Original Article
Umbilical Cord Milking Stabilizes Cerebral Oxygenation and Perfusion in Infants Born before 29 Weeks of Gestation

https://doi.org/10.1016/j.jpeds.2012.03.053Get rights and content

Objective

To investigate the effects of umbilical cord milking at birth on cerebral perfusion and systemic perfusion in very low birth weight (VLBW) infants.

Study design

Cerebral tissue oxygenation index and cerebral fractional tissue oxygen extraction were monitored in 50 stable VLBW infants (gestational age <29 weeks, birth weight <1250 g), with 26 allocated to the milked group and 24 to the control group. We used near-infrared spectroscopy 3-6, 12, 18, 24, 36, 48, and 72 hours after birth. Left ventricular end-diastolic dimension, left ventricular ejection fraction, left ventricle (LV) Tei index (measurement of left ventricular systolic and diastolic function), left ventricular cardiac output, and superior vena cava flow were measured concurrently using echocardiography.

Results

There were no significant differences in gestational age and birth weight between the 2 groups. Hematocrit, left ventricular end-diastolic dimension, left ventricular cardiac output, and superior vena cava flow were higher in the milked group than in the control group, with improvement in the LV Tei index despite the absence of left ventricular ejection fraction changes within 24 hours after birth. Tissue oxygenation index increased and cerebral fractional tissue oxygen extraction decreased in the milked group within 24 hours after birth.

Conclusion

Umbilical cord milking stabilized cerebral oxygenation and perfusion in VLBW infants by improving LV diastolic function by increasing LV preload.

Section snippets

Methods

We evaluated 50 VLBW infants with a gestational age of <29 weeks and a birth weight of <1250 g, who were admitted to the neonatal intensive care unit of our institution between January 1, 2006 and December 31, 2009. Among the 50 subjects who were admitted after November 2007, 26 had umbilical cord milking, as milking management was introduced in our unit after November 1, 2007. However, as this procedure requires the presence of more than 3 doctors at birth, umbilical cord milking was not

Results

There were no significant differences in gestational age, birth weight, Apgar score at 1 minute, sex, cesarean delivery rate, antenatal steroid administration rate, or occurrence of premature rupture of the membranes between the 2 groups (Table I). The initial hemoglobin values in the milked group were significantly higher than for the control group. The initial MABP in the milked group was higher than for the control group. Urine output within 24 hours in the milked group was higher than for

Discussion

Recent randomized controlled studies have shown that umbilical cord milking facilitates the early stabilization of both blood pressure and urine output, as well as a reduced need for both red blood cell transfusion and circulatory and respiratory support in VLBW infants.10, 11 The present study also showed that the initial hemoglobin, MABP, and urine output levels within 24 hours in the milked group were higher, and the need for volume expansion was lower, than in the control group. Within 18

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  • Cited by (0)

    The authors declare no conflicts of interest.

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