Background: Guidelines published by the International Liaison Committee for Resuscitation and by the World Health Organization recommend delaying cord clamping at birth as part of routine care for infants. Objective: To study the use of milking of the cord 4 times as an alternative to enhance the redistribution of placental blood into the baby. Methods: This is a prospective cohort study of neurodevelopmental assessment by the Bayley III method of very preterm infants who had participated in a trial of delayed cord clamping versus cord milking at birth that was conducted in a neonatal tertiary care hospital. The primary outcomes were differences in cognitive, motor and language development at 2 and 3.5 years. Two-tailed analyses were performed with the χ2 test, Fisher's exact test, t test, Mann-Whitney U test and ANCOVA. Results: Out of the 58 infants enrolled in the original study, 39 infants (67%) were assessed at 2 years and 29 (50%) at 3.5 years of age. Neurodevelopmental outcomes at 2 and 3.5 years did not significantly differ between the two groups for the three Bayley III composite scores. At 3.5 years there was a trend towards higher scores for girls in the language composite scores (girls: mean = 121.6, SD = 15.22; boys: mean = 101.07, SD = 19.84) and on the motor scale (girls: mean = 124.60, SD = 18.15; boys: mean = 97.86, SD = 17.23). Conclusions: In this small number of participants followed up at 2 and 3.5 years of age, milking of the cord 4 times did not have any long-term adverse effect on neurodevelopmental outcome, suggesting that cord milking could be used as an alternative to delayed cord clamping.

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.
Rabe H, Reynolds G, Diaz-Rossello J: A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology 2008;93:138-144.
Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, Okada T, et al: Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born less than 29 weeks‘ gestation: a randomized controlled trial. Arch Dis Child Fetal Neonatal Ed 2008;93:F14-F19.
Rabe H, Jewison A, Alvarez RF, Crook D, Stilton D, Bradley R, Holden D; Brighton Perinatal Study Group: Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol 2011;117:205-211.
Mercer JS, Vohr BR, Erickson-Owens DA, Padbury JF, Oh W: Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. J Perinatol 2010;30:11-16.
Bayley N: Bayley Scales of Infant Development III, ed 3. San Antonio, Psych Corp/Harcourt Assessment, 2006.
Johnson S, Moore T, Marlow N: Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used? Pediatr Res 2014;75:670-674.
Richards M, Hardy R, Kuh D, Wadsworth MEJ: Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population based study. BMJ 2001;322:199-203.
Craig WY, Palomaki, GE, Neveux, LM, Haddow JE: Maternal body mass index during pregnancy and offspring neurocognitive development. Oral Biosci Med 2013;1:20-25.
Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR; EPICure Study Group: Neurologic and developmental disability after extremely preterm birth. N Engl J Med 2000;343:378-384.
Raju TNK: Timing of umbilical cord clamping for optimizing placental transfusion. Curr Opin Pediatr 2013;25:180-187.
Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Vento M, Halliday HL; European Association of Perinatal Medicine: European consensus guidelines on the management of respiratory distress syndrome in preterm infants - 2013 update. Neonatology 2013;103:353-368.
American Academy of Pediatrics: Timing of umbilical cord clamping after birth. Pediatrics 2013;131;e1323.
American College of Obstetricians and Gynecologists: Timing of umbilical cord clamping after birth. Obstet Gynecol 2012;1208:1522-1526.
WHO, UNICEF: Every Newborn: An Action Plan to End Preventable Deaths. Geneva, WHO, 2015.
WHO: Early Essential Newborn Care: Clinical Practice Pocket Guide. Geneva, WHO, 2014.
Bhatt S, Alison BJ, Wallace EM, Crossely KJ, Gill AW, Kluckow M, te Pas AB, Morley CJ, Polglase GR, Hooper SB: Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013;591:2113-2126.
Boere I, Smit M, Roest AA, Lopriore E, van Lith JM, te Pas AB: Current practice of cord clamping in the Netherlands: a questionnaire study. Neonatology 2015;107:50-55.
Christensen RD, Carroll PD, Josephson CD: Evidence-based advances in transfusion practices in neonatal intensive care units. Neonatology 2014;106:245-253.
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.
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