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Implementing delayed cord clamping in premature infants
  1. Alfonso Francisco Pantoja,
  2. Ann Ryan,
  3. Michelle Feinberg,
  4. Mark DeMarie,
  5. John Britton,
  6. Ellina Liptsen,
  7. Maggie Chen,
  8. Jordan Crow
  1. Department of Neonatology, Saint Joseph Hospital, Denver, Colorado, USA
  1. Correspondence to Dr Alfonso Francisco Pantoja; Alfonso.Pantoja{at}


The practice of delayed cord clamping (DCC) in premature infants has proven benefit to the neonate. In a community-based perinatal centre, the practice of DCC for more than 60 s for premature infants with gestational age of <35 weeks was identified to occur infrequently at 20% in 2013. The perinatology group in conjunction with nursery, labour and delivery, and obstetric staff sought to improve adherence to the best practice of DCC for premature infants. In an effort to achieve this goal, we developed an evidence-based clinical practice guideline, included key stakeholders in its development and provided timely feedback to delivery providers about DCC performance. The frequency of DCC for this population improved from 19.5% in 2013 to 85% in 2017. The success in improving this best practice is attributed to the involvement of the multidisciplinary team who developed the guideline, and the sustained improvement was encouraged with the continued reaffirmation of DCC goals to delivery providers.

  • healthcare quality improvement
  • pdsa
  • quality Improvement
  • clinical practice guidelines
  • continuing education, continuing professional development

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  • Contributors AFP: author of the guideline, and educated the neonatologists, NNPs, obstetricians and midwives about the guideline. He also created the graphic displays of DCC performance and shared this information with neonatology and OB providers. He wrote both versions of the manuscript. AR: reviewer of the literature for the creation of the DCC guideline, and as NICU Medical Director promoted the inclusion of rate of DCC in premature infants as a quality indicator. MF: reviewer of the literature for the creation of the DCC guideline and contributed to the development of the DCC guideline. MD: organised and conducted the Evidence-Based Journal Club. He selected the literature that was reviewed for the development of the DCC guideline. JB: reviewer of the literature for the creation of the DCC guideline. He created the queries in Neodata that were used to assess DCC compliance. He also updated CPMG about the progressive improvement of this quality measurement. He reviewed and contributed to the generation of the second draft of this manuscript. EL: reviewer of the literature for the creation of the DCC guideline. MC: reviewer of the literature for the creation of the DCC guideline. JC: resident champion. He provided education to the Ob-Gyn residents about the DCC guideline and offered them feedback about the performance of this QI initiative. He also contributed to the writing of the first manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This quality improvement (QI) project was presented to the Institutional Review Board of Saint Joseph Hospital for their consideration. The IRB qualified the project as a QI project.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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