TY - JOUR
T1 - Umbilical cord milking versus delayed cord clamping in term and late-preterm infants
T2 - a systematic review and meta-analysis
AU - Jeevan, Amrit
AU - Ananthan, Anitha
AU - Bhuwan, Manjari
AU - Balasubramanian, Haribalakrishna
AU - Rao, Shripada
AU - Kabra, Nandkishor S.
PY - 2021/2/10
Y1 - 2021/2/10
N2 - Objective: To conduct a systematic review and meta-analysis to compare the efficacy and safety of umbilical cord milking (UCM) versus delayed cord clamping (DCC) in term and late-preterm infants. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Clinical trial registries, and Gray literature were searched for randomized controlled trials (RCTs) comparing UCM with DCC in term and late-preterm infants for both short-term and long-term outcomes. Intact and cut UCM were compared separately with DCC using subgroup analysis. We used fixed effect model to pool the data. Random effects model was used when there was significant heterogeneity. Results: Nine studies (1632 infants) were included in the systematic review. Milking was performed on intact cord (i-UCM) in five studies (n = 829) and on cut cord (c-UCM) in four studies (n = 803). Cord milking significantly improved hemoglobin level at 48–72 h of life when compared to DCC (six studies, n = 924, mean difference 0.36 g/dL; 95% CI: 0.19–0.53). In addition, hemoglobin level at six to eight weeks of age was also significantly higher in the studies comparing i-UCM with DCC (two studies, n = 550: mean difference 0.16 g/dL; 95% CI: 0.06–0.27). There was no difference between the UCM group and DCC group for any other outcome. Only one study provided information on growth and hematological parameters at one year of age. Neurodevelopmental outcomes were not reported. None of the studies included non-vigorous infants. The grade of evidence was low to very low for all the outcomes studied. Conclusion: UCM is comparable to DCC in improving short-term hematological outcomes in term and late-preterm vigorous infants. Trials assessing the effect of UCM on important clinical and long-term outcomes among non-vigorous mature preterm infants are urgently required.
AB - Objective: To conduct a systematic review and meta-analysis to compare the efficacy and safety of umbilical cord milking (UCM) versus delayed cord clamping (DCC) in term and late-preterm infants. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Clinical trial registries, and Gray literature were searched for randomized controlled trials (RCTs) comparing UCM with DCC in term and late-preterm infants for both short-term and long-term outcomes. Intact and cut UCM were compared separately with DCC using subgroup analysis. We used fixed effect model to pool the data. Random effects model was used when there was significant heterogeneity. Results: Nine studies (1632 infants) were included in the systematic review. Milking was performed on intact cord (i-UCM) in five studies (n = 829) and on cut cord (c-UCM) in four studies (n = 803). Cord milking significantly improved hemoglobin level at 48–72 h of life when compared to DCC (six studies, n = 924, mean difference 0.36 g/dL; 95% CI: 0.19–0.53). In addition, hemoglobin level at six to eight weeks of age was also significantly higher in the studies comparing i-UCM with DCC (two studies, n = 550: mean difference 0.16 g/dL; 95% CI: 0.06–0.27). There was no difference between the UCM group and DCC group for any other outcome. Only one study provided information on growth and hematological parameters at one year of age. Neurodevelopmental outcomes were not reported. None of the studies included non-vigorous infants. The grade of evidence was low to very low for all the outcomes studied. Conclusion: UCM is comparable to DCC in improving short-term hematological outcomes in term and late-preterm vigorous infants. Trials assessing the effect of UCM on important clinical and long-term outcomes among non-vigorous mature preterm infants are urgently required.
KW - delayed cord clamping
KW - late-preterm infants
KW - neonates
KW - term infants
KW - Umbilical cord milking
UR - http://www.scopus.com/inward/record.url?scp=85101027791&partnerID=8YFLogxK
U2 - 10.1080/14767058.2021.1884676
DO - 10.1080/14767058.2021.1884676
M3 - Review article
C2 - 33567910
AN - SCOPUS:85101027791
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
SN - 1476-4954
ER -