P1.243: Preemie Power: Increasing Rates of Delayed Cord Clamping through Quality Improvement

Purpose/Objectives: Delayed cord clamping (DCC) is the practice of allowing continued blood transfer from the placenta to the newborn for 30 to 60 seconds before clamping the umbilical cord. Neonatal Resuscitation Program guidelines recommend DCC for at least 30–60 seconds for most vigorous term and preterm infants. In preterm infants, DCC is associated with significant benefits, including smoother neonatal transition to extrauterine life, reduced need for inotropic support within the first 24 hours of life, reduced blood transfusion requirements, lower rates of necrotizing enterocolitis and intraventricular hemorrhage, improved developmental outcomes, and higher survival rates to hospital discharge. Despite these well-documented advantages, DCC remains underutilized in preterm infants, often due to both obstetric and pediatric provider discomfort and concerns about the need for immediate neonatal resuscitation. Recognizing this gap, our SMART aim is to increase the rate of DCC for preterm infants delivered at and admitted to an urban level III NICU from 61% in November 2024 to greater than or equal to 80% by October 2025.

Design/Methods: A multidisciplinary and interprofessional team conducted a quality improvement project at Good Samaritan Hospital, a high-volume level III delivery center in Cincinnati, Ohio. We mapped existing processes and developed a key driver diagram (Figure 1) to guide our interventions. Interventions included revising unit guidelines to establish clear inclusion criteria and outline true and relative contraindications, conducting educational sessions for obstetrics and neonatal delivery teams, standardizing cord clamp planning during pre-delivery huddles, enhancing documentation of cord clamping practices, and implementing regular reminders for on-duty delivery room staff. The primary outcome measure was the rate of DCC in preterm infants born between 22 weeks + 0 days to 34 weeks + 6 days gestation. Balancing measures included delivery room intubation rates and infant admission temperatures, ensuring that improvements in DCC did not negatively impact overall neonatal stability.

Results: Key outcome and balancing measures were tracked using run charts for 380 preterm infants born between November 1, 2024, and February 28, 2025. Following the implementation of the quality improvement initiative, the rate of DCC increased from a baseline median of 61% to 80% (Figure 2), demonstrating improved adherence to evidence-based delivery practices. Furthermore, balancing measures remained stable within common cause variation, with delivery room intubations going from 17% to 15% and hypothermia rates going from 23% to 18% among the infants.

Conclusion/Discussion: DCC rates improved for preterm infants following our single-center quality improvement initiative. Balancing measures, including intubation rates and admission temperatures, were not adversely impacted during the intervention period. These findings suggest that targeted interventions with multidisciplinary and interprofessional collaboration can lead to meaningful improvements in the implementation of DCC for preterm infants.