Effect of Umbilical Cord Milking on Severity of Hypoxic Ischemic Encephalopathy in Asphyxiated Neonates A Pilot study

BackgroundThe present study was aimed to evaluate the effect of umbilical cord milking technique on severity of Hypoxic Ischemic Encephalopathy (HIE) in asphyxiated neonates and assessed by Modified Sarnats staging as primary outcome, APGAR score at 5 minutes and Respiratory support requirement as secondary outcome. MethodsThis was a randomized, controlled pilot study conducted in neonatology department at a tertiary care centre, Thrissur, Kerala for one year starting from March 2020. The neonates were divided into two groups non milking group, control (n=38) and umbilical cord milking, case [UCM] (n=32) and their outcomes were compared. In the intervention group, the cord was cut at 30 cm from umbilical stump within 30 seconds of birth and euthermia was maintained. The umbilical cord was raised and milked from the cut end towards the infant 3 times with speed at 10 cm/sec and then clamped 2-3 cm from the umbilical stump. In the control group, the umbilical cord was clamped without doing cord milking. ResultsIn this study moderate to severe HIE were less in case group 46.9 % than control group 55.1% and less neonates 44.7 % had Mild HIE in control group compared to case group 53.1% even though result was statistically not significant as primary outcome (p value - not significant). Eight neonates (21.6%) in control group had Apgar at 5 min score 0-3, whereas only 4 (12.5%) neonates in cord milking group. ConclusionsThe insufficient knowledge of placental transfusion limits and benefits leads to a wide variation in the management of cord clamping. It would be useful to standardise the UCM procedure in order to offer protocols applicable to clinical practice, and to spread knowledge among professionals through educational programs.