Josephsen Justin B, Potter Shannon, Armbrecht Eric S, Al-Hosni Mohamad
Department of Pediatrics, Saint Louis University, St. Louis, Missouri.
Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St. Louis, Missouri.
Am J Perinatol. 2022 Mar;39(4):436-443. doi: 10.1055/s-0040-1716484. Epub 2020 Sep 7.
This study aimed to assess potential benefits of umbilical cord milking (UCM) when compared with immediate cord clamping (ICC) in extremely preterm infants.
This is a single-center, randomized controlled trial of infants 24 to 27 weeks' gestation who received UCM versus ICC. In the experimental group, 18 cm of the umbilical cord was milked three times. The primary aim was to assess the initial hemoglobin and to assess the number of blood transfusions received in the first 28 days after birth. Secondary outcomes were also assessed, including intraventricular hemorrhage (IVH). A priori, neurodevelopmental follow-up was planned at 15 to 18 months corrected gestational age (CGA).
Baseline characteristics for 56 enrolled infants were similar in both groups with a mean gestational age of 26.1 ± 1.2 weeks and a mean birth weight of 815 ± 204 g. There were no differences in the mean initial hemoglobin in the UCM group when compared with the ICC group, 13.7 ± 2.0 and 13.8 ± 2.6 g/dL, respectively ( = 0.95), with no differences in median number of blood transfusions after birth between the ICC group and the UCM group, 2 (interquartile range [IQR]: 1-4) versus 2.5 (IQR: 1-5) ( = 0.40). There was also no difference in the rate of severe IVH. At 15 to 18 months CGA, there were no differences in death or disability in the ICC group compared with the UCM group (26 vs. 22%; = 1.0) and no differences in neurodevelopmental outcomes.
In a randomized trial of ICC versus UCM in extremely preterm infants, no differences were seen in initial hemoglobin or number of blood transfusions.
· Umbilical cord milking may be an alternative to delayed cord clamping, but its safety and efficacy are not established in extremely premature infants.. · There are minimal available published data on the longer term neurodevelopmental outcomes in extremely premature infants who receive umbilical cord milking compared with immediate clamping.. · We did not find a significant difference in the primary outcomes of initial hemoglobin and blood transfusions between the groups, nor did we find a difference in severe IVH with umbilical cord milking..
本研究旨在评估与即刻断脐（ICC）相比，脐血挤奶（UCM）对极早产儿的潜在益处。
这是一项单中心随机对照试验，纳入24至27周胎龄的婴儿，分为接受UCM组和ICC组。实验组将18厘米脐带挤奶三次。主要目的是评估初始血红蛋白水平，并评估出生后28天内接受输血的次数。还评估了次要结局，包括脑室内出血（IVH）。预先计划在矫正胎龄（CGA）15至18个月时进行神经发育随访。
56名纳入婴儿的基线特征在两组中相似，平均胎龄为26.1±1.2周，平均出生体重为815±204克。与ICC组相比，UCM组的平均初始血红蛋白水平无差异，分别为13.7±2.0和13.8±2.6克/分升（P = 0.95），ICC组和UCM组出生后输血中位数无差异，分别为2次（四分位间距[IQR]：1 - 4）和2.5次（IQR：1 - 5）（P = 0.40）。严重IVH发生率也无差异。在CGA 15至18个月时，ICC组与UCM组在死亡或残疾方面无差异（26%对22%；P = 1.0），神经发育结局也无差异。
在一项极早产儿ICC与UCM的随机试验中，初始血红蛋白水平或输血次数未见差异。
· 脐血挤奶可能是延迟断脐的一种替代方法，但在极早产儿中其安全性和有效性尚未确立。· 与即刻断脐相比，关于接受脐血挤奶的极早产儿长期神经发育结局的已发表数据极少。· 我们未发现两组在初始血红蛋白和输血这两个主要结局上有显著差异，也未发现脐血挤奶在严重IVH方面有差异。
