OBJECTIVE: To compare two strategies to enhance placento- fetal blood transfusion in preterm neonates before 33 weeks of gestation. METHODS: We recruited women at risk for singleton preterm deliveries. All delivered before 33 completed weeks of gestation. In this single-center trial, women were randomized to either standard treatment (clamping the cord for 30 seconds after delivery) or repeated (four times) milking of the cord toward the neonate. Exclusion criteria included inadequate time to obtain consent before delivery, known congenital abnormalities of the fetus, Rhesus sensitization, or fetal hydrops. RESULTS: Of 58 neonates included the trial, 31 were randomized to cord clamping and 27 were randomized to repeated milking of the cord. Mean birth weight was 1,263428 g in the clamping group and 1,235468 g in the milking group, with mean gestational age of 29.22.3 weeks and 29.52.7 weeks, respectively. Mean hemoglobin values for each group at 1 hour after birth were 17.3 g/L for clamping and 17.5 g/L for milking (P.71). There was no significant difference in number of neonates undergoing transfusion (clamping group, 15; milking group, 17; P.40) or the median number of transfusions within the first 42 days of life (median [range]: clamping group 0 [0–7]; milking group 0 [0–20]; P.76). CONCLUSION: Milking the cord four times achieved a similar amount of placento-fetal blood transfusion compared with delaying clamping the cord for 30 seconds.