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Carter Walker
Carter Walker


Background: Delayed cord clamping and umbilical cord milking provide placental transfusion to vigorous newborns. Delayed cord clamping in nonvigorous newborns may not be provided owing to a perceived need for immediate resuscitation. Umbilical cord milking is an alternative, as it can be performed more quickly than delayed cord clamping and may confer similar benefits.


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Objective: We hypothesized that umbilical cord milking would reduce admission to the neonatal intensive care unit compared with early cord clamping in nonvigorous newborns born between 35 and 42 weeks' gestation.

Study design: This was a pragmatic cluster-randomized crossover trial of infants born at 35 to 42 weeks' gestation in 10 medical centers in 3 countries between January 2019 and May 2021. The centers were randomized to umbilical cord milking or early cord clamping for approximately 1 year and then crossed over for an additional year or until the required number of consented subjects was reached. Waiver of consent as obtained in all centers to implement the intervention. Infants were eligible if nonvigorous at birth (poor tone, pale color, or lack of breathing in the first 15 seconds after birth) and were assigned to umbilical cord milking or early cord clamping according to their birth hospital randomization assignment. The baseline characteristics and outcomes were collected following deferred informed consent. The primary outcome was admission to the neonatal intensive care unit for predefined criteria. The main safety outcome was hypoxic-ischemic encephalopathy. Data were analyzed by the intention-to-treat concept.

Conclusion: Among nonvigorous infants born at 35 to 42 weeks' gestation, umbilical cord milking did not reduce neonatal intensive care unit admission for predefined criteria. However, infants in the umbilical cord milking arm had higher hemoglobin, received less delivery room cardiorespiratory support, had a lower incidence of moderate-to-severe hypoxic-ischemic encephalopathy, and received less therapeutic hypothermia. These data may provide the first randomized controlled trial evidence that umbilical cord milking in nonvigorous infants is feasible, safe and, superior to early cord clamping.

Most milking in the developed world is done using milking machines.[2] Teat cups are attached to the cow's teats, and then the cups alternate between vacuum and normal air pressure to extract the milk. The milk is filtered and cooled before being added to a large bulk tank of milk for storage.[3]

A known side effect of machine milking is mastitis in cows.[7] Non-sterile machines can introduce bacteria into the teat and cause infection. Another side effect is physical teat damage by the machine.

Objective: The objective of the study was to investigate the effect of umbilical cord milking as compared with early cord clamping on hematological parameters at 6 weeks of age among term and near term neonates.

The researchers enrolled 197 infants in their study. Mothers went into labor at or before the 32nd week of pregnancy. Of these, 154 were delivered by cesarean, with 75 assigned at random to the umbilical cord milking group and 79 assigned to the delayed clamping group. The 43 infants delivered vaginally also were assigned at random to either delayed clamping or umbilical cord milking.

Standard practice for non-vigorous infants is to immediately clamp and cut the umbilical cord so that the infant can rapidly be resuscitated. Many researchers are concerned, however, that this could deprive them of needed blood and worsen their outcome. Non-vigorous infants are at risk for complications such as low oxygen levels in the brain, cerebral palsy and stroke. In the current study, authors sought to determine if cord milking for non-vigorous infants could provide similar benefits to delayed cord clamping in less time

Non-vigorous infants in the study were assigned at random to undergo either cord milking or immediate clamping. For the cord milking, attending providers milked 20 centimeters of cord for two seconds, then repeated this procedure three times. Of more than 16,000 infants born after 35 to 42 weeks of pregnancy and screened at 10 institutions, 1,730 were included in the analysis.

Question Is there a difference in the rates of death or severe intraventricular hemorrhage among preterm infants who receive placental transfusion with umbilical cord milking vs delayed umbilical cord clamping?

Objective To determine whether the rates of death or severe intraventricular hemorrhage differ among preterm infants receiving placental transfusion with umbilical cord milking vs delayed umbilical cord clamping.

Main Outcomes and Measures The primary outcome was a composite of death or severe intraventricular hemorrhage to determine noninferiority of umbilical cord milking with a 1% noninferiority margin.

