The Effect of Cord Milking on Hemodynamic Status of Preterm Infants
Very preterm babies frequently develop problems with their blood circulation during the first few days after birth. These circulation problems could affect the oxygen and blood flow to their brain and lead to effects such as bleeding in the head or delayed developmental milestones later in life. Currently the care for such problems may include transfusion of intravenous fluids or blood to the baby and/or giving the baby medications that can help circulation.
The current practice at the delivery of these babies is to immediately clamp their umbilical cords after birth. Recent research studies have shown that giving more of the baby's own blood to them at birth by delayed cord clamping (waiting for clamping the cord for about 30-90 seconds) or by milking the cord, may reduce the number of blood transfusions that these babies may need later on. It may also improve their initial blood pressure and reduce the chances of bleeding in their heads.
More research is needed to prove if either delayed cord clamping or milking the cord at birth will be better in terms of improving these babies' health.
The aim of this study is to find out if adding some blood to these babies' circulation, through milking the cord at birth, could prevent or reduce the possible problems with blood circulation and the reduced blood flow to the brain that some of these babies may have after birth.
The investigators will also investigate if milking the cord at birth could improve their long-term developmental outcome.
Hypothesis: In preterm infants less than 31 weeks' gestation, milking the umbilical cord 3 times prior to clamping, compared to immediate clamping after birth will improve systemic blood flow (as assessed by improving superior vena cava flow measured by heart ultrasound in the first 24 hours after birth)
|Preterm Infants||Procedure: Milking the umbilical cord at birth Procedure: immediate umbilical cord clamping|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Prevention
|Official Title:||The Effect of Umbilical Cord Milking on Hemodynamic Status of Preterm Infants: a Randomized Controlled Trial|
- Systemic blood flow as reflected by mean SVC flow measured by echocardiographic study at 4-6 hours after birth. [ Time Frame: at 4-6 hours of age ]
- low SVC flow (< 40 ml/kg/min), as assessed by echocardiography [ Time Frame: at 4-6 and 10-12 hours of age ]
- Hypotension [ Time Frame: during the first 48 hours of life ]Hypotension is defiined as mean blood pressure < corresponding gestational age number for > 30 minutes
- Hyperbilirubinemia and peak bilirubin level recording [ Time Frame: during first 2 weeks of age ]Hyperbilirubinemia requiring phototherapy (as per routine unit practice)
- Systemic blood flow as reflected by mean SVC flow measured by echocardiographic study at 10-12 hours after birth. [ Time Frame: at 10-12 hours of age ]
- Number of blood transfusions during hospital stay [ Time Frame: at 40 weeks of corrected gestational age ]
- Intraventricular hemorrhage (IVH) [ Time Frame: during first 2 weeks of life ]Intraventricular hemorrhage (IVH) as diagnosed by standard-practice cranial ultrasounds
- Neurodevelopmental outcome [ Time Frame: At 36 months of age ]
|Study Start Date:||November 2011|
|Estimated Study Completion Date:||January 2018|
|Estimated Primary Completion Date:||January 2018 (Final data collection date for primary outcome measure)|
Active Comparator: immediate umbilical cord clamping
The control group will receive immediate cord clamping at birth which is the standard of care in our institution
Procedure: immediate umbilical cord clamping
immediate cord clamping without milking as per standard practice
Other Name: standard practice-cord clamping
Experimental: Milking the umbilical cord at birth
Infants in the cord-milked group will be placed at or below the level of the placenta, and about 20 cm of the umbilical cord (or the length of cord that is accessible if less than 20 cm) will be vigorously milked towards the umbilicus three times before clamping the cord.
Procedure: Milking the umbilical cord at birth
Infants in the cord-milked group will be placed at or below the level of the placenta, and about 20 cm of the umbilical cord (or the length of cord that is accessible if less than 20 cm) will be vigorously milked towards the umbilicus three times before clamping the cord
Other Name: Transfusion of blood from umbilical cord to the baby
Please refer to this study by its ClinicalTrials.gov identifier: NCT01487187
|Canada, Nova Scotia|
|IWK Health Centre|
|Halifax, Nova Scotia, Canada|
|Principal Investigator:||Walid I El-Naggar, MD||IWK Health Centre- Dalhousie University|