Background: Delayed Cord Clamping (DCC) has been recommended by multiple medical bodies, including the American Congress of Obstetricians and Gynecologists, especially due to its benefits in preterm neonates, and is being adopted in many practices. Part of DCC protocol entails meeting inclusion criteria. The aim of this study was to evaluate outcomes in those who received DCC and either met or did not meet inclusion criteria.
Methods: IRB-exempt Quality Improvement prospective project was conducted implementing DCC for all infants born at Cooper University hospital 7/15/2016 -7/14/2017. DCC was standardized to 45 seconds. Patient's records were reviewed and whether patient met inclusion criteria was recorded. Exclusion criteria: neonates > 35 and < 24 weeks of gestation, umbilical cord prolapse, antepartum hemorrhage, non-reassuring fetal heart rate, multiple gestation, uterine rupture, terminations of pregnancy, and fetal compromise (heart rate < 100 at birth and poor tone at 15 seconds of life). Data collected and analyzed included maternal and neonatal characteristics and resuscitation data, DCC duration and neonatal outcomes.
Results: DCC was performed in 90 (31%) out of 288 patients analyzed, with 25 (28%) of the patients who received DCC meeting exclusion criteria. There was an increased mortality rate in those who received DCC and met exclusion criteria (3% vs 16%, p=0.03). Of all newborns who met exclusion criteria, there was a higher initial hemoglobin (Hgb) in those who received DCC (15.2 vs 16.7, p=0.019). There was no difference between those who received DCC and met or did not meet exclusion criteria in outcomes such as maximum bilirubin level (p=0.69), duration of phototherapy (p=0.30) or number of blood transfusion needed (p=0.71). There was a trend for improved outcomes in those who met exclusion criteria and received DCC – decreased need for vasopressors (16% vs 5%) and need for respiratory support (62% vs 76 %, p=0.19).
Conclusions: There was a higher mortality rate in neonates who did not meet inclusion criteria but still received DCC. This finding may be due to patients meeting exclusion criteria being at higher-risk for mortality, notwithstanding DCC. There was a higher initial Hgb in those who received DCC. There were trends for some improved outcomes in those who received DCC and did not meet inclusion criteria. This may be due to the higher risk neonates benefiting more from DCC.
