73 Milking of the Cut-Cord during Stabilization of Very Preterm Infants: A Randomized Controlled Trial (The MoCC Study)
Bibliographic record
Abstract
Abstract Background Delayed cord clamping (DCC) for at least 30-60 seconds after birth has been recommended as the standard of care for most preterm infants. However, DCC can be contraindicated or not optimal in certain situations (for example, in cases of interrupted placental circulation). Milking of the long-cut cord (MoCC) while providing stabilization and supporting breathing of the infant after birth is proposed as an alternative to DCC. Objectives To investigate the feasibility of MoCC during stabilization of very preterm infants after birth. Design/Methods This parallel-group, randomized controlled trial was conducted at IWK Health, which is a tertiary care perinatal centre in Halifax, Canada. Infants born to eligible, consenting women presenting in preterm labor at <32 weeks’ gestation were randomized to the MoCC group (where the infant received 30 seconds of DCC while initial resuscitation steps were taken by the obstetric provider, followed by milking of the long-cut cord one time over 10 seconds, with breathing supported by the neonatal team) or to the current standard of care group. For these infants, DCC for 30-60 seconds depended on whether the baby was breathing at birth or not. Primary outcome was feasibility in terms of percentage recruitment, intervention compliance, safety, and study completion. Short-term clinical outcomes were collected. Analysis was by intention-to-treat. Results Fifty infants were randomized to either MoCC (25) or DCC (25) (see Figure below). Baseline characteristics were similar. All infants completed the study. One infant in the MoCC group and five infants in the DCC group did not receive the allocated intervention. Median (IQR) time to cord milking was 62 seconds (54, 99) and median (IQR) length of the cut cord milked was 20 cm (14, 29). MoCC was not associated with adverse effects when compared with DCC (see Table). Conclusion Milking the long-cut cord one time after 30 seconds of DCC, while supporting breathing, was feasible and not associated with adverse effects. A large randomized controlled trial is required to assess the efficacy of this approach for clinical outcomes. MoCC may be especially useful when immediate clamping is indicated. Potential competing interests Dr. El-Naggar has served as a consultant for Aerogen Pharma Limited and is a site investigator of its funded study: A Partially-Blind, Randomized, Controlled, Parallel-Group, Dose-Ranging Study to Determine the Efficacy, Safety and Tolerability of AeroFactTM (SF-RI 1 surfactant for inhalation combined with a dedicated drug delivery system) in Preterm Infants at Risk for Worsening Respiratory Distress Syndrome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".