title: Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - A quality improvement study.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of a quality improvement (QI) program of delayed umbilical cord clamping (DCC) in multiple and singleton preterm infants born at our center.
  
  
  METHODS
  After DCC protocol implementation, compliance and success rate were assessed. Clinical outcomes of selected 150 preterm infants <34 weeks gestation born in 2014 after protocol implementation (Epoch II) were compared to those of preterm infants born in 2013 before protocol implementation (Epoch I).
  
  
  RESULTS
  Overall protocol compliance rate was 92% (246/267). DCC was successfully performed in 77% (205/267) after protocol implementation. There were higher multiple births in Epoch II compared to Epoch I (27.3 vs. 15.3% , p <  0.01). At birth, infants in Epoch II had significantly decreased need for intubation in delivery room (23.3 vs. 39.3% , p <  0.01), had higher hematocrit (46.4±7.3 vs. 44.0±7.1% , p <  0.01) and less metabolic acidosis (base excess -4.1±2.7 vs. -5.3±4.2 mmol/L, p <  0.01) compared to those born in Epoch I. During hospital stay, fewer infants in Epoch II received rescue surfactant therapy (45.3 vs. 56.7% , p = 0.05), medical treatment for PDA (6.7 vs. 16.6% , p = 0.04%) and red blood cell transfusions (20.7 VS. 32.0% , p <  0.01) compared to Epoch I.
  
  
  CONCLUSIONS
  Protocol-guided practice of DCC for 30 seconds can be safely performed in multiple and singleton preterm infants. In addition to higher initial hematocrit, infants in our QI project had lower need for delivery room resuscitation and less metabolic acidosis at birth. We also observed decreased need for rescue surfactant therapy, medical treatment for PDA and red blood cell transfusions after DCC protocol implementation.
authors.forename: C
authors.initials: C
authors.lastname: Ruangkit
authors.forename: V
authors.initials: V
authors.lastname: Moroney
authors.forename: S
authors.initials: S
authors.lastname: Viswanathan
authors.forename: M
authors.initials: M
authors.lastname: Bhola
mesh_terms: D000138:Acidosis / Q000517:prevention & control; D002985:Clinical Protocols; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D004374:Ductus Arteriosus, Patent / Q000628:therapy; D017707:Erythrocyte Transfusion; D005260:Female; D006400:Hematocrit; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D008297:Male; D009099:Multiple Birth Offspring; D047928:Premature Birth / Q000628:therapy*; D015397:Program Evaluation; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D058996:Quality Improvement; D013997:Time Factors; D014470:Umbilical Cord
chemical_list: D011663:Pulmonary Surfactants
keywords: Delayed umbilical cord clamping (DCC); multiple births; preterm infants; quality improvement (QI)