Intact cord milking may be considered for non-vigorous infants from 35 weeks

Design

Technical update; literature search with GRADE rating, an abstraction of evidence

Population

Non-vigorous infants born at 35 weeks or later

Primary outcome

Neonatal mortality and morbidity including HIE, resuscitation and cardiorespiratory support

Effect

May reduce moderate to severe HIE and need for cardiorespiratory support; no clear rise in jaundice needing phototherapy

A Society of Obstetricians and Gynaecologists of Canada technical update looked at intact umbilical cord milking in infants born at 35 weeks or later who remain non-vigorous. The authors searched Medline, PubMed, EMBASE and the Cochrane Library from April 2020 to May 2026, graded the evidence with GRADE, and describe the document as an abstraction of the evidence rather than a full methodological review.

The suggested sequence is deferred clamping for 15 seconds with tactile stimulation and warmth. If the infant is still non-vigorous after that, cord milking may be considered. In this group the update reports that milking may reduce moderate to severe hypoxic-ischaemic encephalopathy and the need for cardiorespiratory support, and that the available evidence does not suggest more adverse neonatal outcomes, including jaundice needing phototherapy.

The wording is permissive, not mandatory. Units that have not used milking should treat this as a prompt to review local resuscitation protocols with neonatal colleagues, not as a reason to change practice at the next delivery.

• Applies to infants of 35 weeks or more who stay non-vigorous after 15 seconds of deferred clamping, stimulation and warmth.
• Milking is something to consider in that group; it is not framed as routine for every delivery.
• Reported benefits are less moderate to severe HIE and less need for cardiorespiratory support.
• No clear rise in jaundice needing phototherapy was found, but check local neonatal agreement first.
• Agree the sequence and who performs it with the neonatal team before using it.

Why it matters

It gives obstetric teams a defined next step for the infant who does not respond to stimulation during deferred clamping.

Don't overread it

The update does not recommend milking for vigorous infants or for babies born before 35 weeks.

The statistics, in plain English

This is a guideline built on a literature search, not a single trial, and the abstract gives no pooled effect sizes. 'May reduce' reflects the strength of the underlying evidence: it supports considering the step, not a firm recommendation for all.

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