Estimated odds ratios (OR) and their 95% confidence intervals (CI) for the effect of pre-milking teat preparation and management period on Staphylococcus spp. (STA), Streptococcus spp. (STR) and coliform (COL) counts

Sheep products in Pennsylvania do not have to be limited to meat and wool. There is a growing interest in milking sheep and sheep milk products. In Europe, sheep dairying is a fairly common enterprise, and sheep breeds have been developed specifically for milk production. It is not unusual for these breeds to average four to seven pounds of milk daily. The European breeds, however, are not available in the United States because of import restrictions. Sheep breeds common to Pennsylvania average between. 0.75 and 2.0 pounds of milk daily. This requires U.S. sheep producers interested in dairying to carefully select ewes based on milk production and durability. Crossbred ewes produce more milk and are more durable than some purebreds.

Ewes in sheep milk production systems can also rear their lambs. However, there are variations in the length of time before the lambs are weaned. One of the more common production practices is to wean the lambs after three days and to rear them on milk replacer and creep feed. In this situation, ewes would probably be milked twice a day. Another practice would allow the lambs to nurse for 30 days. The ewes would be milked only once a day during this period. The normal length of lactation is 100 days. The average number of lambings is 1.5 per year in milking sheep flocks.

Setting up a milking sheep operation is fairly inexpensive when existing housing facilities are available. The milking parlor should be constructed with platforms so the ewes can be milked from behind. Sheep require a special milking machine which consists of a vacuum system, a pulsation system, cluster assemblies, and a system for transportation, release, and storage of the milk.

A well-planned breeding program is important for profitability. Sheep are seasonal breeders and are most fertile during September, October, and November. Day length is the key environmental factor affecting reproduction in ewes. In spite of their reputation, certain breeds of sheep seem to be less affected by day length than others. Certain breeds are recommended for milking sheep because a large percentage will breed through the winter and into the spring. Crossbred ewes developed from these breeds will often breed out-ofseason. In addition, crossbred ewes tend to reach sexual maturity earlier. (See table of recommended sheep breeds for a milking sheep production enterprise.)

Mastitis, or inflammation of the udder, is a problem directly associated with poor management practices. Improper milking tends to make ewes more prone to mastitis. Preventive measures include hygiene during milking, proper ventilation, clean housing, and adequate nutrition.

The following sample budget gives an example of costs and returns, and guidelines for initial resource requirements for milking sheep production. This sample budget should help ensure that all costs and receipts are included in your calculations. Costs and returns are often difficult to estimate in budget preparation because they are numerous and variable. Therefore, you should think of these budgets as an approximation and use the "Your Estimate" column to reflect your specific situation.

There are currently two interventions, which transfer blood from cords or placentae toward the neonates. Delayed umbilical cord clamping (DCC) is the method of umbilical cord clamping from 30 to 180 seconds after delivery which is considered as a passive transfer method. While the umbilical cord milking (UCM) is performed by squeezing blood from a cord toward a newborn. This is called an active transfer method.7

Freedom of choice and well-being for yourself and your cows. Flexibility and well-being for yourself and your cows while at the same time producing high-quality milk. That is what our barn concept offers. From milking to feeding and from care to barn lighting.

Cow milking is considered to be one of the most laborious and time-consuming activities at livestock farms. Additionally, considerable cost goes into this major farm operation. As a result, machine milking was invented to improve labor efficiency due to growing costs [5]. Machine milking has been shown to have the potential to increase milk production by up to 12%, reduce labor by up to 18%, and improve dairy cow welfare.

Our observation of an association between enhanced milking frequency and greater milk yield has been substantiated by the literature. In a previous study, [7] reported that milk yield increased by up to 10.4% in cows milked three times per day compared to those milked twice per day. Similarly, [21] showed that milking three times daily increased milk yield in cows by up to 18%. In another study, [22] showed that the yield of energy corrected milk was higher in cows milked three times per day compared to those milked twice per day.

We considered both Caesarean Section (CS) and vaginal deliveries, due to the insufficient number of isolated CS in connection with cord milking in published data. We did not consider multiple pregnancies cases, due to the lack of sufficient specific data concerning such cases.


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