孕龄小于33周的早产儿脐带结扎操作依从率及持续时间的相关因素。
Factors associated with rates and durations of cord clamping practice compliance in preterm neonates of <33 weeks' gestation.
作者信息
Chan Belinda, Ting Joseph Y, Yoon Eugene, McDonald Sarah D, Orton Melissa, Floyd Ivah, Beltempo Marc M, Mukerji Amit, Augustine Sajit, Coughlin Kevin, Shah Prakesh S
机构信息
Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Department of Pediatrics, University of California, Davis Health, Sacramento, CA, USA.
出版信息
J Perinatol. 2025 Jun 6. doi: 10.1038/s41372-025-02328-8.
OBJECTIVES
To determine maternal, neonatal, and hospital factors influencing deferred cord clamping (DCC) compliance rates in preterm neonates.
METHODS
Neonates born <33 weeks' gestational age (GA) within the Neonatal Intensive Care Units of Canadian Neonatal Network during 2018-2022 were included. Units' DCC quality improvement (QI) efforts were surveyed. The factors were stratified by <15 seconds (s) immediate cord clamping, 15-59 s early cord clamping, or ≥60 s DCC.
RESULTS
Of 16,217 eligible neonates, only 45% received DCC ≥ 60 s. Maternal hypertension and antenatal steroid was asscoiated with higher DCC rates. Cesarean delivery (aOR 0.39, 95% CI 0.33-0.47), <26 weeks GA (aOR 0.25, 95% CI 0.21-0.30), and small-for-gestational-age status had lower DCC odds. Singleton birth, preterm labor, and fetal indications for delivery increased DCC likelihood. Hospital size and QI efforts did not impact DCC compliance.
CONCLUSION
Extreme preterm neonates or cesarean delivery are actionable QI targets to improve DCC compliance and neonatal outcomes.
目的
确定影响早产儿延迟脐带结扎（DCC）依从率的母体、新生儿和医院因素。
方法
纳入2018 - 2022年期间在加拿大新生儿网络新生儿重症监护病房出生、胎龄小于33周（GA）的新生儿。对各单位的DCC质量改进（QI）工作进行调查。这些因素按立即脐带结扎<15秒（s）、早期脐带结扎15 - 59秒或DCC≥60秒进行分层。
结果
在16217名符合条件的新生儿中，只有45%接受了≥60秒的DCC。母体高血压和产前使用类固醇与较高的DCC率相关。剖宫产（调整后比值比[aOR]0.39，95%置信区间[CI]0.33 - 0.47）、胎龄<26周（aOR 0.25，95% CI 0.21 - 0.30）以及小于胎龄状态的DCC几率较低。单胎分娩、早产和胎儿分娩指征增加了DCC的可能性。医院规模和QI工作并未影响DCC依从性。
结论
极早产儿或剖宫产是可采取行动的QI目标，可以提高DCC依从性和新生儿结局。
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