Comparison of umbilical cord milking and delayed umbilical cord clamping on hemoglobin levels in newborns

Background Umbilical cord milking is often used as an alternative to delaying cord clamping in the efforts to prevent anemia in newborns. However, there have been few studies to date on the benefits and risks of umbilical cord milking. Objective To determine the effect of umbilical cord milking compared to delayed umbilical cord clamping on the hemoglobin levels of newborns. Methods We performed simple randomization using lottery draw to allocate mother-newborn pairs to undergo either umbilical cord milking or delayed umbilical cord clamping. Using capillary blood obtained by heel prick, we measured the hemoglobin levels of the neonates before the intervention (pre-test) and 24 hours after birth (post-test). We compared pre- vs. post-test hemoglobin levels within each group, as well as between the two groups. We also compared the difference in hemoglobin increase between the two groups. In addition, we measured the time required to complete the umbilical cord milking procedure. Results Fifty-six infants each were allocated into the umbilical cord milking and delayed cord clamping groups. The mean pre-test hemoglobin level was 18.05 (SD 1.418) g/dL and 17.28 (SD 1.505) g/dL in the umbilical cord milking and delayed cord clamping groups, respectively (P=0.085). The umbilical cord milking group had a significantly higher post-test mean hemoglobin level than the delayed cord clamping group [18.20 (SD 1.349) vs. 17.33 (SD 1.487) g/dL (P=0.025)]. Both groups experienced a significant rise in post-test, compared to pre-test mean hemoglobin levels (P=0.001 in both groups). The mean time required for umbilical cord milking was 19.911 (SD 2.1682), while the standard duration of delayed cord clamping was 2 minutes. Conclusions Umbilical cord milking is more effective than delayed umbilical cord clamping in increasing the hemoglobin levels of newborns.