TY - JOUR
T1 - Clamp late and maintain perfusion (CLAMP) policy
T2 - Delayed cord clamping in preterm infants
AU - Jelin, Angie C.
AU - Zlatnik, Marya G.
AU - Kuppermann, Miriam
AU - Gregorich, Steven E.
AU - Nakagawa, Sanae
AU - Clyman, Ronald
N1 - Funding Information:
This study was supported by Mount Zion Health Fund Grant (MHFG) #20061582/UCSF #A119713 and a gift from the Jamie and Bobby Gates Foundation.
Publisher Copyright:
© 2015 Taylor & Francis.
PY - 2016/6/2
Y1 - 2016/6/2
N2 - Objective: Randomized controlled trials have demonstrated that delayed umbilical cord clamping (DCC) in preterm infants results in improved neonatal outcomes, including increased hematocrit, and decreased rates of intraventricular hemorrhage (IVH) and packed red blood cell transfusions. We hypothesized that implementation of a DCC policy in preterm infants would result in similarly improved outcomes, despite initial clinician resistance. Study design: A DCC policy (30-60 s) for singleton infants <35 weeks gestation was implemented in September 2011. We conducted a pre-test/post-test analysis of neonatal outcomes among singletons delivered between 24 0/7 weeks and 34 6/7 weeks gestation from 2009 to 2013 (2 years pre-implementation and 2 years post-implementation). The primary outcomes were rates of policy compliance and four neonatal outcomes. Results: Despite multiple routes of policy dissemination, DCC was attempted in only 49% of the deliveries. In spite of this, infants delivered post-policy implementation (n = 196) had a significant decrease in IVH, significant increase in initial hematocrits, and improved temperatures compared with infants delivered pre-implementation (n = 204). Conclusion: After implementation of a DCC policy, preterm singleton infants had improved temperatures, increased hematocrits and a decreased prevalence of IVH without significant differences in adverse outcomes, suggesting that the benefits of DCC outweighed the risks.
AB - Objective: Randomized controlled trials have demonstrated that delayed umbilical cord clamping (DCC) in preterm infants results in improved neonatal outcomes, including increased hematocrit, and decreased rates of intraventricular hemorrhage (IVH) and packed red blood cell transfusions. We hypothesized that implementation of a DCC policy in preterm infants would result in similarly improved outcomes, despite initial clinician resistance. Study design: A DCC policy (30-60 s) for singleton infants <35 weeks gestation was implemented in September 2011. We conducted a pre-test/post-test analysis of neonatal outcomes among singletons delivered between 24 0/7 weeks and 34 6/7 weeks gestation from 2009 to 2013 (2 years pre-implementation and 2 years post-implementation). The primary outcomes were rates of policy compliance and four neonatal outcomes. Results: Despite multiple routes of policy dissemination, DCC was attempted in only 49% of the deliveries. In spite of this, infants delivered post-policy implementation (n = 196) had a significant decrease in IVH, significant increase in initial hematocrits, and improved temperatures compared with infants delivered pre-implementation (n = 204). Conclusion: After implementation of a DCC policy, preterm singleton infants had improved temperatures, increased hematocrits and a decreased prevalence of IVH without significant differences in adverse outcomes, suggesting that the benefits of DCC outweighed the risks.
KW - Compliance
KW - delayed clamping
KW - intraventricular hemorrhage
KW - neonatal
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U2 - 10.3109/14767058.2015.1061496
DO - 10.3109/14767058.2015.1061496
M3 - Article
C2 - 26135773
AN - SCOPUS:84939432849
SN - 1476-7058
VL - 29
SP - 1705
EP - 1709
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
IS - 11
ER -