DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20201540

A randomised control trial comparing the efficacy of cord milking over the delayed cord clamping on serum ferritin level in preterm neonates at 6 weeks of age

Sahana Devadas, Roshni R., Mallesh K.

Abstract


Background: Perinatal iron deficiency has received little attention in the past. Umbilical cord milking is a type of placental transfusion, they serve to potentially enhance neonatal blood volume and consequently the iron stores after birth. Among the neonates, the preterm infants are sick and vulnerable babies who are already deprived of iron stores. The aim of this study was to evaluate the effect of cord milking on ferritin values amongst preterm neonates.

Methods: This is a hospital based randomized control trial which included the babies born at 29-36 weeks of gestation. The babies were randomized to two intervention groups; cord milking and delayed cord clamping group. Detailed clinical history taken, including details of labour and clinical examination. Blood samples were analysed for ferritin as required at 6 weeks of post-natal age.

Results: Neonates under cord milking group had higher ferritin values (249.04±21.93 ng/mL) as compared to those neonates under delayed cord clamping group (179.66±32.94 ng/mL) and this was statistically very significant (p= <0.001).

Conclusions: In preterm neonates, umbilical cord milking results in improved iron status as shown by higher ferritin values at 6 weeks of life. UCM can be a used as placental transfusion strategy in preterm neonates for improving iron status and preventing anemia of prematurity.


Keywords


Anemia of prematurity, Ferritin, Placental transfusion, Umbilical cord milking

Full Text:

PDF

References


Grantham MC,GregorS,Ani C. A review of the studies of iron deficiency on cognitive development in children. J Nutr. 2001;131:649-68.

Gupta R, Ramji S. Effect of delayed cord clamping on iron stores in infants born to anaemic mothers: a randomized controlled trial. Indian Pediatr. 2002;39:130-513.

Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, Okada T, et al. Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks' gestation: a randomised controlled trial. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2008 Jan;93(1).

AHA/AAP Neonatal Resuscitation Guidelines 2010: summary of major changes and comment on its utility in resource-limited settings.

Widdowson EM, Spray CM. Chemical development in utero. Arch. Dis. Child. 1957;26:205-14.

Chaparro CM. Timing of umbilical cord clamping: effect on iron endowment of the newborn and later iron status. Nutrition Rev. 2011;69.

Kumar B, Upadhyay A, Gothwal S, Jaiswal V, Joshi P, Dubey K. Umbilical cord milking and hematological parameters in moderate to late preterm neonates: A randomized controlled trial. Indian Pediatr Indian Pediatrics. 2015;52(9):753-7.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks’ gestation: An update with clarifications. Pediatrics. 2009;124:1193-8.

American Academy of Pediatrics Subcommittee on Hyperbilirubinemia, Clinical Practice Guideline: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2009;11:4297-316.

Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews. 2012.

Berger R, Söder S. Neuroprotection in Preterm Infants. Bio Med Research International. 2015;2015:1-14.

Rabe H, Sawyer A, Amess P, Ayers S. Neurodevelopmental Outcomes at 2 and 3.5 Years for Very Preterm Babies Enrolled in a Randomized Trial of Milking the Umbilical Cord versus D elayed Cord Clamping. Neonatology. 2015Oct;109(2):1139.

Hosono S, Tamura M, Kusuda M, Hirano S, Mori R, Fujimura M. Eighteen-Month Corrected Age Developmental Outcomes of Extremely Preterm Infants Enrolled in a Randomized Controlled Trial of One-Time Umbilical Cord Milking Versus Immediate Cord Clamping. Randomized Controlled Trial .Proceedings of annual meeting of Pediatric Academic Societies. Apr 30-May 3;2016.

Katheria A, Blank D, Rich W, Finer N. Umbilical Cord Milking Improves Transition in Premature Infants at Birth. PLoS One. 2014Jul;9(4).

Rabe H, Jewison A, Alvarez RF, Crook D, Stilton D, Bradley R, et al. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstetr Gynecol. 2011 Feb 1;117(2):205-11.

Alan S, Arsan S, Okulu E, Akin IM, Kilic A, Taskin S, et al. Effects of Umbilical Cord Milking on the Need for Packed Red Blood Cell Transfusions and Early Neonatal Hemodynamic Adaptation in Preterm Infants Born ≤1500 g. J Pediatr Hematol Oncol. 2014;36(8).

March MI, Hacker MR, Parson AW, Modest AM, Veciana MD. The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial. J Perinatol J Perinatol. 2013;33(10):763-7

Yadav AK, Upadhyay A, Gothwal S, Dubey K, Mandal U, Yadav CP. Comparison of three types of intervention to enhance placental redistribution in term newborns: randomized control trial. J Perinatol J Perinatol. 2015;35(9):720-4.

Bora R, Akhtar SS, Venkatasubramaniam A, Wolfson J, Rao R. Effect of 40-cm segment umbilical cord milking on hemoglobin and serum ferritin at 6 months of age in full-term infants of anemic and non-anemic mothers. J Perinatol J Perinatol. 2015;35(10):832-6.

Upadhyay A, Gothwal S, Parihar R, Garg A, Gupta A, Chawla D, et al. Effect of umbilical cord milking in term and near-term infants: randomized control trial. Am J Obstetr Gynecol. 2013;208(2).

Jaiswal P, Upadhyay A, Gothwal S, Singh D, Dubey K, Garg A, et al. Comparison of two types of intervention to enhance placental redistribution in term infants: randomized control trial. European Journal of Pediatrics Eur J Pediatr. 2015;174(9):1159-67.

Hosono S, Mugishima H, Takahashi S, Takahashi S, Masaoka N, Yamamoto T, et al. One-time umbilical cord milking after cord cutting has same effectiveness as multiple-time umbilical cord milking in infants born at <29 weeks of gestation: a retrospective study. J Perinatol J Perinatol. 2015 Dec;35(8):590-4.

Hosono S, Hine K, Nagano N, Taguchi Y, Yoshikawa K, Okada T, et al. Residual blood volume in the umbilical cord of extremely premature infants. Pediatrics International Pediatr Int. 2014 Oct;57(1):68-71.

Siddappa AM, Rao R, Long JD, Widness JA, Georgieff MK. The Assessment of Newborn Iron Stores at Birth: A Review of the Literature and Standards for Ferritin Concentrations. Neonatology. 2007;92(2):73-82.

Kaempf JW, Tomlinson MW, Kaempf AJ, Wu Y, Wang L, Tipping N, Grunkemeier G. Delayed umbilical cord clamping in premature neonates. Obstet Gynecol. 2012 Aug;120(2 Pt 1):325-30.

Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants. Pediatrics. 2015;136(1):61-9.

Al-Wassia H, Shah PS. Efficacy and Safety of Umbilical Cord Milking at Birth. JAMA Pediatrics JAMA Pediatr. 2015 Jan;169(1):18.