Delayed Cord Clamping Protocol Research Articles

Thermoregulation-Focused Implementation of Delayed Cord Clamping among

Delayed cord clamping (DCC) is recommended for all neonates; however, adapting such practice can be slow or unsustainable, especially among preterm neonates. During DCC neonates are exposed to a cool environment, raising concerns for neonatal hypothermia. Moderate hypothermia may induce morbidities that counteract the potential benefits of DCC. A quality improvement project on a thermoregulation-focused DCC protocol was implemented for neonates less than 34 weeks' gestational age (GA). The aim was to increase the compliance rate of DCC while maintaining normothermia. The DCC protocol was implemented on October 1, 2020 in a large Level III neonatal intensive care unit. The thermoregulation measures included increasing delivery room temperature and using heat conservation supplies (sterile polyethylene suit, warm towels, and thermal pads). Baseline characteristics, the compliance rate of DCC, and admission temperatures were compared 4 months' preimplementation and 26 months' postimplementation RESULTS: The rate of DCC increased from 20% (11/54) in preimplementation to 57% (240/425) in postimplementation (p < 0.001). The balancing measure of admission normothermia remained unchanged. In a postimplementation subgroup analysis, the DCC cohort had less tendency to experience admission moderate hypothermia (<36°C; 9.2 vs. 14.1%, p = 0.11). The DCC cohort had more favorable secondary outcomes including higher admission hematocrit, less blood transfusions, less intraventricular hemorrhage, and lower mortality. Improving the process measure of accurate documentation could help to identify implementation barriers. Performing DCC in preterm neonates was feasible and beneficial without increasing admission hypothermia. · Thermoregulation-focused DCC protocol was implemented to increase DCC while maintaining normothermia.. · DCC rate increased from 20 to 57% while admission normothermia rate remained the same.. · DCC practice on preterm neonates is safe and feasible while maintaining normothermia..

Effects of delayed cord clamping on neonatal hyperbilirubinemia in pre-gestational diabetes at term

Objective To evaluate the effects of delayed cord clamping on neonatal hyperbilirubinemia in infants born to patients diagnosed with pre-gestational diabetes (type I or type II). Methods In January 2016, our institution implemented an organization-wide thirty-second delayed cord clamping protocol. This retrospective cross-sectional study represents infants of mothers diagnosed with pre-gestational diabetes who delivered before and after protocol implementation. The study period was from October 2014 to August 2017. The primary outcome was peak neonatal transcutaneous bilirubin (mg/dL) level during neonatal hospital stay. The secondary outcomes included neonatal serum bilirubin (mg/dL), jaundice requiring phototherapy, hypoglycemia, polycythemia, respiratory distress, and neonatal intensive care unit (NICU) admission. A subgroup analysis for outcomes stratified by type of pre-gestational diabetes was also performed. Results 145 patients were included in the final analysis. The mean peak neonatal transcutaneous bilirubin level was 10.1 mg/dL ± 3.4 mg/dL for immediate cord clamping and 9.5 mg/dL ± 3.4 mg/dL for delayed cord clamping (p = .25). There were no significant differences between groups for neonatal jaundice requiring phototherapy, hypoglycemia, polycythemia, respiratory distress, or NICU admission. No differences were observed in neonatal outcome by subgroup analysis of pre-gestational diabetes type. Conclusion In our study, there was no significant increase in peak neonatal transcutaneous bilirubin in term (≥37 week) infants of mothers with pre-gestational diabetes after undergoing thirty-seconds of delayed cord clamping. In the absence of contraindications, we advocate for continued use of delayed cord clamping for these infants.

Impact of a delayed cord clamping protocol on maternal and neonatal outcomes in patients undergoing term cesarean section

