extremely poor recruitment & since the study was approved, medical practice has evolved to where cord milking is now common practice.

Anemia in preterm neonates is a significant problem encountered frequently in the neonatal intensive care unit. Most preterm neonates born at less than 33 weeks gestation will require at least one blood transfusion during their hospital course and many will require repeated transfusions. Blood transfusions, albeit necessary, carry increased risk of viral infections and transfusion reactions as well as increase the cost of healthcare. The umbilical cord and placenta harbor up to 40% of blood available during fetal life. The current standard of care is immediate umbilical cord clamping. The investigators are performing a randomized controlled trial comparing immediate cord clamping to milking the umbilical cord prior to clamping in neonate born preterm less than 33 weeks gestation. The investigators hypothesize that milking the umbilical cord will demonstrate the same benefits as delayed cord clamping, without delaying neonatal resuscitation.

Inclusion Criteria:

• Preterm neonates delivered between 24 0/7 and 32 6/7
• Mother carrying a fetus between 24-32 6/7 weeks estimated gestational age
• Written parental consent

Exclusion Criteria:

• Multiple gestation pregnancies (twins or higher order multiples)
• Rh or other antibody sensitization
• Hydrops fetalis
• Known major congenital abnormality
• Suspected abruptio placentae