Departments of Pediatrics.
Benioff Children's Hospital/UCSF Betty Irene Moore Women's Hospital, University of California, San Francisco, San Francisco, California.
Hosp Pediatr. 2023 Apr 1;13(4):292-299. doi: 10.1542/hpeds.2022-006633.
Delayed cord clamping (DCC) provides many benefits for preterm infants. The aim of this quality improvement project was to increase the rate of DCC by 25% within 12 months for neonates <34 weeks' gestation born at a tertiary care hospital.
A multidisciplinary team investigated key drivers and developed targeted interventions to improve DCC rates. The primary outcome measure was the rate of DCC for infants <34 weeks' gestation. Process measures were adherence to the DCC protocol and the rate of births with an experienced neonatology provider present at the bedside. Balancing measures included the degree of neonatal resuscitation, initial infant temperature, and maternal blood loss. Data were collected from chart review and a perinatal research database and then analyzed on control charts. The preintervention period was from July 2019 to June 2020 and the postintervention period was from July 2020 to December 2021.
322 inborn neonates born at <34 weeks' met inclusion criteria (137 preintervention and 185 postintervention). The rate of DCC increased by 63%, from a baseline of 40% to 65% (P <.001), with sustained improvement over 18 months. Significant improvement occurred for all process measures without a significant change in balancing measures.
Using core quality improvement methodology, a multidisciplinary team implemented a series of targeted interventions which was associated with an increased rate of DCC in early preterm infants.
延迟脐带结扎（DCC）可为早产儿带来诸多益处。本质量改进项目的目的是在 12 个月内将三级保健医院出生的胎龄<34 周的新生儿 DCC 率提高 25%。
多学科团队调查了主要驱动因素，并制定了针对性干预措施以提高 DCC 率。主要结局指标为胎龄<34 周的新生儿 DCC 率。过程指标为 DCC 方案的依从性以及有经验的新生儿科医生在床边分娩的比例。平衡指标包括新生儿复苏的程度、初始婴儿体温和产妇失血量。数据来自病历回顾和围产儿研究数据库，然后在控制图上进行分析。干预前阶段为 2019 年 7 月至 2020 年 6 月，干预后阶段为 2020 年 7 月至 2021 年 12 月。
符合纳入标准的<34 周出生的 322 例新生儿（干预前 137 例，干预后 185 例）。DCC 率从基线的 40%提高到 65%（P<.001），增加了 63%，并在 18 个月内持续改善。所有过程指标均显著改善，而平衡指标无显著变化。
多学科团队采用核心质量改进方法，实施了一系列针对性干预措施，与早期早产儿 DCC 率的提高相关。
