Intact Umbilical Cord Milking Versus Early Cord Clamping on the Need for Cardiorespiratory Support in Non-vigorous Neonates ≥29 Weeks Gestation: A Prospective Observational Study

Background For non-vigorous neonates ≥29 weeks of gestation, there is no consensus on the preferred cord management strategy. Objective To compare the need for cardiorespiratory support within the first 24 h of life, hematocrit at 48 h, and the requirement of phototherapy within the first week between non-vigorous neonates ≥29 weeks’ gestation receiving intact umbilical cord milking (I-UCM) and those receiving early cord clamping (ECC). Methods This prospective observational study was conducted in a tertiary care medical college between October 2023 and March 2025. Non-vigorous neonates ≥29 weeks’ gestation were categorized into I-UCM and ECC groups on the basis of umbilical cord management, which was decided by the lead obstetrician as per their preference. Results Ninety-six neonates were enrolled, 48 in each group. Neonates in the I-UCM group required significantly less inotropic support than the ECC group (RR: 0.52; 95% CI: 0.29-0.92), with the greatest benefit in those <34 weeks’ gestation (RR: 0.29; 95% CI: 0.10-0.92). The overall need for respiratory support was comparable, but invasive ventilation was less frequent with I-UCM (45% vs. 57.9%), though not statistically significant. Hematocrit at 48 h was higher in the I-UCM group (57.0% vs. 53.8%; P < .05). No significant difference was observed in the need for phototherapy. Conclusion I-UCM in non-vigorous neonates ≥29 weeks’ gestation reduced the need for inotropes within the first 24 h of life and improved early hematocrit when compared to ECC.