155 - Effects of milking of cut umbilical cord in very preterm neonates: a randomised controlled trial in Southern India

Poster Number: 155
Publication Number: 155.112

Manoj Varanattu Chellappan, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, Kerala, India; Dhanya Divakaran, JUBILEE MISSION MEDICAL COLLEGE AND RESEARCH INSTITUTE, TRICHUR, Kerala, India; Neetha George, Jubilee Mission Medical College, Thrissur, Kerala, India; Sudha Ayyasamy, JUBILEE MISSION MEDICAL COLLEGE AND RESEARCH INSTITUTE, Erode, Tamil Nadu, India; Vijila Paulraj, Jubilee mission medical college, Trichirapalli, Tamil Nadu, India; Anirudh reddy Paidy, ESIC MEDICAL COLLEGE, SANATHNAGAR, HYDERABAD, KAMAREDDY, Telangana, India; Nice Johnson, Jubilee Mission Medical College, Thrissur, Kerala, India; Varghese P R, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India; Unnikrishnan U G, jubilee mission medical college and research institute, Thrissur, Kerala, India; Mridula Vellore, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India; Presthiena Lofi E L, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India; Maya k n, Jubilee mission medical college and research institute, Ernakulam, Kerala, India; Ditty Martin, Jubilee mission medical college and research institute, Thrissur, Kerala, India; Jesmy James, Jubilee Mission Medical College Thrissur, Thrissur, Kerala, India

Background:
Milking of umbilical cord is a method of placental transfusion, suggested by some as an alternative to delayed cord clamping. It has the potential benefit of avoiding delay in initiation of resuscitation, required in some preterm neonates, especially when facility for delayed cord clamping and simultaneous resuscitation near the mother, are not available in resource limited settings.

Objective: We aimed to evaluate if a composite of death and disability was reduced at 12 months of age when milking of cut umbilical cord was done in very preterm neonates. Secondary objectives were the effect of cut cord milking on APGAR score, hematocrit levels, requirement of phototherapy, incidence of cranial ultrasound abnormalities and duration of respiratory support and hospital stay.

Design/Methods: An open labelled randomized controlled trial was done on neonates born between 28 &32 weeks gestation in a tertiary care hospital in Southern India, after necessary approvals. Exclusion Criteria were monochorionic diamniotic twins, intrauterine growth restriction, hydrops fetalis and major congenital anomalies. Randomization was done using computer generated random numbers. In the intervention group, umbilical cord, cut 30 cm long at birth, was milked three times for 10–20 seconds, after initial resuscitation measures. Early cord clamping was done without milking in the controls. Primary outcome was the composite of death and disability at one year. Amiel Tison angles, Trivandrum development screening chart, development assessment scale for Indian infants and detailed neurologic evaluation were used to evaluate the neuro-developmental outcome. 

Results: Of the 218 neonates screened between 1 April 2018 and 1 April 2021, 179 could be evaluated finally. Milking was done in 93 neonates and 86 acted as controls. Composite of death and disability at one year was significantly lower in the intervention group (odds ratio 2.136; 95%CI, 1.006-4.533; p=0.046). Among the other variables, significant association was observed with death (odds ratio 4.7; 95%CI, 1.65-13.2; p=0.002), abnormal cranial ultrasound findings at 28 days (χ2 = 3.983 at P= 0.046) and need for ventilator support (χ2 = 3.344 at P= 0.047). No adverse outcome was observed due to milking.Conclusion(s): Cut umbilical cord milking was found to significantly improve the survival and neurodevelopmental outcome in very preterm neonates in our study. These potential benefits that look promising and relevant in resource limited setting, however need to be further validated by large multicentric trials, before cut cord milking can be recommended as the standard of care.
Table 1: Demographic ProfileData are number of patients unless otherwise indicated. SD: Standard deviation
Table 2: Primary Outcome and other details of death and disability upto one year of corrected ageData are number of patients unless otherwise specified. TDSC: Trivandrum development screening chart, DASII: development assessment scale for Indian infants DASII, SD: Standard deviation, DQ: developmental quotients