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Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - A quality
Insights
Implementing delayed umbilical cord clamping (DCC) for preterm infants improved outcomes. This quality improvement program reduced the need for resuscitation, metabolic acidosis, and medical interventions, demonstrating safety and efficacy.
Area of Science:
- Neonatal Medicine
- Pediatric Quality Improvement
- Perinatal Research
Background:
- Delayed umbilical cord clamping (DCC) is increasingly recognized for its benefits in term infants.
- Evidence for DCC in preterm infants, especially in a quality improvement (QI) framework, requires further evaluation.
- Implementing standardized DCC protocols can impact neonatal outcomes.
Purpose of the Study:
- To assess the safety and effectiveness of a QI program for DCC in singleton and multiple preterm infants.
- To evaluate the impact of a DCC protocol on clinical outcomes in preterm neonates.
- To determine the feasibility and success rate of DCC implementation in a clinical setting.
Main Methods:
- A quality improvement program for DCC was implemented.
- Clinical outcomes of 150 preterm infants (<34 weeks gestation) before (Epoch I) and after (Epoch II) protocol implementation were compared.
- Protocol compliance, success rates, and key neonatal outcomes were analyzed.
Main Results:
- Protocol compliance was high (92%), with successful DCC in 77% of cases.
- Infants in Epoch II showed decreased need for delivery room intubation, less metabolic acidosis, and higher initial hematocrit.
- Fewer infants in Epoch II required rescue surfactant, medical treatment for PDA, or red blood cell transfusions.
Conclusions:
- Protocol-guided DCC for 30 seconds is safe and effective for preterm infants, including multiples.
- DCC implementation led to improved initial physiological parameters and reduced need for neonatal interventions.
- The QI program successfully decreased the incidence of respiratory distress, PDA, and anemia requiring transfusion.
Objectives:
To evaluate the safety and efficacy of a quality improvement (QI) program of delayed umbilical cord clamping (DCC) in multiple and singleton preterm infants born at our center.
Methods:
After DCC protocol implementation, compliance and success rate were assessed. Clinical outcomes of selected 150 preterm infants <34 weeks gestation born in 2014 after protocol implementation (Epoch II) were compared to those of preterm infants born in 2013 before protocol implementation (Epoch I).
Results:
Overall protocol compliance rate was 92% (246/267). DCC was successfully performed in 77% (205/267) after protocol implementation. There were higher multiple births in Epoch II compared to Epoch I (27.3 vs. 15.3% , p < 0.01). At birth, infants in Epoch II had significantly decreased need for intubation in delivery room (23.3 vs. 39.3% , p < 0.01), had higher hematocrit (46.4±7.3 vs. 44.0±7.1% , p < 0.01) and less metabolic acidosis (base excess -4.1±2.7 vs. -5.3±4.2 mmol/L, p < 0.01) compared to those born in Epoch I. During hospital stay, fewer infants in Epoch II received rescue surfactant therapy (45.3 vs. 56.7% , p = 0.05), medical treatment for PDA (6.7 vs. 16.6% , p = 0.04%) and red blood cell transfusions (20.7 VS. 32.0% , p < 0.01) compared to Epoch I.
Conclusions:
Protocol-guided practice of DCC for 30 seconds can be safely performed in multiple and singleton preterm infants. In addition to higher initial hematocrit, infants in our QI project had lower need for delivery room resuscitation and less metabolic acidosis at birth. We also observed decreased need for rescue surfactant therapy, medical treatment for PDA and red blood cell transfusions after DCC protocol implementation.
