Going "the Last Mile" With Guidelines for Deferred Umbilical Cord Clamping.

Abstract

* Abbreviation: DCC — : deferred cord clamping Why are clinicians reluctant to adopt deferred umbilical cord clamping? Deferred cord clamping (DCC) facilitates a smooth transition to extrauterine life, and recent meta-analyses reveal reduced neonatal morbidity and mortality among preterm infants.1–3 In this issue of Pediatrics , Korale Liyanage et al4 present a systematic review of clinical practice guidelines on DCC and umbilical cord milking. All 44 statements from 35 organizations included in the review endorsed deferred umbilical cord clamping for uncompromised preterm infants. Despite the proliferation of guidelines, the authors note that >40% of preterm infants admitted to NICUs across California and Canada do not receive DCC. What is preventing the translation of evidence to practice? Low uptake of clinical practice guidelines is not unique to cord management; however, the case of DCC highlights that publication of guidelines only begins the crucial phase of dissemination, local implementation, and evaluation.5,6 Less than half of guidelines adequately articulated the values and preferences informing their treatment recommendations or provided advice on implementation.4 Regional and national councils and professional organizations often create context-specific guidelines from a common evidence-evaluation base, such as the International Liaison Committee on Resuscitation Consensus on Science. When different regions, … Address correspondence to Susan Niermeyer, MD, MPH, University of Colorado School of Medicine, Section of Neonatology, 13121 E 17th Ave, Mail Stop 8402, Aurora, CO 80045. E-mail: susan.niermeyer{at}cuanschutz.edu