The Effects of Umbilical Cord Milking on Hemodynamics and Neonatal Outcomes in Premature Neonates

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• 作者：Anup C. Katheria ; MD¹ ; ^{anup.katheria@sharp.com" class="auth_mail} ; Tina A. Leone ; MD² ; Doug Woelkers ; MD³ ; Donna M. Garey ; MD⁴ ; Wade Rich ; RRT¹ ; Neil N. Finer ; MD¹ ; ⁴
• 关键词：BP ; Blood pressure ; DCC ; Delayed cord clamping ; FO ; Foramen ovale ; Hct ; Hematocrit ; ICC ; Immediate cord clamping ; IVH ; Intraventricular hemorrhage ; LVO ; Left ventricular output ; OB ; Obstetrician ; PDA ; Patent ductus arterious ; PMA ; Postmenstrual age ; RVO ; Right ventricular output ; SVC ; Superior vena cava ; UCM ; Umbilical cord milking
• 刊名：The Journal of Pediatrics
• 出版年：May, 2014
• 年：2014
• 卷：164
• 期：5
• 页码：1045-1050.e1
• 全文大小：423 K

文摘

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Objective

To determine whether umbilical cord milking (UCM) improves systemic blood flow and reduces neonatal morbidities compared with immediate cord clamping (ICC).

Study design

Women admitted to a tertiary care center and delivering before 32 weeks' gestation were randomized to receive UCM or ICC. Three blinded serial echocardiograms were performed in the first 2 days of the infant's life. The primary outcome was measured systemic blood flow (superior vena cava flow) at each time point.

Results

Of the 60 neonates who were enrolled and randomized, 30 were assigned to cord milking and 30 to ICC. Neonates randomized to cord milking had greater measures of superior vena cava flow and right ventricular output in the first 6 hours and 30 hours of life. Neonates receiving UCM also had greater serum hemoglobin, received fewer blood transfusions, fewer days on oxygen therapy, and less frequent use of oxygen at 36 weeks' corrected postmenstrual age.

Conclusions

We demonstrate greater systemic blood flow with UCM in preterm neonates compared with ICC. Future large prospective trials are needed to determine whether UCM reduces intraventricular hemorrhage and other long-term morbidities.