The effect of placental transfusion on the nonvigorous intrauterine growth restricted (IUGR) neonates with pre-existing subclinical myocardial dysfunction and altered cerebral hemodynamics is largely unknown. The present study was planned to evaluate the effect of umbilical cord milking (UCM) on left ventricular output (LVO) of nonvigorous IUGR neonates of > 28-weeks’ gestation. In the present randomized control trial, 74 nonvigorous IUGR neonates were randomly allocated to UCM (4-times squeezing of 20-cm intact cord, n = 37) and ECC (cord clamping within 30 s, n = 37). The primary outcome was LVO at 24 ± 2 h. Secondary outcomes were right ventricular output (RVO), superior vena cava blood flow (SVC flow), diastolic cardiac functions, venous hematocrit at 24 ± 2 h, peak total serum bilirubin (TSB), need and duration of respiratory support, in-hospital complications, mortality, and duration of hospital stay. Data were analyzed in SPSS version 27. LVO was comparable between the groups (255.53 ± 109.91 and 257.89 ± 103.59 mL/kg/min, in UCM and ECC groups, respectively; p = 0.925). Though all the other cardiac functions including RVO were similar, SVC flow was significantly less in neonates undergoing UCM. Mean hematocrit and need and duration of phototherapy were significantly higher in the UCM group, with comparable rates of polycythemia. Delivery room interventions, Apgar scores, incidences of in-hospital complications including hypoxic-ischemic encephalopathy, mortality, and duration of hospital stay were similar.Conclusion: UCM increased venous hematocrit without affecting LVO or symptomatic polycythemia in nonvigorous IUGR neonates; however, the neurodevelopmental implications of reduced SVC flow warrant further evaluation.Trial registration: CTRI/2024/02/063323, registered prospectively on 29/02/2024, <a href="https://trialsearch.who.int/">https://trialsearch.who.int/</a>.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> What is Known: • Umbilical cord milking (UCM) is a safe alternative to early cord clamping (ECC) among nonvigorous neonates >34 weeks’ gestation. </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> What is New: • UCM helps in achieving placental transfusion among nonvigorous intrauterine growth restricted neonates of >28 weeks’ gestation without increasing the risk of polycythemia, compared to early cord clamping. • UCM results in higher hemoglobin, less need for delivery room cardiorespiratory support, and decreased rates of moderate-to-severe hypoxic-ischemic encephalopathy, compared to ECC. </entry> </row> </tbody> </tgroup> </Table>

Hemodynamic effects of umbilical cord milking versus early cord clamping in nonvigorous intrauterine growth restricted neonates: a randomized controlled trial

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发表日期：

2026年7月9日

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Bhagyashree PR,
Poonam Singh,
Mayank Priyadarshi,
Yash Shrivastava,
Suman Chaurasia,
Jaya Chaturvedi,
Sriparna Basu

摘要

The effect of placental transfusion on the nonvigorous intrauterine growth restricted (IUGR) neonates with pre-existing subclinical myocardial dysfunction and altered cerebral hemodynamics is largely unknown. The present study was planned to evaluate the effect of umbilical cord milking (UCM) on left ventricular output (LVO) of nonvigorous IUGR neonates of > 28-weeks’ gestation. In the present randomized control trial, 74 nonvigorous IUGR neonates were randomly allocated to UCM (4-times squeezing of 20-cm intact cord, n = 37) and ECC (cord clamping within 30 s, n = 37). The primary outcome was LVO at 24 ± 2 h. Secondary outcomes were right ventricular output (RVO), superior vena cava blood flow (SVC flow), diastolic cardiac functions, venous hematocrit at 24 ± 2 h, peak total serum bilirubin (TSB), need and duration of respiratory support, in-hospital complications, mortality, and duration of hospital stay. Data were analyzed in SPSS version 27. LVO was comparable between the groups (255.53 ± 109.91 and 257.89 ± 103.59 mL/kg/min, in UCM and ECC groups, respectively; p = 0.925). Though all the other cardiac functions including RVO were similar, SVC flow was significantly less in neonates undergoing UCM. Mean hematocrit and need and duration of phototherapy were significantly higher in the UCM group, with comparable rates of polycythemia. Delivery room interventions, Apgar scores, incidences of in-hospital complications including hypoxic-ischemic encephalopathy, mortality, and duration of hospital stay were similar.

Conclusion: UCM increased venous hematocrit without affecting LVO or symptomatic polycythemia in nonvigorous IUGR neonates; however, the neurodevelopmental implications of reduced SVC flow warrant further evaluation.

Trial registration: CTRI/2024/02/063323, registered prospectively on 29/02/2024, https://trialsearch.who.int/.

What is Known:

• Umbilical cord milking (UCM) is a safe alternative to early cord clamping (ECC) among nonvigorous neonates >34 weeks’ gestation.

What is New:

• UCM helps in achieving placental transfusion among nonvigorous intrauterine growth restricted neonates of >28 weeks’ gestation without increasing the risk of polycythemia, compared to early cord clamping.

• UCM results in higher hemoglobin, less need for delivery room cardiorespiratory support, and decreased rates of moderate-to-severe hypoxic-ischemic encephalopathy, compared to ECC.