(760) Trends in delayed cord clamping documentation and performance at an urban hospital

Delayed cord clamping (DCC) has beneficial effects on neonates, specifically in preterm infants where it has been shown to decrease the incidence of necrotizing enterocolitis, intracranial bleeds, anemia and subsequent need for blood transfusions, and hospital mortality. Despite these well studied effects, DCC is not universally performed or documented. We aimed to evaluate the trends in DCC documentation and performance with the goal of identifying areas for improvement.


Study Design: This is a retrospective study of DCC documentation and performance at our urban hospital. In October 2022 we implemented formal documentation of DCC performance and duration - documentation was performed by the primary nurse and verified by the primary obstetrician.

Results:

From October 2022 – July 2023, 4352 deliveries of live neonates were performed. Throughout the study period documentation improved from 73.8% to 93.7%. Documentation was more commonly performed in vaginal deliveries (VD) compared to cesarean deliveries (CD) (91.5% vs. 73.8%; Figure 1). When documented, the rate of DCC performance was high in both VD and CD (98.0% vs. 94.4%; Figure 1). When comparing extremely preterm (22-27+6w), very preterm (28-31+6w), moderately preterm (32-33+6w), late preterm (34-36+6w) and term (37+w) deliveries, DCC was less likely to be performed at earlier gestational ages (87.5% vs. 89.5% vs. 95.2% vs. 95.8% vs. 97.2%) and more likely to be performed for shorter duration than in term infants (data not shown).


Conclusion: Documentation and performance of DCC was overall high, but documentation was lower for cesarean deliveries and performance was poorer and of shorter duration at earlier gestational ages. We identified cesarean deliveries and preterm gestations as areas for improvement in documentation and performance, respectively, and plan to develop educational curricula to improve these measures as well as evaluate the associated neonatal outcomes.