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Steps for implementing delayed cord clamping in a hospital setting.

Ryan M McAdams1, Carl H Backes2, David J R Hutchon3

  • 1Department of Pediatrics, Division of Neonatology, University of Washington, Box 356320, Seattle, WA 98195-6320 USA.

Maternal Health, Neonatology and Perinatology
|April 9, 2016
PubMed
Summary

Delayed umbilical cord clamping (DCC) in preterm newborns increases blood volume but faces implementation challenges. Strategies are needed to maintain compliance and ensure consistent application of this practice.

Keywords:
AnemiaBirthNewbornPlacental transfusionPreterm

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Area of Science:

  • Neonatal Medicine
  • Obstetrics
  • Healthcare Quality Improvement

Background:

  • Delayed umbilical cord clamping (DCC) enhances neonatal blood volume via placental transfusion.
  • Adoption of DCC in preterm infants remains suboptimal despite medical body endorsements.
  • Implementation guidelines are crucial for integrating DCC into hospital practices.

Purpose of the Study:

  • To provide a framework for implementing DCC in hospital settings.
  • To guide medical providers in adopting DCC for premature newborns (<37 weeks' gestation).

Main Methods:

  • A descriptive implementation guideline based on University of Washington's experience.
  • Quality improvement data collection to assess DCC compliance over six months.
  • Anonymous electronic survey of obstetrical providers regarding policy awareness and adherence.

Main Results:

  • Initial DCC compliance at UW was 79.2%, decreasing to 40.1% over six months.
  • Most surveyed obstetricians were aware of the DCC policy and had performed it.
  • Concerns about maternal hemorrhage and neonatal resuscitation were primary reasons for immediate clamping.

Conclusions:

  • A procedural practice plan is beneficial for DCC implementation, including readiness assessment and compliance monitoring.
  • Strategies to sustain protocol awareness are recommended as compliance may decline over time.
  • Tracking infant outcomes following DCC is essential for ongoing evaluation.