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Am J Perinatol 2019; 36(10): 990-996
DOI: 10.1055/s-0039-1679915
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

Christina E. Rodriguez
1   Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
2   Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
,
Torri D. Metz
2   Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
3   Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado
,
Shrena Patel
4   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
,
Minda Abbaszadeh
4   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
,
Bradley A. Yoder
4   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
,
Tyler Bardsley
5   Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah
,
Erin A. S. Clark
1   Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
› Author Affiliations Funding This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding, in part, from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant 8UL1TR000105 (formerly UL1RR025764). Dr. Metz was supported by the National Institute on Child Health and Human Development under Award Number 5K12HD001271–18.
Further Information

Publication History

24 January 2018

22 January 2019

Publication Date:
01 March 2019 (online)

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Abstract

Objective Our aim was to evaluate the effect of umbilical cord milking on outcomes for preterm multiples.

Study Design We implemented a policy of cord milking in neonates born at less than 30 weeks' gestation in September 2011. We compared cord milking in multiples with a historical cohort. Multivariable logistic regression models estimated the effect of cord milking on a composite neonatal adverse outcome. Secondary outcomes were hematocrit at birth, need for blood transfusion, and inotrope use.

Results We identified 149 neonates (120 twins, 29 triplets), 51 historical controls, and 98 neonates with cord milking. Cord milking was associated with a lower rate of adverse composite neonatal outcome in univariable analysis (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.15–0.84). However, in multivariable modeling, the effect was not significant (adjusted OR [aOR]: 0.54, 95% CI: 0.23–1.28). Hematocrit was 4.6 unit % (95% CI: 2–7.3) higher in the cord milking group, and cord milking was associated with a lower rate of blood transfusion (aOR: 0.28; 95% CI: 0.1–0.74; p = 0.01). There was no difference in inotrope administration.

Conclusion Umbilical cord milking was not associated with a decrease in composite neonatal adverse outcome. However, we observed an increase in hematocrit and decreased need for blood transfusion in neonates with cord milking.

Keywords

multiple gestations - preterm birth - triplet pregnancy - twin pregnancy - umbilical cord milking

Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


 

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