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Evaluation of Introduction of a Delayed Cord Clamping Protocol for Premature Neonates in a High-Volume Maternity Center

Liu, Lilly Y. MD, MPH; Feinglass, Joe M. PhD; Khan, Janine Y. MD; Gerber, Susan E. MD, MPH; Grobman, William A. MD, MBA; Yee, Lynn M. MD, MPH

doi: 10.1097/AOG.0000000000001987
Contents: Original Research
Cochrane Reviews

OBJECTIVE: To evaluate adherence to a delayed cord clamping protocol for preterm births in the first 2 years after its introduction, perform a quality improvement assessment, and determine neonatal outcomes associated with protocol implementation and adherence.

METHODS: This is a retrospective cohort study of women delivering singleton neonates at 23–32 weeks of gestation in the 2 years before (preprotocol) and 2 years after (postprotocol) introduction of a 30-second delayed cord clamping protocol at a large-volume academic center. This policy was communicated to obstetric and pediatric health care providers and nurses and reinforced with intermittent educational reviews. Barriers to receiving delayed cord clamping were assessed using χ2 tests and multivariable logistic regression. Neonatal outcomes then were compared between all neonates in the preprotocol period and all neonates in the postprotocol period and between all neonates in the preprotocol period and neonates receiving delayed cord clamping in the postprotocol period using multivariable linear and logistic regression analyses.

RESULTS: Of the 427 eligible neonates, 187 were born postprotocol. Of these, 53.5% (n=100) neonates received delayed cord clamping according to the protocol. The rate of delayed cord clamping preprotocol was 0%. Protocol uptake and frequency of delayed cord clamping increased over the 2 years after its introduction. In the postprotocol period, cesarean delivery was the only factor independently associated with failing to receive delayed cord clamping (adjusted odds ratio [OR] 0.49, 95% confidence interval [CI] 0.25–0.96). In comparison with the preprotocol period, those who received delayed cord clamping in the postprotocol period had significantly higher birth hematocrit (β=2.46, P=.007) and fewer blood transfusions in the first week of life (adjusted OR 0.49, 95% CI 0.25–0.96).

CONCLUSION: After introduction of an institutional delayed cord clamping protocol followed by continued health care provider education and quality feedback, the frequency of delayed cord clamping progressively increased. Compared with historical controls, performing delayed cord clamping in eligible preterm neonates was associated with improved neonatal hematologic indices, demonstrating the effectiveness of delayed cord clamping in a large-volume maternity unit.

Adherence to a delayed cord clamping protocol for singleton neonates born at less than 32 weeks of gestation improves with continued health care provider education and is associated with lower frequency of neonatal blood transfusions.

Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York; and the Division of General Internal Medicine and Geriatrics, Department of Medicine, the Division of Neonatology, Department of Pediatrics, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Corresponding author: Lilly Y. Liu, MD, MPH, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, New York, NY 10029; email: lilly.liu@mountsinai.org.

Lynn M. Yee is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development K12 HD050121-11.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as a poster at the Society for Maternal-Fetal Medicine 37th Annual Meeting, January 23–28, 2017, Las Vegas, Nevada.

Each author has indicated that he or she has met the journal’s requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.