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Resuscitation With Placental Circulation Intact Compared With Cord Milking: A Randomized Clinical Trial.
Simone Pratesi1, Martina Ciarcià1, Luca Boni2
1Careggi University Hospital, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Firenze, Italy.
JAMA Network Open
|December 13, 2024
Summary
Maintaining placental circulation for 3 minutes during resuscitation did not improve outcomes for preterm newborns compared to umbilical cord milking. This study found no significant difference in the composite outcome of death or major morbidities.
Area of Science:
- Neonatal Resuscitation
- Perinatal Medicine
- Clinical Trials
Background:
- Delayed cord clamping (60 seconds) in preterm newborns reduces mortality.
- Longer cord clamping durations with respiratory support effects are unknown.
- Umbilical cord milking is an alternative to delayed clamping.
Purpose of the Study:
- To compare intact placental circulation resuscitation (180 seconds) with umbilical cord milking in preterm newborns.
- To evaluate the impact on the composite outcome of death, intraventricular hemorrhage, and bronchopulmonary dysplasia.
Main Methods:
- Randomized clinical trial (PCI Trial) at 8 Italian NICUs.
- Enrolled 209 preterm newborns (23-29 weeks gestation).
- Interventions: intact placental circulation (180s) vs. umbilical cord milking (early clamping <20s).
Main Results:
- Composite outcome occurred in 33% (placental circulation) vs. 38% (cord milking).
- No significant difference in the primary composite outcome (OR, 0.83; 95% CI, 0.47-1.47; P=.53).
- Secondary outcomes also showed no significant differences.
Conclusions:
- Intact placental circulation resuscitation for 3 minutes did not reduce adverse outcomes in preterm infants compared to cord milking.
- Further research may be needed to optimize resuscitation strategies for extremely preterm infants.
- Trial Registration: NCT02671305.
