Safety and Ergonomic Challenges of Ventilating a Premature Infant During Delayed Cord Clamping

Abstract

Delayed cord clamping (DCC) is endorsed by multiple professional organizations for both term and preterm infants. In preterm infants, DCC has been shown to reduce intraventricular hemorrhage, lower incidence of necrotizing enterocolitis, and reduce the need for transfusions. Furthermore, in preterm animal models, ventilation during DCC leads to improved hemodynamics. While providing ventilation and continuous positive airway pressure (CPAP) during DCC may benefit infants, the logistics of performing such a maneuver can be complicated. In this simulation-based study, we sought to explore attitudes of providers along with the safety and ergonomic challenges involved with safely resuscitating a newborn infant while attached to the placenta. Multidisciplinary workshops were held simulating vaginal and Caesarean deliveries, during which providers started positive pressure ventilation and transitioned to holding CPAP on a preterm manikin. Review of videos identified 5 themes of concerns: sterility, equipment, mobility, space and workflow, and communication. In this study, simulation was a key methodology for safe identification of various safety and ergonomic issues related to implementation of ventilation during DCC. Centers interested in implementing DCC with ventilation are encouraged to form multidisciplinary work groups and utilize simulations prior to performing care on infants.

Keywords: delayed cord clamping; delivery room; neonatology; premature infants; resuscitation; simulation.

Figure 1

Room layout for simulations of (A) C-section delivery and (B,C) vaginal deliveries. In the vaginal delivery room setup, neonatal providers could choose to stand on opposite sides of the delivery bed (B) or the same side (C). Neo = neonatal team member, OB RN = obstetric nurse, OB = obstetrician.

Figure 2

Simulation of delayed cord clamping with a premature manikin. In this image, a member of the neonatal team is assessing the infant’s heart rate, while another neonatal provider is providing ventilation with a facemask and t-piece resuscitator.