Abstract
Delayed cord clamping (DCC) is endorsed by multiple professional organizations for both term and preterm infants. In preterm infants, DCC has been shown to reduce intraventricular hemorrhage, lower incidence of necrotizing enterocolitis, and reduce the need for transfusions. Furthermore, in preterm animal models, ventilation during DCC leads to improved hemodynamics. While providing ventilation and continuous positive airway pressure (CPAP) during DCC may benefit infants, the logistics of performing such a maneuver can be complicated. In this simulation-based study, we sought to explore attitudes of providers along with the safety and ergonomic challenges involved with safely resuscitating a newborn infant while attached to the placenta. Multidisciplinary workshops were held simulating vaginal and Caesarean deliveries, during which providers started positive pressure ventilation and transitioned to holding CPAP on a preterm manikin. Review of videos identified 5 themes of concerns: sterility, equipment, mobility, space and workflow, and communication. In this study, simulation was a key methodology for safe identification of various safety and ergonomic issues related to implementation of ventilation during DCC. Centers interested in implementing DCC with ventilation are encouraged to form multidisciplinary work groups and utilize simulations prior to performing care on infants.
Highlights
In recent years, the practice of delayed cord clamping (DCC), defined as clamping of the umbilical cord 30 s or more after delivery, has been endorsed by multiple professional organizations (Table 1).Current evidence suggests that Delayed cord clamping (DCC) may improve outcomes by allowing for greater volume of blood transferred from the placenta to the infant [1]
Evidence from animal models would suggest that inflation of the lung prior to cord clamping is critical. Putting these two practices together, a single center study reported that premature infants who started breathing spontaneously during DCC
All simulated resuscitation scenarios were performed at the Center for Advanced Pediatric and Perinatal Education (CAPE)
Summary
The practice of delayed cord clamping (DCC), defined as clamping of the umbilical cord 30 s or more after delivery, has been endorsed by multiple professional organizations (Table 1). Evidence from animal models would suggest that inflation of the lung prior to cord clamping is critical Putting these two practices together, a single center study reported that premature infants who started breathing spontaneously during DCC had improved outcomes compared to those who did not breathe spontaneously [18]. The process of establishing ventilation in premature infants during delayed cord clamping has been reported as a feasible practice [24,25,26,27], there is scarce detail on what practical challenges may be involved during implementation In this simulation study, we sought to explore attitudes of providers, as well as the safety and ergonomic challenges of how providers may safely resuscitate and apply CPAP to an infant while still attached to the placenta via the umbilical cord
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