National variation in delayed cord clamping implementation – A survey of the challenges in universal adoption of DCC in the United Kingdom

Abstract

Background: Evidence shows that allowing the umbilical cord to pulsate for 1–3 minutes before clamping greatly improves newborn outcomes. In preterm infants, DCC reduces mortality by a third, reduces sepsis, bowel inflammation, and severe brain bleeds yet uptake has been variable in the latter cohort. Our survey aimed to understand the challenges faced when implementing DCC. Methods: Survey questions were designed and user tested prior to dissemination. An electronic and word format of the questionnaire were sent through emails to units in England and Wales. The survey was also disseminated via social media. Results: A total of 116 responses were obtained with 44% being from level three units and 50% from level two and the remainder from Level one. Although all but 1 respondent said they implemented DCC in their hospital, 30% respondents said they only apply DCC for stable term babies. The remaining 70% implement DCC for both preterm and term stable babies. While 21% of respondents said they implemented cord intact stabilisation for planned deliveries, only 3% implemented it in emergency scenarios. 71% of respondents undertaking cord intact stabilisation use the Lifestart TM trolley. Respondents highlighted several challenges when using Lifestart particularly the lack of familiarity with its use, need for advance planning and ineffective heating surface. Conclusion: The survey highlights that challenges in adopting DCC in extreme preterm and sick infants remain unaddressed. More research is required to enable delivery of placental transfusion safely allowing the needs of all newborns to be met.