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Published on: December 31, 2015
A quality improvement initiative for delayed umbilical cord clamping in very low-birthweight infants
Jeff Bolstridge1, Tracy Bell2, Barbara Dean2
1Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA. jeffrey.m.bolstridge.mil@mail.mil.
Insights
Implementing delayed cord clamping (DCC) in premature infants significantly reduced the need for red blood cell transfusions and respiratory support. This program showed high compliance and improved clinical outcomes for very low birth weight infants.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Pediatric Outcomes
Background:
- Delayed cord clamping (DCC) is recommended for infants born before 37 weeks gestation due to established clinical benefits.
- Implementation of a DCC program was initiated to evaluate its impact on clinical outcomes.
Purpose of the Study:
- To establish a delayed cord clamping program within a tertiary care facility.
- To assess the clinical outcomes of very low birth weight (VLBW) infants one year after DCC program initiation.
Main Methods:
- A multidisciplinary team developed a DCC policy and educational programs.
- Two cohorts of VLBW infants (<1500 g) were evaluated: pre-DCC (Cohort 1, n=136) and post-DCC (Cohort 2, n=142).
- Retrospective chart review and intention-to-treat analysis were used to compare demographic data and clinical outcomes.
Main Results:
- A 73% compliance rate with the DCC protocol was achieved, increasing to 93.7% with ongoing monitoring and education.
- A significant decrease in RBC transfusions was observed (53.7% to 35.9%, p=0.003).
- Reduced need for respiratory support was noted, with no increase in hypothermia or jaundice requiring phototherapy.
Conclusions:
- Rapid and safe implementation of DCC was facilitated by a multidisciplinary team approach.
- The DCC program successfully improved key clinical outcomes for VLBW infants without adverse effects.
Background:
Due 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.
Methods:
This 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.
Results:
There 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.
Conclusions:
A multidisciplinary team including key leadership from the obstetric and pediatric departments allowed for the rapid and safe implementation of DCC.
