Implementation of a Delayed Cord Clamping (Dcc) Protocol for Preterm Infants and Delivery Room Practice

Abstract

Background: DCC in preterm babies for >30s may reduce brain injury, number of transfusions, and sepsis. The implementation of DCC requires evaluation. Objective: We describe a quality improvement (QI) initiative applying DCC for 45s to babies born <33 weeks gestational age (GA). Design/Methods: Prior to instituting the protocol, the regional interprofessional Neonatal Resuscitation Committee (a QI committee) ensured that obstetric and neonatal staff were inserviced on the rationale and process for DCC using educational sessions, posters, FAQ documents, and process mapping. An audit process was established using chart review. From May 2008 to Apr 2009, DCC was implemented for all babies born 28 to 32 weeks GA unless contraindicated (adding babies <28 weeks GA in Dec 2008). Using Plan, Do, Study, Act cycles, control charts of DCC rates were fed back to the QI committee. Periods with low compliance were reinforced with further education. Outcomes included C-section (CS), GA, birthweight (BW), 5-min Apgar (5APG), delivery room ventilation (DVENT), admission temperature (TEMP), blood pressure support (BPS), first hemoglobin (HBG), highest bilirubin (BILI), and number of transfusions (TRAN). Results: Of 274 babies (mean GA 29.5 (range 24 to 32) weeks), 204 (74%) were eligible for DCC: of these 123 (60%) had DCC. Ineligible babies were more likely to be delivered by CS, be lighter, and have lower 5APG. There was no significant difference in demographic or outcome measures between eligible babies with or without DCC (see Table). Monthly compliance rates for DCC in eligible babies ranged from 18 to 93% (mean 58%, standard deviation 44%). (Table presented) Conclusions: DCC in eligible babies born <33 weeks gestation had a 60% compliance rate, requiring audit and reinforcement. DCC appears practical, safe, and applicable, and has minimal impact on early neonatal outcomes. Longer term evaluation of morbidity and mortality is needed.