-Ottawa scale were used for RCTs and observational studies, respectively. Eight studies with 1531 participants were included, comprising six RCTs and two observational studies. Serum ferritin at 3 months and initial Hb were significantly higher in the DCC group (MD: 36.16 ng/ml [95% CI: 34.09, 38.24]), (MD: 1.64 gm/dl [95%CI: 0.88, 2.4]) respectively. The risk of polycythemia was higher in the DCC group (RR 1.88, 95% CI [1.27, 2.8]), without an increase in the peak total serum bilirubin or the need for exchange transfusion. Conclusion: DCC may be beneficial and safe in IUGR infants, improving hematological parameters without affecting neonatal morbidity and mortality. Further high-quality, large trials are needed to confirm these findings and assess neurodevelopmental impact.

Cord management in non-vigorous newborns

Cord management in non-vigorous newborns remains up for debate, as limited studies have validated strategies in this high-risk population. While multiple national and international governing bodies now recommend the routine practice of delayed cord clamping (DCC) in vigorous neonates, these organizations have not reached a consensus on the appropriate approach in non-vigorous neonates.1 Benefits of placental transfusion are greatly needed amongst non-vigorous neonates who are at risk of asphyxiation-associated mortality and morbidities, but the need for immediate resuscitation complicates matters. This chapter discusses the physiological benefits of placental transfusion for non-vigorous neonates and reviews the available literature on different umbilical cord management strategies for this population.

Umbilical cord milking-benefits and risks

The most common methods for providing additional placental blood to a newborn are delayed cord clamping (DCC) and umbilical cord milking (UCM). However, DCC carries the potential risk of hypothermia due to extended exposure to the cold environment in the operating room or delivery room, as well as a delay in performing resuscitation. As an alternative, umbilical cord milking (UCM) and delayed cord clamping with resuscitation (DCC-R) have been studied, as they allow for immediate resuscitation after birth. Given the relative ease of performing UCM compared to DCC-R, UCM is being strongly considered as a practical option in non-vigorous term and near-term neonates, as well as preterm neonates requiring immediate respiratory support. However, the safety profile of UCM, particularly in premature newborns, remains a concern. This review will highlight the currently known benefits and risks of umbilical cord milking and explore ongoing studies.