2023, Vol. 6, Issue 2, Part A

Background: Global preterm birth rate 10% and rate is increasing who are at risk of many complications. Anemia of prematurity is one of the preventable complications. Umbilical cord milking is a method of placental transfusion which may help to improve hematological and clinical outcome in preterm babies.

Objective of the study: To evaluate the effect of umbilical cord milking in improving hematological and clinical outcome in preterm babies.

Methodology: This Randomized control trial study was conducted in the Department of Obstetrics and Gynecology and Department of Neonatology, from May 2021 to April 2022. Neonates born between 28 to 34 weeks were assigned to either umbilical cord milking or no intervention group according to a computer-generated randomized sequence. After delivery of a baby umbilical milking was done for two times. Then the cord was clamped close to umbilicus & cut accordingly. The main outcome measure was hematocrit level at 6 hours of age. Total serum bilirubin was measured at 48 hours of age or earlier if clinically jaundice appeared. Clinical outcome data (Systolic blood pressure, need of initial respiratory support, jaundice & need for phototherapy, IVH, necrotizing enterocolitis) were monitored until 3weeks of life or discharge which was earlier.

Results: After meeting all exclusion criteria 114 patients were able to complete the study. Among 114 preterm neonates 57 were umbilical cord milking group and 57 were no milking group. Baseline characteristics of mother and neonate were comparable between two groups. There was significant increase in hematocrit level (57.3±3.5 Vs 47.4±4.5, in cord milking group & non milking group, P less than 0.001 in cord milking group. This study showed significant reduction in need of blood transfusion in first week of life in cord milking group. It was 3.5% V 21.1% in Cord milking group & non-milking group (P less than 0.001). No significant difference found in need of supplemental oxygen but requirement of assisted ventilation was significantly lower in cord milking group (19.3% V 31.5% in cord milking & non milking group respectively, P value 0.024). No statistical differences were found on the incidence of jaundice, need of phototherapy, total serum bilirubin level, blood pressure, intraventricular hemorrhage & necrotizing enterocolitis.

Conclusion: Umbilical cord milking increases hematocrit levels in preterm babies. Newborn who received cord milking, needs less number of blood transfusion and need of assisted ventilation is less in cord milking group. But there is no significant difference in blood pressure, incidence of jaundice, need of phototherapy, intraventricular hemorrhage & necrotizing enterocolitis in cord milking & non milking group.