Baby-directed umbilical cord clamping: A feasibility study

Blank, Douglas A; Badurdeen, Shiraz; Kamlin, C. Omar F.; Jacobs, Susan E; Thió, Marta; Dawson, Jennifer A; Kane, Stefan C.; Dennis, A.T.; Polglase, Graeme R.; Hooper, Stuart B.; Davis, Peter G

doi:10.1016/j.resuscitation.2018.07.020

Cited by 56 publications

(90 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, feedback from involved personnel in our study revealed that behind the seemingly simple intervention of moving equipment and personnel to the potentially compromised infant, lay several logistic challenges, as well as communication and collaboration issues. These issues have also been encountered by other researchers (29,37,43,44). Examples include: ensuring availability and readiness of the equipment with several deliveries going on at the same time, ahead planning and collaboration in rapidly progressing deliveries, and how to manage space constraints at the birthing bed.…”

Section: Secondary Outcomesmentioning

confidence: 96%

“…However, they were less likely to receive ventilation support or to be transferred to NICU (Table 5). (22,37). Several explanations may be plausible: It may reflect reactivity to the study situation, or the researcher's expectations, given that all personnel had been trained by the researcher in operating the new equipment, and was aware of being monitored with regards to protocol adherence.…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…This is a clear limitation for analysis of short-term outcomes. On the other hand, as mentioned in the Baby-DUCC feasibility study (37), it can be argued that term and near-term infants are not the most vulnerable for hypothermia, especially not when transfused with warm blood from the placenta and dried and covered by warm towels straight after birth. Our study has demonstrated the importance of testing and monitoring adherence to protocol in order to assess whether or not operational targets are reached and observed variation is acceptable.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Delayed cord clamping was attempted in all deliveries, while providing essential care. An assistant midwife obtained arterial and venous cord blood gases from a pulsating cord within the first [30][31][32][33][34][35][36][37][38][39][40] seconds. Apgar Scores were evaluated after 1, 5 and 10 minutes by the paediatric team.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: A quality-improvement cohort study

Sæther

Gülpen

Jensen

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Deferring cord clamping has proven benefits for both term and preterm infants, and recent studies have demonstrated better cardio-respiratory stability if clamping is based on the infant’s physiology, and whether the infant has breathed. Nevertheless, current guidelines for neonatal resuscitation still recommend early cord clamping (ECC) for compromised babies, unless equipment and competent personnel to resuscitate the baby are available at the mother’s bedside. The objective of this quality improvement cohort study was to evaluate whether implementing a new delivery room protocol involving mobile resuscitation equipment (LifeStart™) reduced the prevalence of ECC in assisted vaginal deliveries.Methods: Data on cord clamping and transitional care were collected 8 months before and 8 months after implementing the new protocol. The Improvement Model was applied to identify drivers and obstacles to practice change. Statistical Process Control analysis was used to demonstrate signals of improvement, and whether these changes were sustainable. Multivariate logistic regression was used to evaluate the impact of the new protocol on the primary outcome, adjusted for possible confounders.Results: Overall prevalence of ECC dropped from 13 to 1% (P < 0.01), with a 98% relative risk reduction for infants needing transitional support on a resuscitation table (adjusted OR 0.02, P < 0.001). Mean cord clamping time increased by 43% (p < 0.001). Although fewer infants were placed directly on mothers’ chest (n=43 [42%] vs n=69 [75.0 %], P < 0.001), there were no significant differences in needs for immediate transitional care or transfers to Neonatal Intensive Care Unit. A pattern of improvement was seen already before the intervention, especially after mandatory educational sessions and cross-professional simulation training.Conclusions: A new delivery-room protocol involving mobile resuscitation equipment successfully eliminated early cord clamping in assisted vaginal deliveries of term and near-term infants. A systematic approach, like the Improvement Model, seemed crucial for both achieving and sustaining the desired results.Trial registration: The study was approved as a service evaluation as defined by the Regional Committee for Medical and Health Research Ethics (2018/1755/REK midt).

show abstract

Section: Secondary Outcomesmentioning

confidence: 96%

Section: Secondary Outcomesmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: A quality-improvement cohort study

Sæther

Gülpen

Jensen

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Bei sofortiger Abnabelung verbleibt allerdings ein erheblicher Anteil des zirkulierenden Blutvolumens in der Plazenta und Nabelschnur [12]. Die Folge kann eine kurzfristige Umkehr des Blutflusses auf Ebene des Ductus arteriosus sein, infolgedessen es zu einer transienten Unterversorgung der systemischen zugunsten der pulmonalen Zirkulation kommt, was wiederum zu unerwünschten Schwankungen des zerebralen Blutflusses und Blutdrucks führen kann [8,13].…”

Section: Perinatale Kreislaufumstellung Und Atemumstellungunclassified