Postnatal adaptation in preterm newborn comprises complex physiological processes that involve significant changes in the circulatory and respiratory system. Increasing hemoglobin level and blood volume following placental transfusion may be of importance in enhancing arterial oxygen content, increasing cardiac output, and improving oxygen delivery. The European consensus on resuscitation of preterm infants recommends delayed cord clamping (DCC) for at least 60 s to promote placenta-fetal transfusion in uncompromised neonates. Recently, published meta-analyses suggest that DCC is associated with fewer infants requiring transfusions for anemia, a lower incidence of intraventricular hemorrhage, and lower risk for necrotizing enterocolitis. Umbilical cord milking (UCM) has the potential to avoid some disadvantages associated with DCC including the increased risk of hypothermia or delay in commencing manual ventilation. UCM represents an active form of blood transfer from placenta to neonate and may have some advantages over DCC. Moreover, both methods are associated with improvement in hemodynamic parameters and blood pressure within first hours after delivery compared to immediate cord clamping. Placental transfusion appears to be beneficial for the preterm uncompromised infant. Further studies are needed to evaluate simultaneous placental transfusion with resuscitation of deteriorating neonates. It would be of great interest for future research to investigate advantages of this approach further and to assess its impact on neonatal outcomes, particularly in extremely preterm infants.

3rd Faculty of Medicine Charles University Prague Czechia

Department of Paediatrics and Child Health Neonatal Intensive Care Unit University College Cork Cork Ireland

INFANT Centre University College Cork Cork Ireland

Institute for the Care of Mother and Child Prague Czechia

See more in PubMed

Hillman NH, Kallapur SG, Jobe AH. Physiology of transition from intrauterine to extrauterine life. Clin Perinatol (2012) 39:769–83.10.1016/j.clp.2012.09.009 PubMed DOI PMC

Katheria AC, Lakshminrusimha S, Rabe H, McAdams R, Mercer JS. Placental transfusion: a review. J Perinatol (2017) 37:105–11.10.1038/jp.2016.151 PubMed DOI PMC

Wyllie J, Perlman JM, Kattwinkel J, Wyckoff MH, Aziz K, Guinsburg R, et al. Part 7: neonatal resuscitation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation (2015) 95:e169–201.10.1016/j.resuscitation.2015.07.045 PubMed DOI

Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council guidelines for resuscitation 2015: section 7. Resuscitation and support of transition of babies at birth. Resuscitation (2015) 95:249–63.10.1016/j.resuscitation.2015.07.029 PubMed DOI

Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of respiratory distress syndrome – 2016 update. Neonatology (2017) 111:107–25.10.1159/000448985 PubMed DOI

Safarulla A. A review of benefits of cord milking over delayed cord clamping in the preterm infant and future directions of research. J Matern Fetal Neonatal Med (2017) 30:2966–73.10.1080/14767058.2016.1269319 PubMed DOI

Bhatt S, Alison BJ, Wallace EM, Crossley KJ, Gill AW, Kluckow M, et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol (2013) 591:2113–26.10.1113/jphysiol.2012.250084 PubMed DOI PMC

Nevill E, Meyer MP. Effect of delayed cord clamping (DCC) on breathing and transition at birth in very preterm infants. Early Hum Dev (2015) 91:407–11.10.1016/j.earlhumdev.2015.04.013 PubMed DOI

Ersdal HL, Linde J, Mduma E, Auestad B, Perlman J. Neonatal outcome following cord clamping after onset of spontaneous respiration. Pediatrics (2014) 134:265–72.10.1542/peds.2014-0467 PubMed DOI

Baenziger O, Stolkin F, Keel M, von Siebenthal K, Fauchere J-C, Das Kundu S, et al. The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics (2007) 119:455–9.10.1542/peds.2006-2725 PubMed DOI

Al-Wassia H, Shah PS. Efficacy and safety of umbilical cord milking at birth: a systematic review and meta-analysis. JAMA Pediatr (2015) 169:18–25.10.1001/jamapediatrics.2014.1906 PubMed DOI

Backes CH, Huang H, Iams JD, Bauer JA, Giannone PJ. Timing of umbilical cord clamping among infants born at 22 through 27 weeks’ gestation. J Perinatol (2016) 36:35–40.10.1038/jp.2015.117 PubMed DOI PMC

