187 - Umbilical Cord Management in Preterm Infants and Hospital Outcomes

In 2014, our institution published a study on improved hospital outcomes in infants who receive umbilical cord milking (UCM) vs. immediate cord clamping (ICC). Based on this data, the Intermountain Health Care System (IHC) launched an educational initiative throughout its delivery hospitals recommending UMC x 3 for infants ≤28 weeks gestation. With new evidence, in October 2020, IHC revised this recommendation to 30-60 seconds delayed cord clamping (DCC) and launched an educational initiative to support this practice throughout its delivery hospitals. 

 

Objective: To compare the short-term hospital outcomes of infants based on hospital system cord management recommendations and cord management received.

Design/Methods:

Retrospective electronic review of live-born infants ≤28 weeks gestation within the IHC hospitals. Infants born from 1/1/2018 to 9/30/2020 were in the UCM epoch, and those born from 10/1/2020 to 1/31/2022 were in the DCC epoch. Charts were queried for cord management and hospital outcomes. Statistical analysis was done in the R language and environment for statistical computing (R Foundation for Statistical Computing, Vienna, Austria) by an authorized statistician (T.M.B.). We used multiple linear regression to determine whether there were statistically significant associations between variables of interest.

Results:

We identified 487 infants born at 14 delivery hospitals (93% born at level 3 hospitals), 19 did not receive resuscitation, and one infant did not have cord management documented, leaving 467 infants. Of those infants, 142 received DCC, 160 ICC, and 165 received UCM. Infants with ICC were younger in gestational age and had lower birth weight and lower Apgar scores (table 1). ICC was similar between both epochs. Severe intraventricular hemorrhage (IVH) was higher with ICC (p=0.04), but statistical significance was lost when controlled for birthweight (table 2). There was no significant increase in severe IVH in infants who received UCM vs. DCC (p=0.18).

Conclusion(s):

In this review of a large hospital system’s clinical practices, the smallest and most immature infants are receiving ICC. ICC appears to result in worse short-term hospital outcomes for infants ≤28 weeks gestation but is confounded by birth weight. Although DCC appears to be the most beneficial practice, UCM was not associated with an increase in IVH, as seen in other studies. This study is limited as we cannot know how well the providers followed the recommended practice. Further investigations could address barriers to providing placental transfusion to the smallest infants.