Technical Update No. 472: The Resuscitative Use of Intact Umbilical Cord Milking for Non-Vigorous Late Preterm (≥35⁰ weeks of gestation) and Term Infants.

Authors

Jocelynn Cook, Sarah D McDonald, Souvik Mitra, Venu Jain

Published in

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. Volume 48. Issue 11. Pages 103523. Oct 06, 2026. Epub Oct 06, 2026.

Abstract

To assess the benefits and risks of intact umbilical cord milking in non-vigorous infants from 35 weeks onwards.
Non-vigorous infants at a gestational age of ≥35⁰ weeks.
To administer or withhold intact umbilical cord milking in non-vigorous infants at a gestational age of ≥35⁰ weeks.
The primary outcomes assessed included neonatal mortality and morbidity, including hypoxic-ischemic encephalopathy, the need for resuscitation, and cardiorespiratory support.
In term and late preterm infants who remain non-vigorous despite stimulation, intact umbilical cord milking may reduce the incidence of moderate to severe hypoxic ischemic encephalopathy and the need for cardiorespiratory support. Available evidence does not suggest a significant increase in neonatal adverse outcomes, including jaundice requiring phototherapy.
Medline, PubMed, EMBASE, and the Cochrane Library were searched from April 1, 2020 to May 27, 2026 for medical subject heading (MeSH) terms and keywords related to deferred/delayed cord clamping and umbilical cord milking, and neonatal morbidity and mortality. Other relevant guidelines were also included. This document represents an abstraction of the evidence rather than a methodological review.
The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations).
Obstetric care providers, including obstetricians, family physicians, nurses, midwives and maternal-fetal medicine specialists.
If an infant at a gestational age of ≥35⁰ weeks, after 15 seconds of deferred (delayed) cord clamping and tactile stimulation while being kept warm still remains non-vigorous, then intact umbilical cord milking (UCM) may be considered to decrease hypoxic ischemic encephalopathy (HIE) and the need for cardiorespiratory support.

PMID:
42837684
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

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