![[ Visit Client Website ]](images/banner.gif)
Learning Objective 1: The learner will be able to understand the methods of cord "milking" and drawing of admission laboratory tests from the placental vessel.
Learning Objective 2: The learner will realize that hyperviscosity does not occur in VLBW neonates subjected to cord “milking” and drawing the admission laboratory tests from the placenta.
Cord milking at VLBW delivery, followed by drawing all admission laboratory tests from the placenta.
Objective: Reducing blood transfusions among VLBW neonates (very low birth weight, <1500g) can be achieved by milking the umbilical cord before birth (1,2), and by drawing no blood initially on the neonate, but instead drawing the initial laboratory studies using fetal blood in the placenta (3,4). However it is not clear how feasible these two techniques are in actual practice, nor is the risk of neonatal hyperviscosity known.
Results: Feasibility of placental drawing was tested at 96 VLBW births. In 91 the blood tests were successfully obtained this way. The hemoglobin generally increased in the first 24 hours, (p<0.001) and fewer received transfusions or vasopressors (p<0.001). Thirty-six others were subjected to cord milking followed by placental drawing. Blood viscosity was then measured twice in the next 12 hours. None had a viscosity ≥12 cP (a level that defines hyperviscosity among term neonates). Also, those with the highest viscosity levels (5.0 - 7.5 cP) did not have the signs associated with hyperviscosity (plethora, hypotonia, hypoglycemia, hyperbilirubinemia, or thrombocytopenia).
Conclusion:It is feasible to use cord milking and placental phlebotomy at VLBW delivery. Doing so will reduce transfusions and improve hemodynamic stability without causing hyperviscosity.
See more of: Oral Paper & Poster: Clinical Sessions