Does Umbilical Cord Milking Affect Neonatal Cerebral Blood Flow More Than Delayed Cord Clamping?

Amit Upadhyay, Sunil Gothwal, Bimlesh Kumar, Vijay Jaiswal, Payas Joshi, Kirti Dubey


Aim: To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on cerebral blood flow (CBF) in term neonates

Materials and Methods: This randomized controlled trial was conducted in a teaching hospital in North India between August 2012 and August 2013. Two hundred term neonates, born at > 36 weeks of gestation, were randomized into 2 groups—UCM group and DCC group. In the UCM group, UCM was done after cutting and clamping the cord at 25 cm from the umbilicus. In the DCC group, clamping was done after a delay of 60 to 90 seconds. Cranial Doppler indices including the resistive index (RI), pulsatility index (PI), and CBF velocity of middle cerebral artery (MCA) at 24 to 48 hours of life were measured.

Results: Baseline characteristics were comparable in both groups. The mean PI (1.18 [0.26]) and RI (0.65 [0.08]) in UCM group were comparable to the mean PI (1.18 [0.25]) and RI (0.65 [0.08]) in DCC group. There was no difference in hemodynamic status between the 2 groups. The peak systolic velocity and end diastolic velocity of blood flow in the MCA for the UCM group were 34.94 (11.82) cm/s and 11.71 (4.75) cm/s, respectively, while in the DCC group, they were 37.24 (12.63) cm/s and 13.07 (4.78) cm/s, respectively (P = .23 and .07, respectively). The mean velocity was found to be 18.96 (6.57) cm/s in the UCM group and 20.95 (7.23) cm/s in the DCC group (P = .06). Indices among growth-retarded neonates were similar.

Conclusion: Both UCM and DCC have similar effects on CBF velocities and Doppler indices of the MCA in term neonates.

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