Anemia in preterm neonates is a significant problem encountered frequently in the neonatal intensive care unit. Most preterm neonates born at less than 33 weeks gestation will require at least one blood transfusion during their hospital course and many will require repeated transfusions. Blood transfusions, albeit necessary, carry increased risk of viral infections and transfusion reactions as well as increase the cost of healthcare. The umbilical cord and placenta harbor up to 40% of blood available during fetal life. The current standard of care is immediate umbilical cord clamping. The investigators are performing a randomized controlled trial comparing immediate cord clamping to milking the umbilical cord prior to clamping in neonate born preterm less than 33 weeks gestation. The investigators hypothesize that milking the umbilical cord will demonstrate the same benefits as delayed cord clamping, without delaying neonatal resuscitation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
22
The umbilical cord will be "milked" toward the neonate four times prior to clamping the umbilical cord.
The umbilical cord will be clamped and cut immediately after delivery of the neonate.
Johns Hopkins Hospital
Baltimore, Maryland, United States
Hemoglobin during NICU course
Time frame: within 24 hours of birth and through NICU stay
1-min Apgar
Time frame: at 1 minute of life
5 min Apgar
Time frame: at 5 minutes of life
Blood Sugar upon admission to NICU
Time frame: within 1 hour of birth
Temperature on admission to NICU
Time frame: within 1 hour of birth
Cord blood pH
Time frame: within 1 hour of birth
Blood pressure upon admission to NICU
Time frame: within 1 hour of birth
Number of volume challenges in first 24 hours of life
Time frame: at 24 hours of birth
Days requiring ventilation
Time frame: 2 months
Neonatal death
Time frame: 6 months
Length of hospital stay
Time frame: 6 months
Intraventricular hemorrhage
Time frame: 6 months
Number and volume of blood transfusions
Time frame: 10 units
duration of phototherapy
Time frame: 1 month
Maximum serum bilirubin
Time frame: 1 month
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