Randomized Controlled Trial (RCT): Effects on blood pressure of 4 times milking of the cord versus slight delay of cord clamping in very low birth weight infants (VLBW)

Aims: RCTs have shown that a slight delay of 30 seconds in clamping the cord enables placento-fetal transfusion, which benefits VLBW greatly by reducing intraventricular hemorrhages and the need for blood transfusion. Often birth attendees hesitate to wait for 30 seconds, therefore milking of the cord towards the VLBW has been discussed and reported in one trial. Objective: To evaluate the circulatory effects of four times milking the cord (Milk G) versus a slight delay in clamping the cord of 30 seconds (Clamp G) in VLBW <33 weeks' gestation. Design/Method: Prospective, single centre cohort study. Inclusion criteria: inborn singleton VLBW <33 weeks gestation, no congenital malformation or Rhesus-incompatibility. Data analysis for significant differences was performed with Wilcoxon test. Results: 30 VLBW were randomized to the Clamp G (median birth weight 1200g (525–1975), median gestational age 29 w (24–32)) and 28 to the Milk G (median birth weight 1170g (444–2245), median gestational age 30 w (24–32)). Values for blood pressure (median BP, mmHg, Q25, Q75) are summarized in the table for the first 72h of life. No significant differences were found (all values for p>0.05).

Median (Q25 Q75)	BP 1h	BP 4h	BP 6h	BP 12h	BP 24h	BP 48h	BP 72h	BP 120h
Milk G	38 (27 40)	36 (32 42)	38 (35 44)	39 (36 44)	44 (35 48)	44 (37 48)	43 (36 46)	47 (41 54)
Clamp G	31 (27 37)	33 (28 36)	34 (31 39)	37 (34 40)	37 (33 41)	39 (37 48)	40 (32 47)	46 (40 50)

Conclusions: Our study demonstrates that 4 times milking of the cord could substitute a slight delay of clamping the cord in VLBW. The blood transfer from the placenta is similar with both approaches and supports postnatal circulatory adaptation.

The Study was supported by a Sussex R&D grant.