Milking the Umbilical Cord for Extreme Preterm Infants

Saint Louis University (SLU)

Status

Completed

Conditions

Infant, Extremely Premature

Treatments

Procedure: Milking the umbilical cord before cord clamping

Study type

Interventional

Funder types

Other

Identifiers

NCT01666847

21429

Details and patient eligibility

About

Milking the umbilical cord from the placental end toward the infant has been shown to benefit preterm infants when compared to either clamping the umbilical cord immediately or waiting delaying the clamping of the cord. Delaying cord clamping for 30-120 seconds has been shown to improve heart and lung function, reduces the need for blood transfusion, and reduces the risk for brain bleeding seen in some preterm infants. Delaying the clamping of the umbilical cord, however in extremely premature infants is not considered safe, since it also delays the resuscitation that these infants need immediately after birth. Milking the umbilical cord is believed have similar benefits to delaying the clamping of the cord, but can be done much faster (seconds rather than minutes). In this study, the cord will milked three times over about 10-20 seconds and the infant will be passed to the awaiting newborn medical team for routine care. Participants of this study will be randomly assigned to one of two study groups: the first group will have the cord milking intervention and the second group will not have any intervention other than routine, immediate cord clamping with routine care of mother and infant. Data will be collected about the mother prior to delivery and data will also be collected about the baby using computerized health records. The data will look at short term changes in red blood cell volumes, the need for blood transfusions, and rates of known complications of prematurity, including longer term developmental complications at 18-24 months.

The hypothesis is that milking the umbilical cord before cutting the cord will lead to a higher hemoglobin concentration and decrease the need for blood transfusions in extremely preterm neonates compared to the current standard of immediately clamping the umbilical cord.

Full description

Eligible infants include singleton infants born between 24 and 27 6/7 weeks gestation who do not have congenital anomalies.

Enrollment

59 patients

Sex

All

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

pregnant women/child pairs with infants born at an estimated gestation age between 24 0/7 and 27 6/7 weeks based on best estimate made by last menstrual period or ultrasound
informed consent obtained by the pregnant women prior to delivery of the infant.

Exclusion criteria

pregnancy with a multiple gestation
infants with pre- or postnatally diagnosed major congenital anomalies or probable chromosomal abnormalities
infants with hydrops fetalis