Delayed umbilical cord clamping is not a new concept, it has been around since Aristotle\u27s time. This practice ended in the 1950s. In recent years the practice of delayed cord clamping has resurfaced because of its many benefits which include prevention of intraventricular hemorrhage in premature infants

Ydrogo-Borrego, Alejandra O.

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Sigma's 30th International Nursing Research Congress Delay Cord Clamping Reduces Intraventricular Hemorrhage in Premature Infants: An Integrated Research Review Alejandra O. Ydrogo-Borrego, BSN Department of Nursing, Lubbock Christian University, Lubbock, TX, USA Purpose: The risk of brain damage is significant on infants born at 32 or less week gestation and weighing less than 1500 grams. Intraventricular hemorrhages (IVH) are critical as they lead to long-term neurological effects (Bayer, 2016, Kazemi et al., 2017). Delaying cord clamping has been identified as contributing to a decrease in the incidence of IVH on preterm infants (Bayer, 2016, Brocato et al., 2016, Chiruvolu et al., 2015, Fenton et al., 2018, Fogarty et al. 2018, Jelin et al., 2016, Kazemi et al., 2017, Vesoulisa et al., 2018). Physiologically, it is important to sustain good cardiovascular function throughout the birth process to reduce the incidence of IVH, studies suggest that DCC plays a role in sustaining increased initial blood pressure in the post-partum period (Brocato et al.,2016, Chapman et al,2016, Fenton et al., 2018, Fogarty et al., 2018, Stranak et al., 2018). The American College of Obstetricians and Gynecologists, American Academy of Pediatrics, World Health Organization and Neonatal Resuscitation Guidelines recommend delaying cord clamping to 30 to 60s when the infant does not require immediate resuscitation, however, the effects of delayed cord clamping in premature infants in the prevention of IVH is not yet fully known Methods: This review was conducted using the methodology described by Whittemore and Knaff (2015) and Brown (2018), suggested by the question, “Does delayed cord clamping help reduce the incidence of intraventricular hemorrhage in premature infants?” A systematic research of the peer-review literature was completed using the following databases: Cochrane, PubMed, CINAHL Plus, complete: Nursing Academic Edition and bibliography mining. Key words used in searching were: "delayed cord clamping", "intraventricular hemorrhage or ivh", "preterm or infant." Search Criteria was limited to articles published between the year of 2013-2018 for all databases. Inclusion criteria included studies which identified intraventricular hemorrhage as a primary or secondary outcome in preterm infants with delayed cord clamping. The original search identified a total of 66 articles. Contained within the 66 articles were 15 duplicates and 39 were excluded due to pertaining to cord milking, term infants, comparing twins, or not related to the research topic. Twelve articles were appraised using, Long & Gannaway (2015). EBR Tool, Step 2: one article was a level 6, two level 5, two level 4, one level 3, and six level 1. All articles were critically appraised using evaluated checklists and the EBR Tool (Brown, 2018; Long & Gannaway, 2015). Results: Premature infants who received DCC had better admission Hgb, reduced rates of late onset sepsis, higher admission blood pressure and less need for blood transfusion during their hospital stay (Bayer, 2016; Brocato et al., 2016; Chiruvolu et al., 2015; Fenton et al., 2018; Ghavam et al., 2014; Jelin et al., 2016; Kazemi et al., 2017; Vesoulissa et al., 2018). DCC provides an increase in initial blood pressure which help maintain good cardiac output without the need for volume expanders which in turn helps reduce the incidence of IVH. Studies suggest that DCC achieves an increase in blood volume that provides improved hemodynamic stability without compromising resuscitation in premature infants (Chapman et al., 2016; Ghavam et al., 2014). Maintaining higher hemoglobin levels in the newborn period improves neurodevelopmental outcome (Bayer, 2016; Brocato et al., 2016; Ghavam et al., 2014; Kazemi et al., 2017). No difference was noted in the incidence of IVH Grade 3 and 4 between DCC and immediate cord clamping groups (Jelin et al., 2016). Conclusion: The American College of Obstetricians and Gynecologists, American Academy of Pediatrics, World Health Organization and Neonatal Resuscitation Guidelines to DCC for 30 to 60s (Brocato et al., 2016, Chapman et al., 2016, Chiruvolu et al., 2015, Kazemi et al., 2017). Review of literature suggest that, despite studies that show benefits of DCC some still believe that DCC delays immediate resuscitation and its benefits do not outweigh the risks (Bayer, 2016; Ghavam et al., 2014). Due to premature infants increase risk for disability long-term follow up is needed to evaluate long-term benefits of DCC (Bayer, 2016; Fogarty et al., 2018). Results of the integrative research review strongly suggest that delayed cord clamping significantly reduces the incidence of intraventricular hemorrhage (Bayer, 2016; Brocato et al., 2016; Chiruvolu et al., 2015; Fenton et al., 2018; Fogarty et al., 2018; Jelin et al., 2016; Kazemi et al., 2017; Vesoulisa et al., 2018). However, research suggest that further studies are needed to determine the correct timing needed to DCC to accomplish the most benefits for preterm infants (Brocato et al., 2016; Chapman et al., 2016; Chiruvolu et al., 2015; Kazemi et al., 2017).   