A recent study funded by the National Institutes of Health (NIH) has found that umbilical cord milking does not increase the risk of neurodevelopmental impairment in non-vigorous infants. This blood-sparing treatment appears to be a safe alternative to the current standard of early clamping and cutting of the umbilical cord, particularly in newborns who are limp, pale, and have minimal breathing. The study, which involved nearly 1,000 full-term and near-term infants, provides new insights into the safety and efficacy of umbilical cord milking compared to traditional methods.
Image Source NIH
Background and Current Practices
Standard Practice for Non-Vigorous Infants
Non-vigorous infants are at significant risk for complications such as low oxygen levels in the brain, cerebral palsy, and stroke. To address these risks, the standard medical practice involves immediately clamping and cutting the umbilical cord to begin resuscitation efforts as quickly as possible. This practice aims to stabilize the infant and address any immediate health concerns.
Delayed Clamping in Vigorous Infants
In contrast, the current recommendation for vigorous, full-term infants is to delay clamping and cutting the umbilical cord for at least 30 to 60 seconds after birth. This delay allows blood from the cord to enter the newborn’s circulation, resulting in higher levels of hemoglobin (a protein indicating the presence of red blood cells) and iron. Delayed clamping has been shown to provide various health benefits for these infants, leading to its widespread adoption in clinical settings.
The Study and Its Findings
Study Design and Methodology
The recent study was conducted by Anup Katheria, M.D., and his colleagues at Sharp Mary Birch Hospital for Women and Newborns in San Diego, along with researchers from institutions in the United States, Canada, and Poland. The study, published in JAMA Network Open, aimed to evaluate the safety of umbilical cord milking in non-vigorous full-term and near-term infants.
Umbilical cord milking involves moving blood from the umbilical cord into the newborn’s body. During the procedure, attending providers milked 20 centimeters of the umbilical cord for two seconds and repeated this process three times. The study’s primary focus was to compare the neurodevelopmental outcomes of infants who underwent umbilical cord milking with those who received early cord clamping and cutting.
Results of the Study
The study included 964 surviving infants who were evaluated with a developmental screening tool known as the Ages and Stages Questionnaire-3. This tool helps identify potential delays in children’s development before they reach two years of age. The results showed that the 502 children in the umbilical cord milking group had scores ranging from 225 to 280, which were similar to the scores of 469 children in the early cord clamping group, which ranged from 230 to 280.
Additionally, 927 surviving children were assessed using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), a screening tool for autism spectrum disorder (ASD) in toddlers. The proportions of children scoring with medium-to-high risk for ASD did not differ significantly between the two groups: 45 of 486 in the umbilical cord milking group and 37 of 441 in the early cord clamping group.
Implications and Benefits of Umbilical Cord Milking
Reduced Need for Resuscitation
The previous study, which prompted this follow-up research, found that non-vigorous infants who underwent umbilical cord milking were less likely to require heart and respiratory support. They also had a lower incidence of low oxygen and/or blood levels in the brain compared to those who had early cord clamping and cutting. These findings suggest that umbilical cord milking can provide immediate physiological benefits to non-vigorous infants.
Improved Blood Flow and Oxygen Levels
Furthermore, the follow-up study indicated that non-vigorous infants who received cord milking had increased blood pumped from the heart and enhanced blood flow to the lungs and brain. These improvements in circulation and oxygenation are critical for the overall health and development of newborns, particularly those who are non-vigorous at birth.
A Safe and Effective Alternative
The study’s authors concluded that, based on the combined benefits observed in their research, umbilical cord milking is a reasonable intervention for non-vigorous full-term and near-term infants. It does not appear to increase the risk of neurodevelopmental delays, making it a safe alternative to the current standard of immediate cord clamping and cutting.
Future Considerations
As with any medical practice, it is essential to continue monitoring and evaluating the long-term outcomes of infants who undergo umbilical cord milking. Further research may help refine the procedure and optimize its use in various clinical settings. However, the current evidence supports the safety and efficacy of umbilical cord milking, providing healthcare providers with an additional option for managing non-vigorous newborns.
Join TISHHA.
