Article Text
PDF
Abstract
Objectives Deferred cord clamping (DCC) is recommended by the Resuscitation Council UK and British Association of Perinatal Medicine (BAPM) as the preferred method of optimum cord management (OCM).1 2 OCM confers many benefits to preterm infants including reduced risk for mortality, improved mean blood pressure with reduced need for inotropes and improved haematological measures.3 At our trust, in babies born at <34 weeks, data from 2021 and 2022 demonstrated suboptimal OCM rates at 2% and 21.4 respectively and therefore, the aim of this quality improvement project (QIP) was to increase it to above the national average of 60.4%.
Methods This study took place at a large district general hospital in London between January 2022 – October 2023 (pre-intervention phase – Jan-Aug 22, intervention phase – Sep- Dec 22 and monitoring phase – Jan-Oct 23). Data on DCC, defined as clamping ≥ 1 minute on neonates, born <34 weeks’ gestation, was collected from Badgernet and The National Neonatal Audit programme (NNAP) database. Neonates with missing data were excluded from this analysis. A pre-intervention survey was sent out to collate the challenges and key drivers of OCM. It helped to design a tailored approach to multi-disciplinary team (MDT) working followed by deployment of a range of interventions to enhance the knowledge of OCM including: a multidisciplinary educational programme; surveys; OCM quiz; leaflets; ‘message of the week’ and engagement of key stakeholders from the Paediatric, Obstetric and Midwifery teams. Data was compared against North Central and East London (NCEL) Neonatal Network and the national OCM rate in 2022. Statistical analyses were performed using Mann-Whitney U test and one-way Anova.
Results A total of 104 eligible neonates were born in 2022 (n=62) and 2023 (n=42) were included in this study. The rate of OCM compliance increased substantially from 21.4% to 74.9% between 2022 and 2023 (p<0.001) and 14.5% above the national OCM average (figure 1). Analysis of 2023 exhibited a steady improvement in compliance in each quarter during the monitoring phase (Q1=72.2% vs Q2=73.9% vs Q3=78.6%, p<0.9). Within the NCEL neonatal unit, our hospital improved from one of the lowest rates of OCM in 2021 to the highest in 2023.
A comparison of DCC compliance at NMUH between 2022 and 2023 (21.4% vs 74.9%, p<0.001) and against the NNAP national average (60.4%)
Conclusion The interventions and multidisciplinary approach used for this QIP successfully improved DCC rates with sustained effects. Our methods were simple, inexpensive and can be readily adopted by other trusts without introducing extra equipment or costs.
References
Newborn resuscitation and support of transition of infants at birth Guidelines, Resuscitation Council (UK), 2021.
Optimal cord management in preterm babies – a quality improvement toolkit. NICE, BAPM 2020.
Seidler Al, Gyte Gml, Rabe H, Díaz-Rossello Jl, Duley L, Aziz K, Testoni Costa-Nobre D, Davis Pg, Schmölzer Gm, Ovelman C, Askie Lm, Soll R. International liaison committee on resuscitation neonatal life support task force. umbilical cord management for newborns <34 weeks’ gestation: a meta-analysis, 2021.