title: Effect of delayed cord clamping on very preterm infants.
abstract: OBJECTIVE
  Despite significant proposed benefits, delayed umbilical cord clamping (DCC) is not practiced widely in preterm infants largely because of the question of feasibility of the procedure and uncertainty regarding the magnitude of the reported benefits, especially intraventricular hemorrhage (IVH) vs the adverse consequences of delaying the neonatal resuscitation. The objective of this study was to determine whether implementation of the protocol-driven DCC process in our institution would reduce the incidence of IVH in very preterm infants without adverse consequences.
  
  
  METHODS
  We implemented a quality improvement process for DCC the started in August 2013 in infants born at ≤32 weeks' gestational age. Eligible infants were left attached to the placenta for 45 seconds after birth. Neonatal process and outcome data were collected until discharge. We compared infants who received DCC who were born between August 2013 and August 2014 with a historic cohort of infants who were born between August 2012 and August 2013, who were eligible to receive DCC, but whose cord was clamped immediately after birth, because they were born before the protocol implementation.
  
  
  RESULTS
  DCC was performed on all the 60 eligible infants; 88 infants were identified as historic control subjects. Gestational age, birthweight, and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in the DCC cohort were intubated in delivery room, had respiratory distress syndrome, or received red blood cell transfusions in the first week of life compared with the historic cohort. A significant reduction was noted in the incidence of IVH in the DCC cohort compared with the historic control group (18.3% vs 35.2%). After adjustment for gestational age, an association was found between the incidence of IVH and DCC with IVH was significantly lower in the DCC cohort compared with the historic cohort; an odds ratio of 0.36 (95% confidence interval, 0.15-0.84; P < .05). There were no significant differences in deaths and other major morbidities.
  
  
  CONCLUSIONS
  DCC, as performed in our institution, was associated with significant reduction in IVH and early red blood cell transfusions. DCC in very preterm infants appears to be safe, feasible, and effective with no adverse consequences.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX. Electronic address: Arpitha.Chiruvolu@baylorhealth.edu.
authors.forename: Arpitha
authors.initials: A
authors.lastname: Chiruvolu
authors.affiliation: Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX.
authors.forename: Veeral N
authors.initials: VN
authors.lastname: Tolia
authors.affiliation: Department of Quantitative Health Sciences, Baylor Scott & White Health Care System, Dallas, TX.
authors.forename: Huanying
authors.initials: H
authors.lastname: Qin
authors.affiliation: Department of Nursing, Baylor University Medical Center, Dallas, TX.
authors.forename: Genna Leal
authors.initials: GL
authors.lastname: Stone
authors.affiliation: Department of Nursing, Baylor University Medical Center, Dallas, TX.
authors.forename: Diana
authors.initials: D
authors.lastname: Rich
authors.affiliation: Department of Medical Education, Texas A&M Health Science Center College of Medicine, Bryan, TX.
authors.forename: Rhoda J
authors.initials: RJ
authors.lastname: Conant
authors.affiliation: Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Inzer
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D002985:Clinical Protocols; D003250:Constriction; D036861:Delivery, Obstetric / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007234:Infant, Premature; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D014470:Umbilical Cord
keywords: delaying umbilical cord clamping; intraventricular hemorrhage; very preterm infant