Delayed Cord Clamping in the Premature Neonate: Development of an Interdisciplinary Guideline

Evidence supporting delayed cord clamping (DCC) in the premature newborn is increasing, yet in a level IV neonatal intensive care unit (NICU); DCC was not being consistently performed, and when it was there were noted variations in the absence of a standardized guideline. The objective of this quality improvement (QI) project was to develop and secure institutional approval of a DCC guideline for the premature newborn and increase knowledge of DCC among healthcare providers (HCPs). The design was a QI project using Rogers’ Diffusion of Innovations (DOI) Theory to guide the development of a DCC guideline. Educational in-services were conducted to increase knowledge of DCC and the components of the DCC guideline. A panel of nine experts including interdisciplinary HCPs from the NICU and the obstetrics department (OB) defined and approved the DCC guideline content. A convenience sample of 90 HCPs participated in the DCC educational inservices. The use of the DCC Guideline Development tool created from best evidence guided an interdisciplinary committee towards consensus and final approval of the DCC guideline. Eleven standardized DCC in-services were conducted with pretest-posttest knowledge surveys. Essential components of the guideline include a delay of 45 seconds before cord clamping, inclusion and exclusion criteria, thermoregulation interventions, and responsibilities of the NICU and OB team. In-service education of DCC and guideline was effective based on survey results. The DCC guideline and education of the HCPs seeks to translate best evidence into practice and standardize DCC implementation. Future plans include measuring retained knowledge, guideline adherence by the HCPs, and evaluation of clinical outcomes. neonatal intensive care unit (NICU) [4]. Additionally, the authors reported many advantages to DCC including higher birth weight, increased hemoglobin (Hgb) values, and increased iron stores lasting up to six months after birth. DCC facilitates a gentle transition that benefits all newborns, but may be critical to the vulnerable preterm newborn. DCC at birth can support the preterm newborn during the transition to extra-uterine life through an autologous transfusion of blood from the placenta to the newborn which has been found to result in fewer transfusions for anemia, decreased intraventricular hemorrhage (IVH), and decreased necrotizing enterocolitis (NEC) [5]. Furthermore, DCC is the recommendation for premature newborns not requiring immediate resuscitation (no respiratory effort or significant bradycardia at birth)