Abstract: Iron stores at birth can be affected by transplacental transfer of iron and blood from the placenta and cord at the time of delivery. To enhance their transfer from placenta and umbilical cord to baby, interventions like umbilical cord milking and delayed cord clamping have received a lot of scientific attention. Therefore, the present study was conducted with the aim to compare the effect of delayed cord clamping (DCC) and umbilical cord milking (UCM) on hematological parameters in healthy term neonates. This single centered Randomized Control Trial (RCT) was conducted in term neonates (37-41 weeks) born either vaginally or by lower segment cesarean section at Guru Gobind Singh Medical College and Hospital, Faridkot , Punjab, India for the period of one and a half year.  Statistically, it has been analyzed that newborns who underwent DCC and UCM, there was an insignificant difference in the level of hemoglobin (Hb) and haematocrit (HCT) at 30 minutes, 24 hours and 48 hours after birth. Similarly, the insignificant results were observed for hematological parameters in the two treatment groups at six weeks of age. Our study demonstrated that both Delayed Cord Clamping (DCC) and Umbilical Cord Milking (UCM) have comparable benefits in improving hematological status at six weeks of age. Both the methods of placental transfusion do not alter the hemodynamic status of the child and do not result in any significant adverse neonatal outcomes in the first 48 hours of life.

REFERENCES

1. Hemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization; 2011. [cited Jan 11 2017]. Available from: (WHO/ NMH/ NHD/ MNM/ 11.1. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf.
2. Ministry of Health and Welfare. National Family Health survey III (2005-2006): nutrition in India. Government of India. p. 3-17; 2009 [cited Jan 13 2017]. Available from: http://rchiips.org/NFHS/NFHS-4Reports/India.pdf.
3. Walter T. Impact of iron deficiency on cognition in infancy and childhood. Eur J Clin Nutr. 1993;47(5):307-16. PMID 7686486.
4. Gupta R, Ramji S. Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial. Indian Pediatr. 2002;39(2):130-35. PMID 11867842.
5. United Nations Children’s Fund, United Nations University, World Health Organization. Iron deficiency anaemia assessment, prevention, and control. A guide for programme managers. Geneva: World Health Organization; 2001. [cited Jan 19 2017] Available from: (WHO/NHD/01.3. Available from: http://www.who.int/nutrition/publications/en/ida_assessmnt_prevention_control.pdf.
6. Mathew JL. Timing of umbilical cord clamping in term and preterm deliveries and infant and maternal outcomes: a systematic review of randomized controlled trials. Indian Pediatr. 2011;48(2):123-9. doi: 10.1007/s13312-011-0031-z. PMID 21378422.
7. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, Simon WM, Weiner GM, Zaichkin JG. Part 13: Neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care - Part 13. Circulation. 2015;132(18);Suppl 2:S543-60. doi: 10.1161/CIR.0000000000000267, PMID 26473001.
8. Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, Okada T, Takahashi S, Harada K. Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks’ gestation: a randomised controlled trial. Arch Dis Child Fetal Neonat Ed. 2008;93(1):F14-9. doi: 10.1136/adc.2006.108902, PMID 17234653.
9. Kumar B, Upadhyay A, Gothwal S, Jaiswal V, Joshi P, Dubey K. Umbilical cord milking and hematological parameters in moderate to late preterm neonates: A randomized controlled trial. Indian Pediatr. 2015;52(9):753-57. doi: 10.1007/s13312-015-0711-1, PMID 26519708.
10. Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics. 2015;136(1):61-9. doi: 10.1542/peds.2015-0368, PMID 26122803.
11. Rabe H, Jewison A, Alvarez RF, Crook D, Stilton D, Bradley R, Holden D, Brighton Perinatal Study Group. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol. 2011;117(2 Pt 1):205-11. doi: 10.1097/AOG.0b013e3181fe46ff, PMID 21252731.
12. Upadhyay A, Gothwal S, Parihar R, Garg A, Gupta A, Chawla D, Gulati IK. Effect of umbilical cord milking in term and near term infants: randomized control trial. Am J Obstet Gynecol. 2013;208(2):120.e1-6. doi: 10.1016/j.ajog.2012.10.884, PMID 23123382.
13. Erickson-Owens DA, Mercer JS, Oh W. Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial. J Perinatol. 2012;32(8):580-84. doi: 10.1038/jp.2011.159, PMID 22094494.
14. Jaiswal P, Upadhyay A, Gothwal S, Chaudhary H, Tandon A. Comparison of umbilical cord milking and delayed cord clamping on cerebral blood flow in term neonates. Indian J Pediatr. 2015;82(10):890-5. doi: 10.1007/s12098-015-1734-2, PMID 26008758.
15. Yadav AK, Upadhyay A, Gothwal S, Dubey K, Mandal U, Yadav CP. Comparison of three types of intervention to enhance placental redistribution in term newborns: randomized control trial. J Perinatol. 2015;35(9):720-4. doi: 10.1038/jp.2015.65, PMID 26087318.
16. Video Presentation: Vicki Taylor (for Professor William Tarnow-Mordi) on correct umbilical cord ’milking’ technique. Australian Placental Transfusion Study. Sydney, Australia: West Mead Hospital [cited Jan 21 2017]. Available from: http://www.videos.med.usyd.edu.au/unitube/videos/file19/