Objective Given concerns amongst physicians and other maternity providers for increased maternal blood loss with delayed cord clamping, our objective was to determine the impact of routine delayed clamping with term cesarean section on maternal blood loss metrics. Study design A retrospective cohort study evaluated the impact of delayed cord clamping in term cesareans at our tertiary care center following protocol implementation. The pre-protocol group (PRE) ranged 1 October 2015 to 31 March 2016. The post-protocol (POST) group ranged 1 October 2017 to 31 March 2018. The primary outcome was maternal estimated blood loss (EBL) during cesarean section. Secondary outcomes included maternal transfusion, hemorrhage (EBL > 1,000 mL), and changes in hemoglobin (Hgb) and hematocrit (HCT). Neonatal outcomes were APGAR scores at 1 and 5 min. Results 733 subjects were included, (PRE = 416, POST = 317). Overall 44.7% reported prior cesarean section. Preop differences included only platelets k/µL (222 vs. 211, p = .015), Hgb g/dL (11.7 vs. 11.9, p = .002) and HCT% (36.2 vs. 35.2, p = .027), with Hgb and HCT differences in opposite clinical directions. EBL actually decreased after the delayed cord clamping protocol (p = .04). The median [interquartile range] was the same (700 [600–800]), but the PRE group had higher proportions of EBL 800–1,000 (16% vs. 11%) and EBL > 1,000 (4.3% vs 3.7%) comprising this statistical difference. There was no difference in maternal transfusion (2.2%), hemorrhage (11.1%), or change in Hgb (Δ = –1.6 g/dL) or HCT (Δ = –4.6%), (all p > .05). APGAR scores were slightly lower in the POST group at 1 min (8 [8–9] vs. 9 [8–9], p = .035) but similar by 5 min (9 [9–9], p = .38). Conclusion Concerns for increased maternal blood loss during cesarean delivery after implementing a routine delayed cord clamping protocol were not supported. While EBL was lower with delayed cord clamping, all differences between groups appear to lack clinical significance. This offers reassuring evidence there is no negative impact on maternal hematologic characteristics including blood loss from the delayed cord clamping protocol.

Analysis of All Preterm Infants Receiving Delayed Cord Clamping versus Immediate Clamping after Introducing a Delayed Cord Clamping Protocol

Background: Delayed Cord Clamping (DCC) has been recommended by multiple medical bodies, including the American Congress of Obstetricians and Gynecologists, especially due to its benefits in preterm neonates, and is being adopted in many practices. Previous studies have shown benefits such as decreased blood transfusions, improved thermoregulation, decreased rates of intraventricular hemorrhage and necrotizing enterocolitis, however recent studies have found no improved morbidity or mortality. Goal: To evaluate whether there was an effect of delayed cord clamping on short term neonatal …

Analysis of All Preterm Infants Receiving Delayed Cord Clamping versus Immediate Clamping after Introducing a Delayed Cord Clamping Protocol

Analysis of All Preterm Infants Receiving Delayed Cord Clamping versus Immediate Clamping after Introducing a Delayed Cord Clamping Protocol

Short Term Outcomes in Preterm Neonates that underwent Delayed Cord Clamping Who Met or Did Not Meet Inclusion Criteria

Background: Delayed Cord Clamping (DCC) has been recommended by multiple medical bodies, including the American Congress of Obstetricians and Gynecologists, especially due to its benefits in preterm neonates, and is being adopted in many practices. Part of DCC protocol entails meeting inclusion criteria. The aim of this study was to evaluate outcomes in those who received DCC and either met or did not meet inclusion criteria. Methods: IRB-exempt Quality Improvement prospective project was conducted implementing DCC …

Initiation of a Delayed Cord Clamping Protocol in Preterm Infants with a Focus on Interdisciplinary Communication

Background: Delayed Cord Clamping (DCC) has been recommended by multiple medical bodies, including the American Congress of Obstetricians and Gynecologists, especially due to its benefits in preterm neonates, however it has only been minimally adopted in many practices. Studies in protocol initiation of DCC have demonstrated stepwise initiation of a protocol for preterm infants in the delivery room with variable compliance. This study evaluated if a DCC protocol can be successfully initiated with minimal education, primarily through clear communication between interdisciplinary providers at all levels. …

Initiation of a Delayed Cord Clamping Protocol in Preterm Infants with a Focus on Interdisciplinary Communication

Initiation of a Delayed Cord Clamping Protocol in Preterm Infants with a Focus on Interdisciplinary Communication

Use of Delayed Cord Clamping in Preterm Dichorionic Twin Gestations [27B

INTRODUCTION: Delayed cord clamping (DCC) for premature neonates has become standard of care in singleton gestations, but the outcomes after DCC in twin gestations are unclear. The aim of this study was to examine feasibility and outcomes associated with DCC in twins. METHODS: This is a retrospective cohort study of women delivering dichorionic-diamniotic twin gestations between 23-32 weeks gestation at a single center (2013-2015). In 6/2013, this institution introduced a DCC protocol for singleton neonates delivering &lt; 32 weeks, with some dichorionic twins who also received DCC. Clinical characteristics and neonatal outcomes of twins receiving DCC were compared to those who did not. Bivariable assessments and fixed effects multivariable logistic and linear regression were utilized. RESULTS: Of 58 women delivering dichorionic twins &lt; 32 weeks, 8 (13.8%) had both neonates receive DCC, resulting in 16 neonates who received DCC. DCC occurred both among those who were delivered vaginally (n=7), and by cesarean section (n=9). Neonates who received DCC, compared to those who did not, had similar umbilical artery pH, initial temperature, 5-minute Apgar score, and peak bilirubin. Additionally, there were no differences in neonatal intensive care unit length of stay, birth hematocrit, total number of blood transfusions or transfusions received in the first week, mechanical ventilation, need for pressors, death, or other adverse outcomes. CONCLUSION: Performance of DCC in dichorionic twin gestations born &lt; 32 weeks is feasible and not associated with worse neonatal outcomes in this small cohort. Further investigation of expansion of DCC protocols to dichorionic twin gestations appears worthy of exploration.

