981 Addressing clinical and process factors associated with delayed cord clamping for preterm neonates

Delayed cord clamping (DCC) has significant benefits for preterm neonates, including decreased mortality and intraventricular hemorrhage. Variability in DCC adoption is known to exist, but there is limited data on reasons for variability among preterm neonates. We sought to determine factors associated with lack of receipt of DCC for neonates <37 weeks gestation and utilize this data for a quality improvement (QI) initiative. A retrospective cohort study at a single academic hospital of neonates delivered ≥23 weeks and <37 weeks gestation during 6/2019-12/2019 was performed. Monoamniotic twins were excluded. DCC was considered received if done for ≥ 30 seconds. Data was analyzed separately for singletons and twins. Multidisciplinary meetings were held to determine key facilitators and barriers to DCC. Data informed DCC QI efforts. 226 neonates met criteria for inclusion in the retrospective cohort. 50 (22.1%) were twins; there was no difference in DCC rates between twins and singletons (25/50, 50.0% vs 99/176, 56.3%, p = 0.43). Among singletons, cesarean section, general anesthesia, lower gestational age, and lower birthweight were associated with lower rate of DCC (Table 1). Associations between DCC and available clinical factors were not found for twins (Table 2). Meetings revealed having experienced neonatal providers observing neonates during DCC as key facilitator. Implementation of such presence for deliveries <34 weeks and increased provider education about DCC benefits in late 7/2020 resulted in a 93% (27/29) DCC rate for all preterm neonates in the following month, which was higher than retrospective cohort DCC rate of 55.9% (124/226, p = 0.03). Younger, smaller, and cesarean-born preterm singleton neonates were less likely to receive DCC than other preterm neonates during baseline period. This data and multidisciplinary meetings informed a QI initiative that has realized improvement in DCC rates. Ongoing evaluation will be done to determine the sustainability of these gains.View Large Image Figure ViewerDownload Hi-res image Download (PPT)