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Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants
Angie C Jelin1, Marya G Zlatnik2, Miriam Kuppermann2
1a Department of Obstetrics and Gynecology , Washington Hospital Center , Washington , DC , USA .
Insights
Implementing delayed umbilical cord clamping (DCC) for preterm infants improved outcomes like hematocrit and temperature, while decreasing intraventricular hemorrhage (IVH). These benefits suggest DCC is a valuable practice despite initial challenges.
Area of Science:
- Neonatal Medicine
- Pediatric Health
- Clinical Implementation Science
Background:
- Randomized controlled trials show delayed umbilical cord clamping (DCC) benefits preterm infants.
- Observed benefits include increased hematocrit and reduced intraventricular hemorrhage (IVH).
- Clinician resistance can be a barrier to implementing new policies.
Purpose of the Study:
- To assess the impact of a DCC policy on preterm infants.
- To evaluate neonatal outcomes following DCC policy implementation.
- To determine if DCC benefits persist despite initial compliance challenges.
Main Methods:
- A DCC policy (30-60 seconds) was implemented for preterm infants (<35 weeks gestation).
- A pre-test/post-test design analyzed outcomes from 2009-2013 (2 years pre- and 2 years post-implementation).
- Primary outcomes included policy compliance and key neonatal indicators.
Main Results:
- DCC policy compliance was 49% despite dissemination efforts.
- Post-implementation, infants showed significantly decreased IVH rates.
- Infants also had significantly increased initial hematocrits and improved temperatures.
Conclusions:
- DCC policy implementation improved preterm infant outcomes.
- Observed benefits included higher hematocrits, better temperatures, and less IVH.
- The advantages of DCC outweighed potential risks, supporting its clinical use.
Objective:
Randomized controlled trials have demonstrated that delayed umbilical cord clamping (DCC) in preterm infants results in improved neonatal outcomes, including increased hematocrit, and decreased rates of intraventricular hemorrhage (IVH) and packed red blood cell transfusions. We hypothesized that implementation of a DCC policy in preterm infants would result in similarly improved outcomes, despite initial clinician resistance.
Study Design:
A DCC policy (30-60 s) for singleton infants <35 weeks gestation was implemented in September 2011. We conducted a pre-test/post-test analysis of neonatal outcomes among singletons delivered between 24 0/7 weeks and 34 6/7 weeks gestation from 2009 to 2013 (2 years pre-implementation and 2 years post-implementation). The primary outcomes were rates of policy compliance and four neonatal outcomes.
Results:
Despite multiple routes of policy dissemination, DCC was attempted in only 49% of the deliveries. In spite of this, infants delivered post-policy implementation (n = 196) had a significant decrease in IVH, significant increase in initial hematocrits, and improved temperatures compared with infants delivered pre-implementation (n = 204).
Conclusion:
After implementation of a DCC policy, preterm singleton infants had improved temperatures, increased hematocrits and a decreased prevalence of IVH without significant differences in adverse outcomes, suggesting that the benefits of DCC outweighed the risks.
