Study: Newborn umbilical cord procedure safe for long-term neurodevelopment in children

(Press-News.org) An alternative method of transferring blood cells to weakened newborns through their umbilical cord does not carry long-term neurodevelopmental risks compared to standard practice, a recent study found. The research will be presented at the Pediatric Academic Societies (PAS) 2024 Meeting, held May 3-6 in Toronto. 

Umbilical cord blood contains oxygen and beneficial nutrients for newborns, experts say. Doctors may delay clamping a newborn’s umbilical cord to pass nutrients through their cord if they have poor breathing or a low heart rate immediately after birth. A study found that umbilical cord milking (UCM), an alternative method of transferring cord blood where a doctor squeezes the umbilical cord toward the infant before clamping, does not cause long-term harm.

Researchers assessed 971 children’s communication, motor skills, problem-solving, and social skills across 10 U.S. medical centers. Study authors found that children who received UCM at birth were no more likely to have neurological challenges two years after the procedure compared to those who received early cord clamping.

“The short- and long-term benefits point to UCM as a safe alternative for ensuring weakened newborns can live a full, healthy life,” said Anup Katheria, MD, physician at Sharp Mary Birch Hospital for Women & Newborns and presenting author. “UCM is a no-cost option for obstetricians to preserve the health and wellbeing of children.”

Study authors say raising awareness of UCM as a safe option for supporting weakened newborns is important to promoting equity among resource-limited settings.

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EDITOR:

Dr. Anup Katheria will present “Long term outcomes for the Milking in non-vigorous infants (MINVI) Trial” on Sunday, May 5 from 11:15-11:30 AM E.T.

Reporters interested in an interview with Dr. Katheria should contact Amber Fraley at amber.fraley@pasmeeting.org.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit www.pas-meeting.org. Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: Long term outcomes for the Milking in non-vigorous infants (MINVI) Trial

Presenting Author: Anup Katheria, MD

Organization

Sharp Mary Birch Hospital for Women & Newborns

Topic

Neonatal Clinical Trials

Background

Umbilical cord milking (UCM) can provide an alternative for placental transfusion in non-vigorous newborns who may need immediate resuscitation. In our initial trial (Katheria et al), UCM compared with early cord clamping (ECC), reduced delivery room cardiorespiratory support, hypoxic-ischemic encephalopathy, and therapeutic hypothermia. However, long-term safety of UCM in term infants is not known.

Objective

To investigate if infants randomized to UCM would have better neurodevelopmental scores on the Ages and Stages Questionnaire, third Edition (ASQ-3) and a lower frequency of medium or high scores on the Modified Checklist for Autism in Toddlers (M-CHAT-R) compared to ECC at 22 to 26 months.

Design/Methods

This was a pragmatic cluster randomized crossover trial of infants born at 35 to 42 weeks’ gestation in 10 medical centers randomized to UCM or ECC for 1 year and then crossed over until study completion. Waiver of consent was approved in all centers. Infants were eligible if non-vigorous (poor tone, pale color, or lack of breathing in the first 15 seconds after birth) and were assigned to 4 times milking of the attached cord or ECC. Families provided consent for long term neurodevelopmental follow-up via ASQ-3 and M-CHAT-R questionnaires at 22-26 months of age. Treatment groups were compared using generalized linear mixed models accounting for the cluster randomized crossover study design. Potential interaction between treatment group and child sex and maternal education was evaluated.

Results

Among 1730 newborns in the primary trial, 1207 consented for long term follow-up, 4 infants died in the hospital and 3 after discharge. 971 participants (81%) had ASQ-3 scores available for analysis, and 927 parents (77%) completed the M-CHAT-R (Figure 1). There were no major differences in maternal and neonatal characteristics (Table 1). Median (IQR) ASQ-3 total scores (UCM: 255 (225-280) vs ECC 255 (230-280), p=0.49) or any of its 5 sub-domains (Table 2), or medium to high-risk M-CHATR scores (UCM 9.3% vs ECC 8.4%, p=0.59) were similar between groups. Results were similar in models adjusted for sex and maternal education.

Conclusion(s)

Among non-vigorous infants born at 35 to 42 weeks’ gestation, neurodevelopmental scores at 22-26 months, of age were similar between the UCM and ECC groups. These data, combined with the previously reported short-term benefits, suggest that UCM is a safe intervention. UCM is a no-cost intervention that can be easily implemented even in resource-limited settings and may improve short-term outcomes without long-term neurodevelopmental risks to development.

Tables and Images

Table 1 Maternal and Neonatal Characteristics Table only image 10.31.23.jpg

Table 2 Developmental Screening Characteristics Table only image 10.31.23.jpg

Figure 1. MINVI Follow-up Consort 10.31.2023 image.jpg

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