Despite significant proposed benefits, delayed umbilical cord clamping (DCC) is not practiced widely in preterm infants largely because of the question of feasibility of the procedure and uncertainty regarding the magnitude of the reported benefits, especially intraventricular hemorrhage (IVH) vs the adverse consequences of delaying the neonatal resuscitation. The objective of this study was to determine whether implementation of the protocol-driven DCC process in Elsahel teaching hospital would improve the outcome in preterm infants without adverse consequences. Study Design: We implemented a quality improvement process for DCC for 13months started in August 2014 in infants born at less than 37 weeks’ gestational age. Eligible infants were left attached to the placenta for 45 seconds after birth. Neonatal process and outcome data were collected until discharge. We compared infants who received DCC with infants who were born for 13 months started at February 2014, but whose cord was clamped immediately after birth, because they were born before the protocol implementation. Results:DCC was performed on 79infants; and 81 infants were identified as control. Gestational age, birth weight, and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in the DCC group were intubated in delivery room, had respiratory distress syndrome, or received red blood cell transfusions in the first week of life compared with the control group. A significant reduction was noted in the incidence of IVH in the DCC compared with the historic control group, after adjustment for gestational age, an association was found between the incidence of IVH and DCC , IVH was significantly lower in the DCC compared with control group. There were no significant differences in deaths and other major morbidities. Conclusion:DCC, as performed in our institution, was associated with significant reduction in IVH and early red blood cell transfusions. DCC in preterm infants appears to be safe, feasible, and effective with no adverse consequences.
Delayingumbilical cord clamping, intraventricular hemorrhage, preterm infant.