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Oral Concurrent Session 3 - Fetus and Fetal Intervention

Oral Concurrent Sessions

Oral Concurrent Session 3 - Fetus and Fetal Intervention

(36) Two year outcomes in premature infants randomized to umbilical cord milking versus delayed cord clamping.

Wednesday, February 11, 2026

2:45 PM - 3:00 PM

Location: Summit 218 - 221

Submitting Author and Presenting Author(s)

Anup Katheria, MD

Director, Neonatal Research Institute
Sharp Mary Birch Hospital for Women & Newborns
San Diego, California, United States

Coauthor(s)

JS

Jeff M. Szychowski, PhD

Associate Professor
Department of Biostatistics, University of Alabama at Birmingham
Birmingham, Alabama, United States
NW

Nicole Wilson

Department of Biostatistics, University of Alabama at Birmingham
Burmingham, Alabama, United States
KA

Kathy Arnell, RN

Sharp Mary Birch Hospital for Women & Newborns
San Diego, California, United States
YV

Yvonne Vaucher

Sharp Mary Birch Hospital for Women & Newborns
San Diego, California, United States

Objective:
The PREMOD2 trial showed umbilical cord milking (UCM) vs delayed cord clamping (DCC) increases severe intraventricular hemorrhage in extremely preterm infants (23-27 weeks) but not in very preterm infants (28-32 weeks). We compare post-discharge neurodevelopmental (ND) outcomes at 2 years corrected age (CA) in children from PREMOD2.

Study Design:
ND outcomes of preterm infants born 23 0/7-32 6/7 weeks were assessed with Bayley Scales of Infant Development 3^rd (BSID-3) or 4^th (BSID-4) ed. Assessors were blinded to treatment allocation. Motor and neurosensory impairments were ascertained by in-person exams, parent phone interviews or chart abstraction. BSID scores were compared between study groups and strata and evaluated at a 2-point non-inferiority margin. Mild, moderate and severe ND impairment (NDI) were classified using standard definitions of cognitive impairment, abnormal gross motor classification score, vision or hearing impairment.

Results:
Of 1201 infants enrolled in the original study there were 40 deaths (20 per group). Of the remaining infants, 996 (86%) had some information on ND outcomes at 22-26 months CA. Demographics in those assessed by in-person BSID-3 or 4 (UCM, n=436 and DCC, n=438) groups were similar. Children in both groups had similar cognitive and language scores, though differences exceeded the non-inferiority margin (Table 1). UCM motor scores were marginally lower. There were no differences in hearing loss (1.7% vs 2.1%, p=0.66), visual impairment (4.7% vs 3.5%, p=0.38), cerebral palsy (4.3% vs 3.7%, p=0.64), mild NDI (12.2% vs 12.6%, p=0.86), or moderate to severe NDI (8.3% vs 8.2%, p=0.98) in UCM vs DCC, respectively. Rates of normal BSID scores by gestational age strata are in Table 2.

Conclusion:
In PREMOD2, rates of NDI assessed by BSID at 2 years CA did not differ substantially between UCM and DCC groups. Combined with previously reported similar short-term outcomes in infants 28-32 weeks, these data suggest UCM in this group is a feasible, no-cost intervention without longer-term neurodevelopmental risks of cord milking.