Liu Lilly Y, Feinglass Joe M, Khan Janine Y, Gerber Susan E, Grobman William A, Yee Lynn M
Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York; and the Division of General Internal Medicine and Geriatrics, Department of Medicine, the Division of Neonatology, Department of Pediatrics, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Obstet Gynecol. 2017 May;129(5):835-843. doi: 10.1097/AOG.0000000000001987.
To evaluate adherence to a delayed cord clamping protocol for preterm births in the first 2 years after its introduction, perform a quality improvement assessment, and determine neonatal outcomes associated with protocol implementation and adherence.
This is a retrospective cohort study of women delivering singleton neonates at 23-32 weeks of gestation in the 2 years before (preprotocol) and 2 years after (postprotocol) introduction of a 30-second delayed cord clamping protocol at a large-volume academic center. This policy was communicated to obstetric and pediatric health care providers and nurses and reinforced with intermittent educational reviews. Barriers to receiving delayed cord clamping were assessed using χ tests and multivariable logistic regression. Neonatal outcomes then were compared between all neonates in the preprotocol period and all neonates in the postprotocol period and between all neonates in the preprotocol period and neonates receiving delayed cord clamping in the postprotocol period using multivariable linear and logistic regression analyses.
Of the 427 eligible neonates, 187 were born postprotocol. Of these, 53.5% (n=100) neonates received delayed cord clamping according to the protocol. The rate of delayed cord clamping preprotocol was 0%. Protocol uptake and frequency of delayed cord clamping increased over the 2 years after its introduction. In the postprotocol period, cesarean delivery was the only factor independently associated with failing to receive delayed cord clamping (adjusted odds ratio [OR] 0.49, 95% confidence interval [CI] 0.25-0.96). In comparison with the preprotocol period, those who received delayed cord clamping in the postprotocol period had significantly higher birth hematocrit (β=2.46, P=.007) and fewer blood transfusions in the first week of life (adjusted OR 0.49, 95% CI 0.25-0.96).
After introduction of an institutional delayed cord clamping protocol followed by continued health care provider education and quality feedback, the frequency of delayed cord clamping progressively increased. Compared with historical controls, performing delayed cord clamping in eligible preterm neonates was associated with improved neonatal hematologic indices, demonstrating the effectiveness of delayed cord clamping in a large-volume maternity unit.
评估在引入延迟脐带结扎方案后的头两年内，该方案在早产分娩中的依从性，进行质量改进评估，并确定与方案实施和依从性相关的新生儿结局。
这是一项回顾性队列研究，研究对象为在一家大型学术中心引入30秒延迟脐带结扎方案之前（方案实施前）的两年和之后（方案实施后）的两年中，孕周为23 - 32周的单胎新生儿分娩的女性。该政策已传达给产科和儿科医疗保健提供者及护士，并通过间歇性教育回顾加以强化。使用χ检验和多变量逻辑回归评估延迟脐带结扎的障碍因素。然后，使用多变量线性和逻辑回归分析，比较方案实施前期的所有新生儿与方案实施后期的所有新生儿，以及方案实施前期的所有新生儿与方案实施后期接受延迟脐带结扎的新生儿之间的新生儿结局。
在427名符合条件的新生儿中，187名在方案实施后出生。其中，53.5%（n = 100）的新生儿按照方案接受了延迟脐带结扎。方案实施前延迟脐带结扎的比例为0%。在引入后的两年中，方案的采用率和延迟脐带结扎的频率有所增加。在方案实施后期，剖宫产是唯一与未接受延迟脐带结扎独立相关的因素（调整后的优势比[OR]为0.49，95%置信区间[CI]为0.25 - 0.96）。与方案实施前期相比，方案实施后期接受延迟脐带结扎的新生儿出生时的血细胞比容显著更高（β = 2.46，P = 0.007），且出生后第一周的输血次数更少（调整后的OR为0.49，95% CI为0.25 - 0.96）。
在引入机构延迟脐带结扎方案并持续对医疗保健提供者进行教育和质量反馈后，延迟脐带结扎的频率逐渐增加。与历史对照相比，对符合条件的早产新生儿进行延迟脐带结扎与改善新生儿血液学指标相关，这表明在大型产科单位中延迟脐带结扎是有效的。
