Neonatal Cord Clamping

The hospital that I work at does not have a labor and delivery unit, so my facility does not deliver infants. In the article Beliefs and Practices of Obstetric Care Providers Regarding Umbilical Cord Clamping, it is an interesting discussion to the timing of cutting the umbilical cord in full-term and preterm infants. Hill and Fontenot (2014) state, “If the umbilical cord remains unclamped for a small amount of time (approximately 30 to 120 seconds), rather than clamping immediately (15 to 20 seconds), placental transfusion occurs, increasing blood volume to the newborn and improving blood flow to vital organs” (Hill & Fontenot, p. 413). The article describes that waiting one minute or longer to clamp the umbilical cord can benefit the newborn

The neonatal specialists care [NICE] (2010) quality standards are drawn from key priorities for implementation which are listed in the [NICE] Clinical guideline, which emphasises on patient experience and the whole clinical team. It requires that physical, psychological and social needs of babies and their families are the main focus of all care given, it covers the care whilst babies are in the need of specialist services that should be commissioned across all relevant agencies for on-going care (NICE, 2010). This According to the [NICE] Guidelines (2015) preterm birth is the single biggest cause of neonatal mortality and morbidity in the United Kingdom [UK]. This guideline reviews evidence to provide the best treatment when caring for women

According to the World Health Organization (WHO, 2016), preterm birth are the birth that happened before 37 ended weeks of pregnancy and is one of the number reason of newborn deaths and the second prominent cause of deaths in children below five. The preterm babies have chances of an amplified risk of illness, disability and death. In the first weeks, the complications of premature birth may include: breathing problems, heart problems, brain problems, temperature control problems, gastrointestinal problems, blood problems, metabolism problems, immune system problems. Long-term complications includes cerebral palsy, impaired cognitive skills, vision problem, hearing problems, dental problems, behavioral and psychological problems, chronic health issues.

At each delivery, obstetricians or midwifes decide when to clamp and cut the umbilical cord. Early cord clamping has become the routine practice in the developed world without scientific assessment of its potential impact on an newborn’s health and development. Several systematic reviews have recommended that clamping the umbilical cord in all births should be delayed for at least 30-60 seconds, with the infant kept at or below the level of the placenta because of the related neonatal benefits, including increased blood volume, decreased incidence of intracranial hemorrhage in preterm infants, reduced need for blood transfusion, and lower percentages of iron deficiency anemia in full-term infants. Clear evidence to guide a obstetrical provider’s

The problem arises when health care team members get mundane in their assessments or routine care so much that they are not on high alert with every patient. Active management includes the following steps, using uterotonic drugs, controlling the cord traction and cutting the clamp early, and massage the fundus immediately after the placenta has been delivered. Using uterotonic drugs like oxytocin help to make the uterus contract its muscle in order to control the flow of blood. Controlling the cord traction aids in reducing the risk of postpartum hemorrhage by a small fraction. Nonetheless, every effort is beneficial and in this case it reduces the risk of manually removing the placenta (Hofmeyr, Mshweshwe, & Gulmezoglu, 2015). Massaging the fundus generates the uterine muscle to contract and decrease blood blow. It also includes after delivery care of massaging the uterus and monitoring bleeding and uterine hardness at regular intervals. The intervals consist of every 15 minutes for the first two hours after birth. The patient should still be closely monitored in regular intervals thereafter. When using these steps in coordination with each other it supports the reduction of vaginal bleeding. Postpartum hemorrhage is more likely to occur when these steps are neglected to be followed through. Furthermore, women who are induced have a

McDonald et al. (2013) claim that that delayed cord clamping leads to over transfusing red blood cells and it predisposes the baby to jaundice requiring treatment with phototherapy. Airey et al. (2008) agree that babies are higher risk of jaundice, however they question whether there is an increased requirement to treat

Nevertheless, the capacity to sustain premature or sick infants is an important medical advancement, the goal is to eliminate

