Umbilical Cord Milking in Non-Vigorous Infants

At birth, it is critical that an infant begins breathing quickly. The infant has to switch
from relying on the placenta for oxygen to using its lungs for the first time. The currently
recommended practice for infants who need resuscitation is to immediately clamp the umbilical
cord. Animal studies show that clamping the cord before the baby breathes can cause the heart
beat to slow and can decrease the amount of blood being pumped out of the heart each minute.
This study will test whether infants will benefit from UCM. The cord will be quickly milked
four times before cutting and will not delay the resuscitation procedures. This study is
important because when there is need for resuscitation, neither UCM or delayed cord clamping,
are recommended by national and international organizations due to lack of evidence. Yet,
several large studies from around the world have identified that infants needing
resuscitation are more likely to develop conditions such as cerebral palsy, autism and other
developmental problems.

The trial is a cluster crossover design in which each hospital will be randomly assigned to
use either early cord clamping or UCM for any infant needing resuscitation over a period of
12 months. Then sites will change to the other method for an additional 12 months.

Inclusion Criteria:

- Non-vigorous newborns born between 35-42 weeks gestation

Exclusion Criteria:

- Known major congenital or chromosomal anomalies of newborn

- Known cardiac defects other than small ASD, VSD and PDA

- Complete placental abruption/cutting through the placenta at time of delivery

- Monochorionic multiples

- Cord Avulsion

- Presence of non-reducible nuchal cord

- Perinatal providers unaware of the protocol