639: Implementation of an evidence-based delayed cord clamping protocol for neonates <32 weeks

Abstract

1.2 is the equivalent of HC 3% / weight 25%. Diagnosis codes were obtained from electronic medical records. RESULTS: 28,886 newborns met inclusion criteria. 3.1% had a HC< 3%tile based on Fenton standards. (Female: 3.5%; Male: 2.6%; Preterm: 3.2%; Full-term: 2.6%). However, only 40 (0.1%) had a discharge diagnosis of microcephaly. 2.8% of the total population met criteria for HCWD. Notably, 34% of those with the discharge diagnosis of microcephaly had HCWD. All HCs in this group were < 15 th percentile. Of those with the diagnosis of microcephaly, 15% had abnormal head imaging, 2.5% were diagnosed with a potential infectious etiology of microcephaly (CMV), 65% did not require neurologic follow-up, and 40% were full term newborns who were discharged with only routine follow-up. CONCLUSION: Microcephaly is an uncommon diagnosis without clear diagnostic criteria. Congenital infection is associated with a small percentage of microcephalic infants. The vast majority of infants with small HC do not have HCWD. As awareness of microcephaly increases due to discussions of Zika virus, we risk overdiagnosis of infants without clinically significant findings. Additional studies are needed to determine which features of newborns require further workup and to establish clear diagnostic criteria for microcephaly.