Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Department of Pediatrics, Division of Neonatology, University of California San Diego, San Diego, CA, USA.
Semin Perinatol. 2024 Apr;48(3):151905. doi: 10.1016/j.semperi.2024.151905. Epub 2024 Apr 19.
Delayed or deferred cord clamping (DCC) and umbilical cord milking (UCM) benefit all infants by optimizing fetal-neonatal transition and placental transfusion. Even though DCC is recommended by almost all maternal and neonatal organizations, it has not been universally implemented. There is considerable variation in umbilical cord management practices across institutions. In this article, we provide examples of successful quality improvement (QI) initiatives to implement optimal cord management in the delivery room. We discuss a number of key elements that should be considering among those undertaking QI efforts to implement DCC and UCM including, multidisciplinary team collaboration, development of theory for change, mapping of the current and ideal process and workflow for cord management, and creation of a unit-specific evidence-based protocol for cord management. We also examine important strategies for implementation and provide suggestions for developing a system for measurement and benchmarking.
延迟或推迟脐带结扎（DCC）和脐带挤奶（UCM）通过优化胎儿-新生儿过渡期和胎盘输血使所有婴儿受益。尽管几乎所有的母婴组织都推荐 DCC，但它并没有被普遍实施。各机构在脐带管理实践方面存在相当大的差异。在本文中，我们提供了一些成功的质量改进（QI）举措的例子，以在分娩室实施最佳的脐带管理。我们讨论了在进行 QI 以实施 DCC 和 UCM 时应考虑的一些关键因素，包括多学科团队合作、变革理论的发展、脐带管理当前和理想流程和工作流程的映射，以及创建特定于单位的基于证据的脐带管理协议。我们还研究了实施的重要策略，并为开发测量和基准系统提供了建议。
