title: Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants.
abstract: OBJECTIVE
  Randomized controlled trials have demonstrated that delayed umbilical cord clamping (DCC) in preterm infants results in improved neonatal outcomes, including increased hematocrit, and decreased rates of intraventricular hemorrhage (IVH) and packed red blood cell transfusions. We hypothesized that implementation of a DCC policy in preterm infants would result in similarly improved outcomes, despite initial clinician resistance.
  
  
  METHODS
  A DCC policy (30-60 s) for singleton infants <35 weeks gestation was implemented in September 2011. We conducted a pre-test/post-test analysis of neonatal outcomes among singletons delivered between 24 0/7 weeks and 34 6/7 weeks gestation from 2009 to 2013 (2 years pre-implementation and 2 years post-implementation). The primary outcomes were rates of policy compliance and four neonatal outcomes.
  
  
  RESULTS
  Despite multiple routes of policy dissemination, DCC was attempted in only 49% of the deliveries. In spite of this, infants delivered post-policy implementation (n = 196) had a significant decrease in IVH, significant increase in initial hematocrits, and improved temperatures compared with infants delivered pre-implementation (n = 204).
  
  
  CONCLUSIONS
  After implementation of a DCC policy, preterm singleton infants had improved temperatures, increased hematocrits and a decreased prevalence of IVH without significant differences in adverse outcomes, suggesting that the benefits of DCC outweighed the risks.
authors.affiliation: a Department of Obstetrics and Gynecology , Washington Hospital Center , Washington , DC , USA .
authors.forename: Angie C
authors.initials: AC
authors.lastname: Jelin
authors.affiliation: b Department of Obstetrics, Gynecology and Reproductive Sciences .
authors.forename: Marya G
authors.initials: MG
authors.lastname: Zlatnik
authors.affiliation: b Department of Obstetrics, Gynecology and Reproductive Sciences .
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
authors.affiliation: c Department of Medicine , and.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.affiliation: b Department of Obstetrics, Gynecology and Reproductive Sciences .
authors.forename: Sanae
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: d Department of Pediatrics , University of California , San Francisco , CA , USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Clyman
mesh_terms: D000328:Adult; D003250:Constriction; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D014470:Umbilical Cord
keywords: Compliance; delayed clamping; intraventricular hemorrhage; neonatal