A quality improvement initiative for delayed umbilical cord clamping in very low-birthweight infants.
Due to clinical benefits, delayed cord clamping (DCC) is recommended in infants born before 37 weeks gestational age. The objective was to institute a delayed cord clamping program and to evaluate clinical outcomes one year after initiation.



This study occured at Christiana Care Health System, a tertiary care facility with a 52 bed level 3 Neonatal Intensive Care Unit (NICU). A multidisciplinary team created a departmental policy, a DCC protocol and educational programs to support the development of a DCC program. A year after initiation of DCC, we evaluated two cohorts of very low birth weight (VLBW) infants (<1500 g) prior to (Cohort 1) and after initiation (Cohort 2) of DCC (n = 136 and n = 142 respectively). Chart review was conducted to evaluate demographic data and clinical outcomes. Analysis was completed with a retrospective, cohort analysis on an intention-to-treat basis.



There were no differences in demographic factors between the two cohorts. We demonstrated a 73 % compliance rate with the delayed cord clamping protocol and a decrease in the percentage of VLBW infants requiring red blood cell transfusion from 53.7 to 35.9 % (p = 0.003). We also found a decreased need for respiratory support in the second cohort with no increases in the balancing measures of admission hypothermia and jaundice requiring phototherapy. During the Control Phase ongoing monitoring and education has led to a 93.7 % compliance rate.



A multidisciplinary team including key leadership from the obstetric and pediatric departments allowed for the rapid and safe implementation of DCC.
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA. jeffrey.m.bolstridge.mil@mail.mil.
Jeff
0000-0003-2151-0360
J
Bolstridge
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA.
Tracy
T
Bell
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA.
Barbara
B
Dean
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA.
Amy
A
Mackley
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA.
Gina
G
Moore
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA.
Cheryl
C
Swift
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA.
Dina
D
Viscount
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA.
David A
DA
Paul
Department of Neonatology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Suite 217, MAP I, Newark, DE, 19718, USA.
Stephen A
SA
Pearlman
D003250:Constriction; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D057194:Intention to Treat Analysis; D008297:Male; D010348:Patient Care Team / Q000592:standards / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014470:Umbilical Cord
Delayed cord clamping; Neonatal blood transfusion