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16078

Effect of Umbilical Cord Milking On Hematological Parameters In Term and near Term Infants: A Randomised Control Trial

Friday, October 19, 2012
Room R02-R05 (Morial Convention Center)
Sunil Gothwal1, Amit Upadhyay1, Rajeshwari Dhandhai1, Amit Garg2, Abhilasha Gupta3, Deepak Chawla4 and Ish K. Gulati5, (1)Department of Pediatrics, L.L.R.M.Medical College, Meerut, India, (2)Department of Microbilogy, L.L.R.M.Medical College, Meerut, India, (3)Department of Obstetrics, L.L.R.M.Medical College, Meerut, India, (4)Department of Pedaitrics, Government Medical College, Chandigarh,India, (5)Division of Neonatology,Department of Pediatrics, Nationwide Children's Hospital, OH, United States.

Purpose: To investigate the effect of umbilical cord milking as compared to early cord clamping on haematological parameters at 6 weeks of age among term and near term  neonates.

Methods: Design: A randomised controlled trial. Subjects: The subjects were term & near term newborns randomized in two groups (100 each). Group 1: Umbilical cord milking(UCM) group, Group 2 (Control) No milking of umbilical cord (Control group). Newborn management other than cord milking was identical in both the groups. Method of cord milking: After delivery, baby was held at the level of introitus. The umbilical cord was clamped and cut at placental end within 30 seconds (early cord clamping) after leaving at least 25 cm length from umbilical end of cord. The baby was then placed under radiant warmer and the umbilical cord was milked from cut end towards the umbilical end 3 times, with speed of 10 cm/sec and then clamped 2-3 cm above from umbilicus. Primary Outcome variables were Haemoglobin & Serum ferritin at 6 weeks of life.Unpaired t test and chi square /fisher exact test were used for stastistical analysis.

Results: Baseline characteristics were comparable in the two groups. Mean Hb at 48 hours and mean Hb and serum ferritin at 6 weeks were significantly higher in milking group.

Table 1 Haematological Parameters

Parameters

UCM group

Control group

P value

95% CI of difference

Hb at 12 hours

15.16 (2.53)

13.52 (2.12)

0.0001

-2.29 to -0.99

Hb at 48 hours

11.90 (1.553)

10.82 (0.90)

0.0001

-1.48 to -0.69

Hb at 6 weeks

11.87 (1.53)

10.83 (0.90)

0.0001

-1.48 to -0.694

Serum ferritin at 6 weeks

355.86(182.56)

177.47(135.8)

0.0001

-231.20 to -125.56

Mean (SD), CI= Confidence interval, Hb=haemoglobin

Mean blood pressure at 30min, 12hrs, and 48 hrs after birth was significantly higher, but within normal range, in milked group. No significant difference was observed in heart rate, respiratory rate and serum bilirubin in the two groups.

Conclusion: Umbilical cord milking is a safe procedure and it improved haemoglobin and iron status at 6 weeks among term and near term infants, without causing significant increase in respiratory distress or jaundice.