Abstract / Summary
Objective: To assess the benefits and risks of intact umbilical cord milking in non-vigorous infants from 35 weeks onwards.
Target population: Non-vigorous infants at a gestational age of ≥350 weeks.
Options: To administer or withhold intact umbilical cord milking in non-vigorous infants at a gestational age of ≥350 weeks.
Outcomes: The primary outcomes assessed included neonatal mortality and morbidity, including hypoxic-ischemic encephalopathy, the need for resuscitation, and cardiorespiratory support.
Benefits, harms, and costs: 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.
Evidence: 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.
Validation methods: 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).
Intended audience: Obstetric care providers, including obstetricians, family physicians, nurses, midwives and maternal-fetal medicine specialists.
Social media abstract: 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.