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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

Melissa Orton
1   Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
,
Lauren Theilen
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Erin Clark
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Mariana Baserga
1   Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
,
Sarah Lauer
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Zhining Ou
3   Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
,
Angela P. Presson
3   Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
,
Tara Dupont
1   Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
,
Anup Katheria
4   San Diego Neonatology, Department of Pediatrics, Sharp Mary Birch Hospital for Women and Newborn, San Diego, California
5   Division of Neonatology, Department of Pediatrics, University of California at San Diego, San Diego, California
,
Yogen Singh
6   Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
,
Belinda Chan
1   Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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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

Supplementary Material



Publication History

Received: 21 April 2023

Accepted: 17 October 2023

Article published online:
21 November 2023

© 2023. Thieme. All rights reserved.

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