NIH: Umbilical cord milking may be linked to higher risk of brain bleeding in preterm infants

Milking the umbilical cord — gently squeezing the cord and pushing the contents into the newborn’s abdomen before clamping the cord — could increase the risk for severe intraventricular hemorrhage, or bleeding into the brain’s fluid-filled cavities, in extremely preterm infants, according to results of a study funded by the National Institutes of Health that was halted for safety concerns.

The study, led by Anup Katheria, M.D., of the Sharp Mary Birch Hospital for Women and Newborns in San Diego and colleagues at institutions in the United States and Europe, had sought to determine if cord milking was an alternative to delayed cord clamping. Unlike cord milking, a delay in clamping allows time for the blood to flow naturally from the cord into the abdomen before clamping and cutting the cord.

After extremely preterm infants (23 to 27 weeks gestation) in the cord milking group were found to have more hemorrhages inside the ventricles, compared to the earliest preterm infants in the delayed clamping group, the study was stopped before enough infants could be enrolled to allow for a statistically valid analysis.

Some studies of term infants have found that delayed cord clamping reduces the chances of anemia and appears to benefit cognitive development in early childhood. In preterm infants, however, the extra time needed for delayed cord clamping also may delay the start of the respiratory support often needed for the infants’ underdeveloped lungs.

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Katheria, A, et al Association of umbilical cord milking vs delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants. Journal of the American Medical Association. 2019