Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: a quality-improvement cohort study

Autor:	Christer André Jensen, Friedrich Reinhart-van Gülpen, Elisabeth Sæther, Tor Åge Myklebust, Beate Horsberg Eriksen
Rok vydání:	2020
Předmět:	Relative risk reduction medicine.medical_specialty Resuscitation Neonatal intensive care unit Time Factors Reproductive medicine lcsh:Gynecology and obstetrics Umbilical cord Umbilical Cord Cohort Studies Clinical Protocols Pregnancy medicine Humans Transitional care lcsh:RG1-991 business.industry Infant Newborn Obstetrics and Gynecology Infant Delivery Obstetric Constriction Quality Improvement medicine.anatomical_structure Emergency medicine Female Umbilical cord clamping business Assisted vaginal delivery Neonatal resuscitation Cohort study Research Article
Zdroj:	BMC Pregnancy and Childbirth 20:496 BMC Pregnancy and Childbirth, Vol 20, Iss 1, Pp 1-14 (2020)
ISSN:	1471-2393
Popis:	Background Deferring cord clamping has proven benefits for both term and preterm infants, and recent studies have demonstrated better cardio-respiratory stability if clamping is based on the infant’s physiology, and whether the infant has breathed. Nevertheless, current guidelines for neonatal resuscitation still recommend early cord clamping (ECC) for compromised babies, unless equipment and competent personnel to resuscitate the baby are available at the mother’s bedside. The objective of this quality improvement cohort study was to evaluate whether implementing a new delivery room protocol involving mobile resuscitation equipment (LifeStart™) reduced the prevalence of ECC in assisted vaginal deliveries. Methods Data on cord clamping and transitional care were collected 8 months before and 8 months after implementing the new protocol. The Model for Improvement was applied to identify drivers and obstacles to practice change. Statistical Process Control analysis was used to demonstrate signals of improvement, and whether these changes were sustainable. Multivariate logistic regression was used to evaluate the impact of the new protocol on the primary outcome, adjusted for possible confounders. Results Overall prevalence of ECC dropped from 13 to 1% (P P p n = 43 [42%] vs n = 69 [75.0%], P Conclusions A new delivery-room protocol involving mobile resuscitation equipment successfully eliminated early cord clamping in assisted vaginal deliveries of term and near-term infants. A systematic approach, like the Model for Improvement, seemed crucial for both achieving and sustaining the desired results. Trial registration The study was approved as a service evaluation as defined by the Regional Committee for Medical and Health Research Ethics (2018/1755/REK midt).
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::91f05f0e8ad650bbc4eaa1b0bbfae5f3 https://pubmed.ncbi.nlm.nih.gov/32854647 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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