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Milking the Umbilical Cord for Extreme Preterm Infants

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ClinicalTrials.gov Identifier: NCT01666847
Recruitment Status : Active, not recruiting
First Posted : August 16, 2012
Last Update Posted : November 17, 2017
Information provided by (Responsible Party):

Study Description
Brief Summary:

Milking the umbilical cord from the placental end toward the infant has been shown to benefit preterm infants when compared to either clamping the umbilical cord immediately or waiting delaying the clamping of the cord. Delaying cord clamping for 30-120 seconds has been shown to improve heart and lung function, reduces the need for blood transfusion, and reduces the risk for brain bleeding seen in some preterm infants. Delaying the clamping of the umbilical cord, however in extremely premature infants is not considered safe, since it also delays the resuscitation that these infants need immediately after birth. Milking the umbilical cord is believed have similar benefits to delaying the clamping of the cord, but can be done much faster (seconds rather than minutes). In this study, the cord will milked three times over about 10-20 seconds and the infant will be passed to the awaiting newborn medical team for routine care. Participants of this study will be randomly assigned to one of two study groups: the first group will have the cord milking intervention and the second group will not have any intervention other than routine, immediate cord clamping with routine care of mother and infant. Data will be collected about the mother prior to delivery and data will also be collected about the baby using computerized health records. The data will look at short term changes in red blood cell volumes, the need for blood transfusions, and rates of known complications of prematurity, including longer term developmental complications at 18-24 months.

The hypothesis is that milking the umbilical cord before cutting the cord will lead to a higher hemoglobin concentration and decrease the need for blood transfusions in extremely preterm neonates compared to the current standard of immediately clamping the umbilical cord.

Condition or disease Intervention/treatment
Infant, Extremely Premature Procedure: Milking the umbilical cord before cord clamping

Detailed Description:
Eligible infants include singleton infants born between 24 and 27 6/7 weeks gestation who do not have congenital anomalies.

Study Design

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 80 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Milking the Umbilical Cord for Extreme Preterm Infants
Study Start Date : October 2012
Primary Completion Date : August 2016
Estimated Study Completion Date : July 2018
Arms and Interventions

Arm Intervention/treatment
Experimental: Cord Milking
Infant receiving cord milking intervention before umbilical cord clamped.
Procedure: Milking the umbilical cord before cord clamping
The procedure will involve positioning the neonate below the level of the placenta and milking approximately 20cm of umbilical cord three times over 10-20 seconds total from the placental end to the neonate. The cord will then be clamped and the neonate handed to the awaiting medical team for routine care of a premature infant.
No Intervention: Immediate Cord Clamping
Infant whose umbilical cord is immediately clamped after delivery.

Outcome Measures

Primary Outcome Measures :
  1. To evaluate and compare hemoglobin and hematocrit concentrations in extremely low birth weight infants (ELVW) after cord milking intervention to ELBW infants receiving immediate cord clamping [ Time Frame: Within 4 hour of birth ]
  2. To evaluate and compare the incidence and numbers of blood transfusions after cord milking [ Time Frame: Prior to initial infant discharge ]

Secondary Outcome Measures :
  1. To evaluate and compare blood pressure after intervention and need for support medications [ Time Frame: For first seven days of life ]
  2. To evaluate and compare the incidence of hyperbilirubinemia and length of phototherapy [ Time Frame: Three weeks ]
    Highest bilirubin or maximum at 120 hours of life, plus total days of phototherapy.

  3. To evaluate the incidence of complications of prematurity in the study and control groups [ Time Frame: Until 3 years corrected gestational age ]
  4. To evaluate long term outcomes of prematurity in both groups in a follow-up study [ Time Frame: Until 3 years corrected gestational age ]
  5. To compare the difference in hemoglobin and hematocrit from umbilical cord blood [ Time Frame: Within 4 hours of birth ]

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • pregnant women/child pairs with infants born at an estimated gestation age between 24 0/7 and 27 6/7 weeks based on best estimate made by last menstrual period or ultrasound
  • informed consent obtained by the pregnant women prior to delivery of the infant.

Exclusion Criteria:

  • pregnancy with a multiple gestation
  • infants with pre- or postnatally diagnosed major congenital anomalies or probable chromosomal abnormalities
  • infants with hydrops fetalis
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01666847

United States, Missouri
Saint Louis University, Division of Neonatology, SSM Cardinal Glennon Children's Medical Center
Saint Louis, Missouri, United States, 63104
Saint Louis University, Division of Neonatology, SSM St. Mary's Health Center
Saint Louis, Missouri, United States, 63117
Sponsors and Collaborators
St. Louis University
Principal Investigator: Justin B Josephsen, MD St. Louis University
More Information

Responsible Party: Justin Josephsen M.D., Assistant Professor, St. Louis University
ClinicalTrials.gov Identifier: NCT01666847     History of Changes
Other Study ID Numbers: 21429
First Posted: August 16, 2012    Key Record Dates
Last Update Posted: November 17, 2017
Last Verified: November 2017

Keywords provided by Justin Josephsen M.D., St. Louis University:
Umbilical Cord Milking
Extremely Low Birth Weight Infant (ELBW)