Improving the Rate of Delayed Cord Clamping in Preterm Infants: A Quality Improvement Project

Hosp Pediatr. 2023 Apr 1;13(4):292-299. doi: 10.1542/hpeds.2022-006633.


Objective: Delayed cord clamping (DCC) provides many benefits for preterm infants. The aim of this quality improvement project was to increase the rate of DCC by 25% within 12 months for neonates <34 weeks' gestation born at a tertiary care hospital.

Method: A multidisciplinary team investigated key drivers and developed targeted interventions to improve DCC rates. The primary outcome measure was the rate of DCC for infants <34 weeks' gestation. Process measures were adherence to the DCC protocol and the rate of births with an experienced neonatology provider present at the bedside. Balancing measures included the degree of neonatal resuscitation, initial infant temperature, and maternal blood loss. Data were collected from chart review and a perinatal research database and then analyzed on control charts. The preintervention period was from July 2019 to June 2020 and the postintervention period was from July 2020 to December 2021.

Results: 322 inborn neonates born at <34 weeks' met inclusion criteria (137 preintervention and 185 postintervention). The rate of DCC increased by 63%, from a baseline of 40% to 65% (P <.001), with sustained improvement over 18 months. Significant improvement occurred for all process measures without a significant change in balancing measures.

Conclusion: Using core quality improvement methodology, a multidisciplinary team implemented a series of targeted interventions which was associated with an increased rate of DCC in early preterm infants.

MeSH terms

  • Delivery, Obstetric
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Pregnancy
  • Quality Improvement*
  • Resuscitation
  • Time Factors
  • Umbilical Cord Clamping