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

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.