Kugelman A, Borenstein-Levin L, Riskin A, Chistyakov I, Ohel G, Gonen R, et al. Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study. Am J Perinatol (2007) 24:307–15.10.1055/s-2007-981434 PubMed DOI

Sommers R, Stonestreet BS, Oh W, Laptook A, Yanowitz TD, Raker C, et al. Hemodynamic effects of delayed cord clamping in premature infants. Pediatrics (2012) 129:e667–72.10.1542/peds.2011-2550 PubMed DOI PMC

Katheria AC, Leone TA, Woelkers D, Garey DM, Rich W, Finer NN. The effects of umbilical cord milking on hemodynamics and neonatal outcomes in premature neonates. J Pediatr (2014) 164:1045–50.e1.10.1016/j.jpeds.2014.01.024 PubMed DOI

Ibrahim HM, Krouskop RW, Lewis DF, Dhanireddy R. Placental transfusion: umbilical cord clamping and preterm infants. J Perinatol (2000) 20:351–4.10.1038/sj.jp.7200408 PubMed DOI

Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics (2015) 136:61–9.10.1542/peds.2015-0368 PubMed DOI PMC

March MI, Hacker MR, Parson AW, Modest AM, de Veciana M. The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial. J Perinatol (2013) 33:763–7.10.1038/jp.2013.70 PubMed DOI PMC

Oh W, Fanaroff AA, Carlo WA, Donovan EF, McDonald SA, Poole WK, et al. Effects of delayed cord clamping in very-low-birth-weight infants. J Perinatol (2011) 31(Suppl 1):S68–71.10.1038/jp.2010.186 PubMed DOI PMC

Mercer JS, Erickson-Owens DA, Vohr BR, Tucker RJ, Parker AB, Oh W, et al. Effects of placental transfusion on neonatal and 18 month outcomes in preterm infants: a randomized controlled trial. J Pediatr (2016) 168:50–5.e1.10.1016/j.jpeds.2015.09.068 PubMed DOI PMC

Popat H, Robledo KP, Sebastian L, Evans N, Gill A, Kluckow M, et al. Effect of delayed cord clamping on systemic blood flow: a randomized controlled trial. J Pediatr (2016) 178:81–6.e2.10.1016/j.jpeds.2016.08.004 PubMed DOI

Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev (2012) 8:CD003248.10.1002/14651858.CD003248.pub3 PubMed DOI

Mercer JS, McGrath MM, Hensman A, Silver H, Oh W. Immediate and delayed cord clamping in infants born between 24 and 32 weeks: a pilot randomized controlled trial. J Perinatol (2003) 23:466–72.10.1038/sj.jp.7210970 PubMed DOI

Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics (2006) 117:1235–42.10.1542/peds.2005-1706 PubMed DOI PMC

Tarnow-Mordi W, Morris J, Kirby A, Robledo K, Askie L, Brown R, et al. Delayed versus immediate cord clamping in preterm infants. N Engl J Med (2017) 377:2445–55.10.1056/NEJMoa1711281 PubMed DOI

Hosono S, Mugishima H, Fujita H, Hosono A, Okada T, Takahashi S, et al. Blood pressure and urine output during the first 120 h of life in infants born at less than 29 weeks’ gestation related to umbilical cord milking. Arch Dis Child Fetal Neonatal Ed (2009) 94:F328–31.10.1136/adc.2008.142935 PubMed DOI

Takami T, Suganami Y, Sunohara D, Kondo A, Mizukaki N, Fujioka T, et al. Umbilical cord milking stabilizes cerebral oxygenation and perfusion in infants born before 29 weeks of gestation. J Pediatr (2012) 161:742–7.10.1016/j.jpeds.2012.03.053 PubMed DOI

Rabe H, Jewison A, Alvarez RF, Crook D, Stilton D, Bradley R, et al. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol (2011) 117:205–11.10.1097/AOG.0b013e3181fe46ff PubMed DOI

Katheria A, Poeltler D, Durham J, Steen J, Rich W, Arnell K, et al. Neonatal resuscitation with an intact cord: a randomized clinical trial. J Pediatr (2016) 178:75–80.e3.10.1016/j.jpeds.2016.07.053 PubMed DOI PMC

Backes CH, Rivera BK, Haque U, Bridge JA, Smith CV, Hutchon DJR, et al. Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstet Gynecol (2014) 124:47–56.10.1097/AOG.0000000000000324 PubMed DOI