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Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial

Journal of Perinatology volume 32, pages 580–584 (2012)Cite this article

Subjects

Abstract

Objective:

The study's objective was to compare hematocrit (Hct) levels at 36 to 48 h of age in term infants delivered by cesarean section exposed to immediate cord clamping or umbilical cord milking (UCM).

Study Design:

In this randomized controlled trial, 24 women scheduled for elective cesarean section were randomized to either immediate clamping (<10 s) or UCM (milked × 5 by the obstetrical provider) at birth.

Result:

All subjects received their allocated intervention. The milking group had a smaller placental residual blood volume (13.2±5.6 vs 19.2±5.4 ml kg–1, P=0.01) and higher Hct levels at 36 to 48 h (57.5±6.6 vs 50.0±6.4 %, P=0.01). Five infants (42%) in the immediate group had a Hct of ⩽47%, indicative of anemia.

Conclusion:

UCM results in placental transfusion in term infants at the time of elective cesarean section with higher Hct levels at 36 to 48 h of age.

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References

  1. Yao AC, Moinian M, Lind J . Distribution of blood between infant and placental after birth. Lancet 1969; 2: 871–873.

    Article  CAS  Google Scholar 

  2. Dewey KG, Chaparro CM . Session 4: mineral metabolism and body composition. P Nutr Soc 2007; 66: 412–422.

    Article  CAS  Google Scholar 

  3. Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG . Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet 2006; 367: 1997–2004.

    Article  CAS  Google Scholar 

  4. Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C et al. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics 2006; 117: e779–e786.

    Article  Google Scholar 

  5. Ceriani Cernadas JM, Carroli G, Pellegrini L, Ferreira M, Ricci C, Casas O et al. The effect of early and delayed umbilical cord clamping on ferritin levels in term infants at six months of life: a randomized, controlled trial. Arch Argent Pediatr 2010; 108: 201–208.

    PubMed  Google Scholar 

  6. McCausland A, Holmes F, Schumann W . Management of cord and placental blood and its effect upon the newborn. Part I. Transact Pac Coast Obstet Gynecol Soc 1949; 17: 87–104.

    CAS  Google Scholar 

  7. Siddall R, Crissey R, Knapp W . Effect on cesarean section babies of stripping or milking of the umbilical cord. Am J Obstet Gynecol 1952; 63: 1059–1064.

    Article  CAS  Google Scholar 

  8. Siddall R, Richardson R . Milking or stripping the umbilical cord; effect on vaginally delivered babies. Obstet Gynecol 1953; 1: 230–233.

    CAS  PubMed  Google Scholar 

  9. Colozzi AE . Clamping of the umbilical cord; its effect on the placental transfusion. New Engl J Med 1954; 250: 629–632.

    Article  CAS  Google Scholar 

  10. Lanzkowsky P . Effects of early and late clamping of umbilical cord on infant′s haemoglobin level. Brit Med J 1960; 2: 1777–1782.

    Article  CAS  Google Scholar 

  11. Whipple GA, Sisson TR, Lund CJ . Delayed ligation of the umbilical cord; its influence on the blood volume of the newborn. Obstet Gynecol 1957; 10: 603–610.

    Article  CAS  Google Scholar 

  12. Usher R, Shephard M, Lind J . The blood volume of the newborn infant and placental transfusion. Acta Paediatr 1963; 52: 497–512.

    Article  CAS  Google Scholar 

  13. Walsh SZ . Early clamping versus stripping of cord: comparative study of electrocardiogram in neonatal period. Brit Heart J 1969; 31: 122–126.

    Article  CAS  Google Scholar 

  14. Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, Okada T et al. Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks′ gestation: a randomised controlled trial. Arch Dis Child-Fetal 2008; 93: F14–F19.

    Article  CAS  Google Scholar 

  15. Hutton EK, Hassan ES . Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. J Amer Med Assoc 2007; 297: 1241–1252.

    Article  CAS  Google Scholar 

  16. Nelle M, Zilow EP, Bastert G, Linderkamp O . Effect of Leboyer childbirth on cardiac output, cerebral and gastrointestinal blood flow velocities in full-term neonates. Am J Perinat 1995; 12: 212–216.

    Article  CAS  Google Scholar 

  17. Luchtman-Jones L, Schwartz AL, Wilson DB . Hematologic problems in the fetus and neonate. In: Martin RJ, Fanaroff AA, Walsh C (eds). Fanaroff and Martin′s Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant, 8th edn, vol. 2. Mosby-Elsevier: Philadelphia, 2006, pp 1287–1356.

    Google Scholar 

  18. Rao R, Georgieff MK . Iron in fetal and neonatal nutrition. Semin Fetal Neonat M 2007; 12: 54–63.

    Article  Google Scholar 

  19. Mercer J, Skovgaard R . Neonatal transitional physiology: a new paradigm. J Perinat Neonat Nur 2002; 15: 56–75.

    Article  Google Scholar 

  20. McDonald SJ, Middleton P . Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane DB Syst Rev 2008. Art. No.: CD004074. doi:10.1002/14651858.CD004074.pub2.

  21. Grajeda R, Perez-Escamilla R, Dewey KG . Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. Am J Clin Nutr 1997; 65: 425–431.

    Article  CAS  Google Scholar 

  22. Gupta R, Ramji S . Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial. J Indian Acad Pediatr 2002; 39: 130–135.

    Google Scholar 

  23. Emhamed MO, van Rheenen P, Brabin BJ . The early effects of delayed cord clamping in term infants born to Libyan mothers. Trop Doct 2004; 34: 218–222.

    Article  Google Scholar 

  24. van Rheenen P, Brabin BJ . Late umbilical cord-clamping as an intervention for reducing iron deficiency anaemia in term infants in developing and industrialised countries: A systematic review. Ann Tropical Paediatr 2004; 24: 3–16.

    Article  Google Scholar 

  25. Lukowski AF, Burden MJ, Jonides J, Nelson CA, Kaciroti N, Jimenez E et al. Iron deficiency in infancy and neurocognitive functioning at 19 years: evidence of long-term deficits in executive function and recognition memory. Nutr Neurosci 2010; 13: 54–70.

    Article  CAS  Google Scholar 

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Acknowledgements

This work was funded by the American College of Nurse-Midwives Foundation, Sigma Theta Tau International-Delta Upsilon Chapter-at-Large, the Rhode Island Nursing Foundation.

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Authors and Affiliations

  1. University of Rhode Island, College of Nursing, Kingston, RI, USA

    D A Erickson-Owens & J S Mercer

  2. Warren Alpert Medical School of Brown University, Providence, RI, USA

    W Oh

Authors
  1. D A Erickson-Owens
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  2. J S Mercer
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  3. W Oh
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Correspondence to D A Erickson-Owens.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Erickson-Owens, D., Mercer, J. & Oh, W. Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial. J Perinatol 32, 580–584 (2012). https://doi.org/10.1038/jp.2011.159

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