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

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

Am J Perinatol. 2023 Nov 21. doi: 10.1055/s-0043-1776916. Online ahead of print.

Authors

Affiliations

¹ Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
² Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.
³ Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
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.
⁶ Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California.

PMID: 37989208
DOI: 10.1055/s-0043-1776916

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..