Skip Ribbon Commands
Skip to main content
SharePoint

PublicComment

 Feedback

If you have any comments or questions on this page, please email us at:
 

Umbilical cord milking

Question Type:
Intervention
Full Question:
In very preterm infants  (P), does milking the umbilical cord (I), compared with immediately clamping the umbilical cord (C), change airway pressure (O)?
Consensus on Science:
For the critical outcome of death, we found low-quality evidence (downgraded for very serious imprecision) from 3 randomized clinical trials (Hosono 2008, F14; March 2013, 763; Katheria 2014, 1045) showing that there is no difference in death (OR, 0.76; 95% CI, 0.25–2.29). For the critical outcome of cardiovascular stability, we found low-quality evidence (downgraded for imprecision) from 2 randomized studies (Hosono 2008, F14; Katheria 2014, 1045) showing that the initial mean blood pressure was 5.43 mm Hg higher (range, 1.98–8.87 mm Hg) in the group receiving umbilical cord milking. For the critical outcome of IVH, we found low-quality evidence (downgraded for very serious imprecision) from 2 randomized clinical trials (Hosono 2008, F14; March 2013, 763) showing a reduction of IVH (all grades: OR, 0.37; 95% CI, 0.18–0.77) but no difference (from 1 randomized clinical trial (Hosono 2008, F14) in severe IVH; OR, 0.44; 95% CI, 0.07–2.76) (low-quality evidence, downgraded for very serious imprecision) when umbilical cord milking was performed. For the critical outcome of neurologic outcome at 2 to 3 years, we did not identify any evidence to address this. For the important outcome of hematologic indices, we found low-quality evidence (downgraded for imprecision) from 2 randomized clinical trials (Hosono 2008, F14; Katheria 2014, 1045) showing that cord milking increased the initial hemoglobin level (MD, 2.27 g/dL; 95% CI, 1.57–2.98 g/dL) and low-quality evidence (downgraded for imprecision) from 3 randomized clinical trials (Hosono 2008, F14; March 2013, 763; Katheria 2014, 1045) showing that cord milking decreased transfusion (OR, 0.2; 95% CI, 0.09–0.44). For the important outcome of temperature, we found low-quality evidence (downgraded for very serious imprecision) from 1 randomized clinical trial (Katheria 2014, 1045) showing that the temperature of the milking group was not different on admission. For the important outcome of bilirubin indices, we found low-quality evidence (downgraded for very serious imprecision) showing that the maximum bilirubin measurement (3 randomized clinical trials (Hosono 2008, F14; March 2013, 763; Katheria 2014, 1045) and use of phototherapy (1 study (March 2013, 763)) was not different between groups.
Treatment Recommendation:
We suggest against the routine use of cord milking for infants born at ≤28 weeks of gestation, because there is insufficient published human evidence of benefit. Cord milking may be considered on an individual basis or in a research setting, as it may improve initial mean blood pressure and hematologic indices and reduce intracranial hemorrhage. There is no evidence for improvement in long-term outcomes (weak recommendation, low-quality evidence). All studies included in this evidence review milked 20 cm of umbilical cord toward the umbilicus 3 times while the infant was held at the level of the introitus or below the level of the placenta before cord clamping. Values, Preferences, and Task Force Insights In making this recommendation, we place a higher value on the unknown safety profile and less value on the simplicity/economy of this intervention. Much of the deliberations focused on the wording of the treatment recommendation. The first recommendation proposed was, “We suggest that cord milking be performed at delivery for VLBW infants as opposed to immediate cord clamping.” A second recommendation was, “We suggest that cord milking may be performed at delivery for VLBW as opposed to immediate cord clamping but should not be regarded as a standard of care.” A third recommendation was, “We suggest that cord milking may be performed at delivery for VLBW as opposed to immediate cord clamping to improve initial mean blood pressure, hematologic indices, and IVH (Grades 1 and 2).” However, concerns were raised related to the absence of evidence pertinent to long-term outcomes and, in particular, neurologic outcome. Moreover, there was serious imprecision in the data. These factors led to the final treatment recommendation.
CoSTR Attachments:
GRADE GRID - 849.pdf    
Milking PDF.pdf    

 Contact Us

 
If you have any comments or questions on this page, please email us at: