Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care UnitsFunding None.
26 August 2018
18 February 2019
21 March 2019 (online)
Objective To assess the current practice of delayed cord clamping (DCC) and to determine patient and hospital factors that predict DCC.
Study Design The California Perinatal Quality Care Collaborative (CPQCC) collects data on preterm and acutely ill infants. In 2016, 52 CPQCC neonatal intensive care units (NICUs) collected data on DCC. Hospital and patient characteristics were analyzed using multivariable logistic regression.
Results Of 5,332 deliveries, 1,555 (29%) newborns received DCC. Hospital rates ranged from 0 to 74.5% and increased from 21 to 37% throughout 2016. Infants delivered at <32 weeks or with birth weight <1,500 g were more likely to receive DCC (odds ratio: 2.80; 95% confidence interval: 2.33, 3.36). Cesarean delivery was associated with less likelihood of DCC (odds ratio: 0.68; 95% confidence interval: 0.59, 0.79). After risk adjustment, 17 (33%) hospitals had higher than expected DCC rate. Hospitals with less than 50 NICU beds are more likely to practice DCC, whereas Level 3 American Academy of Pediatrics NICUs, nonprofit owned hospitals, and teaching institutions were less likely to practice DCC (p < 0.001).
Conclusion There are opportunities to implement quality improvement activities to increase DCC rates.
- 1 World Health Organization. Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes: Guideline. Geneva: World Health Organization; 2014
- 2 Fogarty M, Osborn DA, Askie L. , et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 2018; 218 (01) 1-18
- 3 McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Evid Based Child Health 2014; 9 (02) 303-397
- 4 Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA 2007; 297 (11) 1241-1252
- 5 Katheria AC, Leone TA, Woelkers D, Garey DM, Rich W, Finer NN. The effects of umbilical cord milking on hemodynamics and neonatal outcomes in premature neonates. J Pediatr 2014; 164 (05) 1045-1050
- 6 Hosono S, Mugishima H, Fujita H. , et al. Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks' gestation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2008; 93 (01) F14-F19
- 7 Al-Wassia H, Shah PS. Efficacy and safety of umbilical cord milking at birth: a systematic review and meta-analysis. JAMA Pediatr 2015; 169 (01) 18-25
- 8 Andersson O, Hellström-Westas L, Andersson D, Domellöf M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ 2011; 343: d7157
- 9 Committee on Obstetric Practice. Committee opinion no. 684: delayed umbilical cord clamping after birth. Obstet Gynecol 2017; 129 (01) e5-e10
- 10 American Academy of Pediatrics. Timing of umbilical cord clamping after birth. Pediatrics 2013; 131 (04) e1323
- 11 Wyckoff MH, Aziz K, Escobedo MB. , et al. Part 13: neonatal resuscitation: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care (reprint). Pediatrics 2015; 136 (Suppl. 02) S196-S218
- 12 American College of Nurse Midwives. Delayed umbilical cord clamping. Position Statement. Silver Spring (MD): ACNM; 2014 . Available at: http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000290/Delayed-Umbilical-Cord-Clamping-May-2014.pdf . Accessed February 21, 2018
- 13 Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee opinion no. 543: timing of umbilical cord clamping after birth. Obstet Gynecol 2012; 120 (06) 1522-1526
- 14 Liu LY, Feinglass JM, Khan JY, Gerber SE, Grobman WA, Yee LM. Evaluation of introduction of a delayed cord clamping protocol for premature neonates in a high-volume maternity center. Obstet Gynecol 2017; 129 (05) 835-843
- 15 Bolstridge J, Bell T, Dean B. , et al. A quality improvement initiative for delayed umbilical cord clamping in very low-birthweight infants. BMC Pediatr 2016; 16 (01) 155
- 16 Aziz K, Chinnery H, Lacaze-Masmonteil T. A single-center experience of implementing delayed cord clamping in babies born at less than 33 weeks' gestational age. Adv Neonatal Care 2012; 12 (06) 371-376
- 17 Vermont Oxford Network. Available at: http://www.vtoxford.org/about/about.aspx . Accessed August 23, 2016
- 18 Song D, Jegatheesan P, DeSandre G, Govindaswami B. Duration of cord clamping and neonatal outcomes in very preterm infants. PLoS One 2015; 10 (09) e0138829
- 19 Rabe H, Jewison A, Alvarez RF. , et al; Brighton Perinatal Study Group. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol 2011; 117 (2 Pt 1): 205-211
- 20 Oddie S, Rhodes P. ; Very Preterm Birth Qualitative Collaborative Group. Barriers to deferred cord clamping in preterm infants. Arch Dis Child Fetal Neonatal Ed 2014; 99 (05) F391-F394
- 21 Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics 2015; 136 (01) 61-69
- 22 Katheria A, Garey D, Truong G. , et al. A randomized clinical trial of umbilical cord milking vs delayed cord clamping in preterm infants: neurodevelopmental outcomes at 22-26 months of corrected age. J Pediatr 2018; 194: 76-80