Safety and Ergonomic Challenges of Ventilating a Premature Infant During Delayed Cord Clamping

Lapcharoensap, Wannasiri; Cong, Allison; Sherman, Jules; Schwandt, Doug; Crowe, Susan; Daniels, Kay; Lee, Henry

doi:10.3390/children6040059

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…15 Clinical trials have shown that delayed cord clamping reduces the incidence of necrotizing enterocolitis by preventing hypovolemia. 35,36 In the present study, none of the preterm infants developed necrotizing enterocolitis, and there was no difference in the incidence of feeding intolerance between the DCC group and the ECC group.…”

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confidence: 37%

The Short and Long Term Consequences of Delayed Cord Clamping on Late Pre-Term Infants

Yan¹,

Ren²,

Zhang³

et al. 2023

IJWH

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To explore the effect of delayed cord clamping on preterm infants. Methods: A retrospective analysis was conducted using the clinical data of 163 preterm infants with a gestational age of 34-36 weeks + 6 who were admitted to the neonatology department within 2 hours after birth. The blood routine examination indices within 2 hours and at 3-5 days after birth, the biochemical indices and arterial blood gas (ABG) indices within 2 hours after birth, and the hemoglobin level 5-6 months after birth were compared between the early cord clamping (ECC) group and the delayed cord clamping (DCC) group. Results: Compared with the ECC group, the DCC group had significantly higher venous blood levels of red blood cells, hemoglobin, and hematocrit within 2 hours and at 3-5 days after birth. The ABG bicarbonate (HCO 3 ) level within 2 hours after birth was obviously higher in the DCC group than in the ECC group, and the ABG absolute base excess(BE) and lactate levels were lower in the DCC group than in the ECC group (P < 0.05). There was no significant difference between the two groups in the incidence of hypothermia, hypoglycemia, respiratory distress, septicemia, feeding intolerance, polycythemia, and hyperbilirubinemia requiring phototherapy during hospitalization (P > 0.05). Compared with the ECC group, the DCC group had a significantly higher venous blood hemoglobin level 5-6 months after birth. The incidence of anemia in the DCC group was significantly lower than in the ECC group (P < 0.05). Conclusion: Delayed cord clamping can significantly increase the hemoglobin levels of preterm infants at birth and at 5-6 months after birth and can improve the oxygen circulation supply to the organs of such infants. Therefore, delayed cord clamping can improve the prognosis of preterm infants.

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confidence: 37%

The Short and Long Term Consequences of Delayed Cord Clamping on Late Pre-Term Infants

Yan¹,

Ren²,

Zhang³

et al. 2023

IJWH

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“…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, collaboration and planning ahead in rapidly progressing deliveries, and how to manage space constraints at the birthing bed.…”

Section: Discussionmentioning

confidence: 97%

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

Sæther

Gülpen

Jensen

et al. 2020

BMC Pregnancy Childbirth

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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 Model for Improvement 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 Model for Improvement, seemed crucial for both achieving and sustaining the desired results.

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“…These findings are consistent with the study done by Ibrahim et al ( 11 ) where the majority of respondents agreed that DCC is beneficial for both term (69%) and preterm (71%) neonates not requiring PPV. In fact, DCC in preterm neonates who require PPV can now be facilitated by providing a mobile resuscitation trolley before UCC ( 21 ) and this was proven to be feasible as demonstrated by Lapcharoensap et al ( 22 ) and Joshi et al ( 23 ). Having said that, only 30% of the respondents agreed that DCC was good for neonates who require PPV.…”

Section: Discussionmentioning

confidence: 99%

A Survey on Current Practices of Umbilical Cord Clamping in Malaysia

2022

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BackgroundDelayed cord clamping (DCC) has been demonstrated to have significant benefits in reducing the incidence of intraventricular hemorrhage, blood transfusion and neonatal mortality in preterm neonates and improving hemodynamic and long-term neurodevelopment among term infants. There is no clear guideline on umbilical cord clamping (UCC) practices in Malaysia.ObjectiveThe aim of this survey was to assess the knowledge and practice of DCC among obstetric doctors and midwives in Malaysia, and pediatric colleagues who witness the delivery.MethodThis is a cross-sectional survey conducted in childbirth facilities in Malaysia from October 2020 to January 2021. A convenient snowball sampling was adopted. A validated questionnaire was disseminated to practicing obstetric and pediatric doctors and midwives electronically via email and WhatsApp using Google Form. The data were analyzed using descriptive and analytical statistics.ResultsA total of 327 respondents completed the questionnaires, comprising 206 obstetric doctors, 72 pediatric doctors and 49 midwives. The majority of respondents were specialists or higher in rank (53.2%). Only 29% reported the existence of guidelines on UCC in their place of work. Midwives (P = 0.003) and staff of lower ranks and level of education (P < 0.001) appeared to be more aware of the existence of a UCC guideline. Most respondents had positive knowledge of DCC for both term and preterm neonates. A large proportion (82%) of respondents agreed that DCC helped increase neonatal iron stores, and was good for both preterm (70.7%) and term (76.2%) neonates not requiring positive pressure ventilation. Doctors, specialists, those who are 40 years old and above, and those who have been in service for at least 10 years were found to have better knowledge regarding DCC (P < 0.05).ConclusionThe awareness and practice of obstetric, pediatric and midwifery staff of guidelines on UCC were less than satisfactory. Even though most respondents have good knowledge and positive perception regarding benefits of DCC, these were not translated into their routine practice. Hence, a national guideline emphasizing the benefits of DCC should be made available in all childbirth facilities.

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Safety and Ergonomic Challenges of Ventilating a Premature Infant During Delayed Cord Clamping

Cited by 7 publications

References 30 publications

The Short and Long Term Consequences of Delayed Cord Clamping on Late Pre-Term Infants

The Short and Long Term Consequences of Delayed Cord Clamping on Late Pre-Term Infants

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

A Survey on Current Practices of Umbilical Cord Clamping in Malaysia

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