Title: Delay Cord Clamping Reduces Intraventricular Hemorrhage in Premature Infants: An Integrated Research Review  Keywords: Delayed cord clamping, intraventricular hemorrhage or IVH and premature infant  References: Bayer, K. (2016). Delayed Umbilical Cord Clamping in the 21st Century: Indications for Practice. Advances In Neonatal Care (Lippincott Williams & Wilkins), 16(1), 68-73. doi:10.1097/ANC.0000000000000247 Brocato, B., Holliday, N., Whitehurst Jr, R. M., Lewis, D., Varner, S., & Whitehurst, R. J. (2016). Delayed Cord Clamping in Preterm Neonates: A Review of Benefits and Risks. Obstetrical & Gynecological Survey, 71(1), 39-42. doi:10.1097/OGX.0000000000000263 Chapman, J., Marfurt, S., & Reid, J. (2016). Effectiveness of Delayed Cord Clamping in Reducing Postdelivery Complications in Preterm Infants: A systematic review. Journal Of Perinatal & Neonatal Nursing, 30(4), 372-378. doi:10.1097/JPN.0000000000000215 Chiruvolu, A., Tolia, V. N., Qin, H., Stone, G. L., Rich, D., Conant, R. J., & Inzer, R. W. (2015). Effect of delayed cord clamping on very preterm infants. American Journal Of Obstetrics & Gynecology, 213(5), 676.e1-676.e7. doi:10.1016/j.ajog.2015.07.016 Fenton, C., McNinch, N. L., Bieda, A., Dowling, D., Damato, E., & Thibeau, S. (2018). Clinical Outcomes in Preterm Infants Following Institution of a Delayed Umbilical Cord Clamping Practice Change. Advances In Neonatal Care (Lippincott Williams & Wilkins), 18(3), 223-231. doi:10.1097/ANC.0000000000000492  Fogarty, M., Osborn, D. A., Askie, L., Seidler, A. L., Hunter, K., Lui, K., & ... Tarnow-Mordi, W. (2018). Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. American Journal Of Obstetrics & Gynecology, 218(1), 1-18. doi:10.1016/j.ajog.2017.10.231 Ghavam, S., Batra, D., Mercer, J., Kugelman, A., Hosono, S., Oh, W., & ... Kirpalani, H. (2014). Effects of placental transfusion in extremely low birthweight infants: meta-analysis of long- and short-term outcomes. Transfusion, 54(4), 1192-1198. Jelin, A. C., Zlatnik, M. G., Kuppermann, M., Gregorich, S. E., Nakagawa, S., & Clyman, R. (2016). Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants. Journal Of Maternal-Fetal & Neonatal Medicine, 29(11), 1705-1709. doi:10.3109/14767058.2015.1061496 Kazemi, M. V., Akbarianrad, Z., Zahedpasha, Y., Mehraein, R., & Mojaveri, M. H. (2017). Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants. Iranian Journal Of Pediatrics, 27(5), 1-4. doi:10.5812/ijp.6570 Nevill, E., & Meyer, M. P. (2015). Effect of delayed cord clamping (DCC) on breathing and transition at birth in very preterm infants. Early Human Development, 91(7), 407-411. doi:10.1016/j.earlhumdev.2015.04 Straňák, Z., Feyereislová, S., Korček, P., & Dempsey, E. (2018). Placental Transfusion and Cardiovascular Instability in the Preterm Infant. Frontiers In Pediatrics, 639. doi:10.3389/fped.2018.00039   Vesoulisa, Z. A., Rhoades, J., Muniyandi, P., Conner, S., Cahill, A. G., Mathur, A. M., & Vesoulis, Z. A. (2018). Delayed cord clamping and inotrope use in preterm infants. Journal Of Maternal-Fetal & Neonatal Medicine, 31(10), 1327-1334. doi:10.1080/14767058.2017.1315663  Abstract Summary: Delayed umbilical cord clamping is not a new concept, it has been around since Aristotle’s time. This practice ended in the 1950s. In recent years the practice of delayed cord clamping has resurfaced because of its many benefits which include prevention of intraventricular hemorrhage in premature infants.  Content Outline: I. Introduction and background on delayed cord clamping in the prevention of intraventricular hemorrhage (IVH) a.Premature infants are at risk for long-term neurological effects b.Sustaining good cardiovascular function in premature infants throughout the birth process reduces the incidence of intraventricular hemorrhage c. Delayed cord clamping is recommended by many health organizations II. Research and measurement of methodology was conducted using the methodology described by Whittemore and Knaff (2015) and Brown (2018) a. A systematic research of the peer-review literature was completed using several databases b. Findings from the studies were synthesized for comparative analysis of results c. All articles were critically appraised using evaluated checklist and the EBR Tool (Brown, 2018; Long & Gannaway, 2015) III. Studies suggest that delayed cord clamping has many benefits however the effects on premature infants in the prevention of IVH is not yet fully known a. An increase in initial blood pressure helps maintain good cardiac output b. Long-term follow up is needed to evaluate long-term benefits of DCC c. Further studies are needed to determine the correct timing needed to DCC to accomplish the most benefits for preterm infants  First Primary Presenting Author Primary Presenting Author Alejandra O. Ydrogo-Borrego, BSN   Lubbock Christian University Department of Nursing Graduate student Lubbock TX  USA  Author Summary: Neonatal Intensive care nurse for 9 years. certified in Neonatal ICU in 2015, served as a mentor to students and nurses, participates in various committees that improve and promote better patient outcomes. Immediately after becoming a charge nurse she became involved in the development and implementation of the Neonatal “Golden Hour” and guidelines for care of the extreme low birth weight/extreme premature infant to improve neonatal clinical outcomes and prevent long-term disabilities. 

Delay cord clamping reduces intraventricular hemorrhage in premature infants: An integrated research review

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Delay cord clamping reduces intraventricular hemorrhage in premature infants: An integrated research review

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