Maternal outcomes following the initiation of an institutional delayed cord clamping protocol: an observational case–control study

Objective: The objective of this study is to evaluate maternal outcomes before and after implementation of an institutional delayed cord clamping (DCC) protocol.Study design: We performed a secondary analysis of a retrospective cohort study of deliveries occurring at <34 weeks at a tertiary care center in 2013–2014. About 139 women who underwent early cord clamping were compared with 130 women delivered after DCC protocol implementation. Maternal estimated blood loss (EBL) was the primary outcome of interest. Operative times, post-Cesarean decrease in hemoglobin (Hgb), and rates of post-partum hemorrhage and transfusion were also examined in bivariate and multivariable analyses.Results: About 75% of post-guideline deliveries had actual DCC. In regression analyses, only Cesarean delivery and multifetal gestation increased EBL. No trends were identified in EBL over time. In post-hoc analysis, the study had over 80% power to detect a difference in post-partum hemorrhage rates of 20%.Conclusion: An institutional DCC protocol for deliveries <34 weeks was not associated with an identifiable increase in adverse maternal outcomes.

940: Evaluation of implementation of a delayed cord clamping protocol for premature infants in a high volume maternity center

940: Evaluation of implementation of a delayed cord clamping protocol for premature infants in a high volume maternity center

639: Implementation of an evidence-based delayed cord clamping protocol for neonates

639: Implementation of an evidence-based delayed cord clamping protocol for neonates <32 weeks

A quality improvement initiative for delayed umbilical cord clamping in very low-birthweight infants.

BackgroundDue to clinical benefits, delayed cord clamping (DCC) is recommended in infants born before 37 weeks gestational age. The objective was to institute a delayed cord clamping program and to evaluate clinical outcomes one year after initiation.MethodsThis study occured at Christiana Care Health System, a tertiary care facility with a 52 bed level 3 Neonatal Intensive Care Unit (NICU). A multidisciplinary team created a departmental policy, a DCC protocol and educational programs to support the development of a DCC program. A year after initiation of DCC, we evaluated two cohorts of very low birth weight (VLBW) infants (<1500 g) prior to (Cohort 1) and after initiation (Cohort 2) of DCC (n = 136 and n = 142 respectively). Chart review was conducted to evaluate demographic data and clinical outcomes. Analysis was completed with a retrospective, cohort analysis on an intention-to-treat basis.ResultsThere were no differences in demographic factors between the two cohorts. We demonstrated a 73 % compliance rate with the delayed cord clamping protocol and a decrease in the percentage of VLBW infants requiring red blood cell transfusion from 53.7 to 35.9 % (p = 0.003). We also found a decreased need for respiratory support in the second cohort with no increases in the balancing measures of admission hypothermia and jaundice requiring phototherapy. During the Control Phase ongoing monitoring and education has led to a 93.7 % compliance rate.ConclusionsA multidisciplinary team including key leadership from the obstetric and pediatric departments allowed for the rapid and safe implementation of DCC.

A Single-Center Experience of Implementing Delayed Cord Clamping in Babies Born at Less Than 33 Weeks' Gestational Age

To describe the implementation and outcomes of delayed cord clamping (DCC) in preterm babies. Following staff orientation, a policy of DCC for 45 seconds was instituted for all eligible babies born between 28 and 32 weeks' gestational age, and later to all those younger than 33 weeks. Of 480 babies, 349 (73%) were eligible for DCC. Of these, 236 (68%) received DCC. Monthly compliance rates to DCC protocol in eligible babies ranged from 18% to 93%. There was no significant difference in demographic measures or rates of delivery room ventilation between eligible babies who did or did not receive DCC. Delayed cord clamping was associated with less hypothermia, higher initial hemoglobin levels, and less necrotizing enterocolitis, with a trend toward lower 1-minute Apgar scores and less blood pressure support. The DCC protocol is feasible in preterm babies with reinforcement and education. It appears practical, safe, and applicable, and has minimal impact on immediate neonatal transition, with possible early neonatal benefits.