Anup Katheria, MD, FAAP and Eric Gibson, MD
Umbilical cord milking has been regarded as a potential viable alternative to delayed cord clamping in infants who require immediate resuscitation, but how safe is this alternative means of placental transfusion?
Infants requiring immediate resuscitation may benefit considerably from placental transfusion, but their need for immediate intervention may preclude the ability to perform delayed cord clamping. The PREMOD2 trial is a multi-national trial of premature infants between 23-31 weeks gestation, designed to test the hypothesis that infants receiving umbilical cord milking are not inferior to the those receiving delayed cord clamping with regard to severe intraventricular hemorrhage (IVH) and/or death. However, following an interim assessment, recruitment into the trial was stopped based on the safety outcome of increased severe IVH in the subset of infants at 23-27 weeks gestation randomized to umbilical cord milking. This may have been related to higher comorbidities in the most premature infants, but can also potentially be attributed to a rapid surge of cerebral and carotid blood flow as compared to that achieved with delayed cord clamping. There were no differences in those infants at higher gestational ages. The remarkably large sample size in this study was achieved due to enrollment via deferred consent, which was a feasible strategy due to the fact that umbilical cord milking was initially regarded as a safe strategy with significant equipoise across most study sites.