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Background:  Delayed cord clamping and umbilical cord milking provide placental transfusion to vigorous newborns. Delayed cord clamping in nonvigorous newborns may not be provided owing to a perceived need for immediate resuscitation. Umbilical cord milking is an alternative, as it can be performed more quickly than delayed cord clamping and may confer similar benefits.
Objective:  We hypothesized that umbilical cord milking would reduce admission to the neonatal intensive care unit compared with early cord clamping in nonvigorous newborns born between 35 and 42 weeks' gestation.
Study design:  This was a pragmatic cluster-randomized crossover trial of infants born at 35 to 42 weeks' gestation in 10 medical centers in 3 countries between January 2019 and May 2021. The centers were randomized to umbilical cord milking or early cord clamping for approximately 1 year and then crossed over for an additional year or until the required number of consented subjects was reached. Waiver of consent as obtained in all centers to implement the intervention. Infants were eligible if nonvigorous at birth (poor tone, pale color, or lack of breathing in the first 15 seconds after birth) and were assigned to umbilical cord milking or early cord clamping according to their birth hospital randomization assignment. The baseline characteristics and outcomes were collected following deferred informed consent. The primary outcome was admission to the neonatal intensive care unit for predefined criteria. The main safety outcome was hypoxic-ischemic encephalopathy. Data were analyzed by the intention-to-treat concept.
Conclusion:  Among nonvigorous infants born at 35 to 42 weeks' gestation, umbilical cord milking did not reduce neonatal intensive care unit admission for predefined criteria. However, infants in the umbilical cord milking arm had higher hemoglobin, received less delivery room cardiorespiratory support, had a lower incidence of moderate-to-severe hypoxic-ischemic encephalopathy, and received less therapeutic hypothermia. These data may provide the first randomized controlled trial evidence that umbilical cord milking in nonvigorous infants is feasible, safe and, superior to early cord clamping.
Most milking in the developed world is done using milking machines.[2] Teat cups are attached to the cow's teats, and then the cups alternate between vacuum and normal air pressure to extract the milk. The milk is filtered and cooled before being added to a large bulk tank of milk for storage.[3]
A known side effect of machine milking is mastitis in cows.[7] Non-sterile machines can introduce bacteria into the teat and cause infection. Another side effect is physical teat damage by the machine.
Objective:  The objective of the study was to investigate the effect of umbilical cord milking as compared with early cord clamping on hematological parameters at 6 weeks of age among term and near term neonates.
The researchers enrolled 197 infants in their study. Mothers went into labor at or before the 32nd week of pregnancy. Of these, 154 were delivered by cesarean, with 75 assigned at random to the umbilical cord milking group and 79 assigned to the delayed clamping group. The 43 infants delivered vaginally also were assigned at random to either delayed clamping or umbilical cord milking.
Standard practice for non-vigorous infants is to immediately clamp and cut the umbilical cord so that the infant can rapidly be resuscitated. Many researchers are concerned, however, that this could deprive them of needed blood and worsen their outcome. Non-vigorous infants are at risk for complications such as low oxygen levels in the brain, cerebral palsy and stroke. In the current study, authors sought to determine if cord milking for non-vigorous infants could provide similar benefits to delayed cord clamping in less time
Non-vigorous infants in the study were assigned at random to un

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