Premature Infants Receiving Delayed Cord Clamping with and without Cord Milking: A Randomized Control Trial

Abstract Background: Premature babies often have long hospital stays and frequent blood tests; they often develop anemia requiring multiple blood transfusions. Placental transfusion via delayed cord clamping (DCC) or umbilical cord milking (UCM) helps increase blood volume. We hypothesized umbilical cord milking (UCM), together with DCC, would be a superior in reducing blood transfusions.Objectives: To compare the effects of DCC and DCC combined with UCM on hematologic outcomes among preterm infants. Methods: 120 singleton preterm infants born at 280/7- 336/7 weeks of gestation at Thammasat University Hospital were enrolled in a randomized controlled, open label, trial. They were placed into three groups (1:1:1) by a block-of-three randomization: DCC for 45 seconds, DCC with UCM performed before clamping (DCM-B), and DCC with UCM performed after clamping (DCM-A). The primary outcomes were hematocrit levels and number of infants receiving blood transfusions during the first 28 days of life. Intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) were secondary outcomes. Analysis were performed with an intent-to-treat approach.Results: 120 preterm infants were randomized. There was no statistically significant difference in neonatal outcomes; hematocrit on admission 54.0 ± 5.5, 53.3 ± 6.0, and 54.3 ± 5.8, receiving blood transfusions 25%, 20% and 12.5%, incidence of NEC 7.5, 0 and 10% in the DCC, DCM-B and DCM-A groups, respectively. There were no preterm infants with severe IVH, polycythemia, maternal or neonatal death.Conclusion: Although it was not significantly different, preterm infants in DCM-B and DCM-A groups requiring blood transfusion were less than those in DCC group. All three placental transfusion techniques provided the same benefit in preterm infants in reducing the incidence of severe IVH and NEC without increasing complication and comorbidity. Trial Registration: TCTR20190131002Registered 31 January 2019 - Retrospectively registered http://www.thaiclinicaltrials.org/show/TCTR20190131002