Thermoregulation-Focused Implementation of Delayed Cord Clamping among <34 Weeks' Gestational Age Neonates

Melissa Orton; Lauren Theilen; Erin Clark; Mariana Baserga; Sarah Lauer; Zhining Ou; Angela P. Presson; Tara Dupont; Anup Katheria; Yogen Singh; Belinda Chan

doi:10.1055/s-0043-1776916

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(S 01): e3099-e3106
DOI: 10.1055/s-0043-1776916

Original Article

Thermoregulation-Focused Implementation of Delayed Cord Clamping among <34 Weeks' Gestational Age Neonates

Authors

Melissa Orton

¹Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
Lauren Theilen

²Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
Erin Clark

²Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
Mariana Baserga

¹Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
Sarah Lauer

²Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
Zhining Ou

³Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
Angela P. Presson

³Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
Tara Dupont

¹Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
Anup Katheria

⁴San Diego Neonatology, Department of Pediatrics, Sharp Mary Birch Hospital for Women and Newborn, San Diego, California

⁵Division of Neonatology, Department of Pediatrics, University of California at San Diego, San Diego, California
Yogen Singh

⁶Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
Belinda Chan

¹Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah

Abstract

Objective Delayed cord clamping (DCC) is recommended for all neonates; however, adapting such practice can be slow or unsustainable, especially among preterm neonates. During DCC neonates are exposed to a cool environment, raising concerns for neonatal hypothermia. Moderate hypothermia may induce morbidities that counteract the potential benefits of DCC. A quality improvement project on a thermoregulation-focused DCC protocol was implemented for neonates less than 34 weeks' gestational age (GA). The aim was to increase the compliance rate of DCC while maintaining normothermia.

Study Design The DCC protocol was implemented on October 1, 2020 in a large Level III neonatal intensive care unit. The thermoregulation measures included increasing delivery room temperature and using heat conservation supplies (sterile polyethylene suit, warm towels, and thermal pads). Baseline characteristics, the compliance rate of DCC, and admission temperatures were compared 4 months' preimplementation and 26 months' postimplementation

Results The rate of DCC increased from 20% (11/54) in preimplementation to 57% (240/425) in postimplementation (p < 0.001). The balancing measure of admission normothermia remained unchanged. In a postimplementation subgroup analysis, the DCC cohort had less tendency to experience admission moderate hypothermia (<36°C; 9.2 vs. 14.1%, p = 0.11). The DCC cohort had more favorable secondary outcomes including higher admission hematocrit, less blood transfusions, less intraventricular hemorrhage, and lower mortality. Improving the process measure of accurate documentation could help to identify implementation barriers.

Conclusion Performing DCC in preterm neonates was feasible and beneficial without increasing admission hypothermia.

Key Points

Thermoregulation-focused DCC protocol was implemented to increase DCC while maintaining normothermia.
DCC rate increased from 20 to 57% while admission normothermia rate remained the same.
DCC practice on preterm neonates is safe and feasible while maintaining normothermia.

Keywords

delayed cord clamping - thermoregulation - quality improvement - prematurity - hypothermia

Full Text

References

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Supplementary Material

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