75 Cesarean infants assigned to cord milking group were seen to have improved blood circulation towards brain and within body. A recent study by researchers at the Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns in San Diego, and Loma Linda University, Loma Linda, Calif describes a novel technique to help increase blood flow from the umbilical cord to an infant’s circulatory system.

The study, published in Pediatrics, could significantly help in improving blood pressure and levels of red blood cells in preterm infants delivered via cesarean section (C-section). The work was funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Coming Up With The Idea

Authors of the study noted that in 2012, the American College of Obstetricians and Gynecologists suggested for all preterm deliveries – a delay of 30 to 60 seconds before clamping the umbilical cord. This delay allows ample time for blood to flow from the umbilical cord and fill the blood vessels of the infant’s lungs. It also protects the preterm new-born from developing hypotension (low blood pressure) that might lead to intraventricular hemorrhage (bleeding of cavities inside the brain). The latter can further result in developmental abnormalities, cerebral palsy and even death.

Dr. Anup C. Katheria, M.D., a neonatologist at the Neonatal Research Institute at the Sharp Mary Birch Hospital and first author of the study, observed that in certain cases, intraventricular hemorrhage could not be reduced through cord clamping in preterm infants delivered via C-section. This was attributed to the use of an anesthetic that scientists believe reduces intrauterine contraction and causes blood to drain from the umbilical cord.

Based on these observations, researchers reasoned that ‘cord milking’ – encircling the umbilical cord using the thumb and forefingers, squeezing gently, and gradually pushing the blood through the cord into the infant’s abdomen – could compensate for the decreased flow in blood through the cord and increase the amount available to the infant.

Conducting The Study

The research team conducted a study on 197 infants whose mothers went into labor in or prior to their 32nd week of pregnancy. Out of these infants, 154 were delivered via C-section. Of these, 75 were randomly assigned to the intervention group (cord milking) and 79 were assigned to the non-intervention group (delayed clamping). The 43 infants who were delivered vaginally were also assigned to an intervention or clamping group.

Overall Promising Findings

The 75 Cesarean infants assigned to the cord milking group were seen to have a higher blood flow in their superior vena cava (large vein carrying blood to the heart from the brain), and an increased output of blood from their right ventricle.

Both these observations indicated that the level of blood circulation towards the brain and within the body had improved. Moreover, these infants also had better blood pressure and higher amounts of hemoglobin, the latter indicating higher levels of red blood cells.

For the infants delivered vaginally, no significant differences were seen among those undergoing cord milking and the ones undergoing cord clamping.

“The study results are very encouraging,” stated Tonse Raju, M.D., Chief of NICHD’s Pregnancy and Perinatology Branch. “However, these findings need to be confirmed in a larger number of births, but at this point, it appears that umbilical cord milking may prove to be of great benefit to preterm infants delivered via C-sections.”