Barriers to change in practice includes whether noise in the Neonatal Intensive Unit (NICU) can be lowered to a goal level because of high traffic, staffing changes, equipment changes, unpredictable noise, alarms, phones, ventilators and certain staff or family resilient to the change (Wachman & Lahav, 2011). The impact of the clinical problem shows to be of low cost in the delivery of care, along with effective and efficient because of the small changes that can be implemented. Numerous interventions are simple tasks that cost nothing but a change in practice such as doing report away from the crib, being mindful when closing doors, changing metal to plastic, creating signs to hang up etc. etc. Further exploration of this topic should be ongoing as there may be things that can be changes or implemented in regards to the safety of the neonate. All Quality and Safety Education for Nurses competencies are important when it comes to the development of a premature infant. With noise mitigation patient – centered care is especially importance because this population is so invasive and unable to communicate. Health care professionals are their advocates for a positive maturation

In a study done in Sweden investigators used continuous KC for neonatal intensive care infants. Previously, the infants that were admitted to neonatal intensive care units did not have the chance to do KC, and the mothers often felt removed from their infants. What the researchers discovered is that continuous KC was not feasible for various reason, the qualitative information that the study showed is propelling them to do another study with slight variations (Blomqvist, & Nyqvist, 2010).

This delayed clamping is associated with improved outcomes for the neonate. Hill and Fontenot (2014) stated, “Healthy, full-term infants who experienced delayed cord clamping were found to have significantly higher birth weights, elevated hemoglobin concentrations immediately post birth and increased iron reserves lasting up to 6 months post birth” (p. 414). The risks related to a delay in cord clamping were also included. Some of the risks found to be associated with delayed cord clamping are interfering with resuscitation efforts, impeding attempts to bank cord blood, and a correlation with the occurrence of jaundice (Hill and Fontenot, 2014, p. 414). The studies found the majority of clamping occurs immediately after birth. More information and education must be provided to health care professionals regarding the potential benefits of delayed cord clamping. Further research must be conducted to reinforce the benefits of a delay in cord clamping and when a delay in cord clamping is not

In order to experience the treatment of umbilical cord postnatally we observed nurses at Saint Peter’s University Hospital in New Brunswick as they followed the hospital policy and implement the recommended intervention. We were able

Sanabria had encountered an issue in his hospital with high mortality rate of LBW newborns, shortage of incubators, and shortage of medical personnel. “Dr. Sanabria, in a classic case of reverse engineering, analyzed what standard incubator care provided for LBW/preterm newborns and concluded that mother were ideally suited to provide the warmth and nourishment that even the neediest neonates required” (Rodgers, 2013, p.249). Beneficially, his technique is very simple and free of cost, it consist of placing the newborn uncovered in between the mother’s breast, in which it provides the newborn constant warmth just like an incubator, but in a natural skin to skin contact. Other benefits included early breastfeeding, increase of newborn weight, promotes growth, increase mother-infant bonding. Dr. Sanabria noticed his theory was correct, and saw a decrease in morbidity and mortality among low birth weight and preterm newborns in his hospital, which lead to early hospital discharge.

Nearly one-fifth of the babies were preterm, similar to a finding of another study from the same site 21. Preterm babies had a higher risk of neonatal mortality; preterm babies could be the proxy for low birth weight (LBW) babies, which predisposes them to have an increased risk of infections, hypoglycemia, and hypothermia 22. Globally, prematurity is one of the leading causes of neonatal deaths 23, 24. Prevention and management of prematurity are crucial to reducing

Prematurity remains the leading cause of neonatal morbidity and mortality, accounting for 60 to 80% of deaths in live born infants without congenital malformations. Up to 10% of surviving newborns at very low birth weight (<25mm at 24 weeks was associated with an increased risk of preterm birth . (Goldenberg et al, 1996).

Things have been developed such as suction equipment, bag-and-mask equipment, intubation systems; umbilical vessel catheterization supplies (Kattwinkel & Bloom, 2011). It has been proven that if the baby is born pre-term there is a higher chance that some type of resuscitation will be needed (Kattwinkel & Bloom, 2011). The resuscitation of babies at birth is a lot different from resuscitating any other age, at birth a baby goes from two extremes within a matter of moments, one being from a fetus with lungs filled with fluid whose respiratory function is carried out by the placenta, to the second one being a new born baby whose lungs are filled with air and can successfully take over these functions itself (Kattwinkel & Bloom,