A Feasibility Study of a Novel Delayed Cord Clamping Cart

Abstract

Delaying umbilical cord clamping (DCC) for 1 min or longer following a neonate’s birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anemia, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and blood transfusion. Despite these benefits, clinicians typically cut the umbilical cord without delay in neonates requiring resuscitation and move them to a radiant warmer for further care; this effectively prevents these patients from receiving any benefits from DCC. This study evaluated the feasibility of a delayed cord clamping cart (DCCC) in low-risk neonates born via Cesarean section (CS). The DCCC is a small, sterile cart designed to facilitate neonatal resuscitation while the umbilical cord remains intact. The cart is cantilevered over the operating room (OR) table during a CS, allowing the patient to be placed onto it immediately after birth. For this study, a sample of 20 low-risk CS cases were chosen from the non-emergency Labor and Delivery surgical case list. The DCCC was utilized for 1 min of DCC in all neonates. The data collected included direct observation by research team members, recorded debriefings and surveys of clinicians as well as surveys of patients. Forty-four care team members participated in written surveys; of these, 16 (36%) were very satisfied, 12 (27%) satisfied, 13 (30%) neutral, and 3 (7%) were somewhat dissatisfied with use of the DCCC in the OR. Feedback was collected from all 20 patients, with 18 (90%) reporting that they felt safe with the device in use. This study provides support that utilizing a DCCC can facilitate DCC with an intact umbilical cord.

A Survey on Current Practices of Umbilical Cord Clamping in Malaysia

“…These findings are consistent with the study done by Ibrahim et al ( 11 ) where the majority of respondents agreed that DCC is beneficial for both term (69%) and preterm (71%) neonates not requiring PPV. In fact, DCC in preterm neonates who require PPV can now be facilitated by providing a mobile resuscitation trolley before UCC ( 21 ) and this was proven to be feasible as demonstrated by Lapcharoensap et al ( 22 ) and Joshi et al ( 23 ). Having said that, only 30% of the respondents agreed that DCC was good for neonates who require PPV.…”

Toward greater nuance in delayed cord clamping

“…A survey of practice in the UK revealed a significant portion of neonatal intensive care units planning to implement ICR for preterm infants, but cited delays in education on the practice and supporting equipment to be barriers [40]. To assist with ICR, multiple resuscitation platforms have been developed and adapted to the limited physical space for resuscitation [41][42][43][44][45]. Other solutions address costeffective methods suitable for low-resource settings [46].…”

Neonatal Resuscitation in Children 2021: Focus on Training, Technology, and New Clinical Approaches

“…Last year, several articles on different aspects related to neonatal resuscitation were published in the journal Children. The topics covered included staff training [ 1 , 2 ], technological aspects [ 3 , 4 , 5 , 6 ], and the investigation of “new” clinical interventions [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

“…Amongst the many articles published in Children, four of them describe emerging technologies for improving neonatal care at birth [ 3 , 4 , 5 , 6 ]. Two of them reported on new models of trolleys that could aid in the resuscitation of neonates with intact placental circulation at the bed side of the mother [ 3 , 4 ].…”

“…Amongst the many articles published in Children, four of them describe emerging technologies for improving neonatal care at birth [ 3 , 4 , 5 , 6 ]. Two of them reported on new models of trolleys that could aid in the resuscitation of neonates with intact placental circulation at the bed side of the mother [ 3 , 4 ]. While one study was conducted in a high-resource setting, the other one described a low-cost trolley which could be used in low-resource settings.…”