Umbilical cord milking for non-vigorous term and late preterm neonates: are we there yet?

The International Liaison Committee on Resuscitation (ILCOR) recently issued a weak recommendation, based on low-certainty evidence, favouring intact umbilical cord milking (UCM) over early cord clamping (ECC) for term and late preterm infants who remain non-vigorous despite initial stimulation.1 This recommendation was primarily informed by evidence from a multicentre, cluster-randomised crossover trial that enrolled 1730 infants.2 The results of this pragmatic trial showed no significant difference in the primary outcome, ‘Neonatal intensive care unit (NICU) admission’, for which it was adequately powered. The ILCOR committee, however, based their recommendation on secondary findings, including a reduction in moderate or severe hypoxic-ischaemic encephalopathy (HIE), and improvement in early haemoglobin levels without adverse effects.