Factors associated with rates and durations of cord clamping practice compliance in preterm neonates of <33 weeks’ gestation

ObjectivesTo determine maternal, neonatal, and hospital factors influencing deferred cord clamping (DCC) compliance rates in preterm neonates.MethodsNeonates born <33 weeks’ gestational age (GA) within the Neonatal Intensive Care Units of Canadian Neonatal Network during 2018–2022 were included. Units’ DCC quality improvement (QI) efforts were surveyed. The factors were stratified by <15 seconds (s) immediate cord clamping, 15–59 s early cord clamping, or ≥60 s DCC.ResultsOf 16,217 eligible neonates, only 45% received DCC ≥ 60 s. Maternal hypertension and antenatal steroid was asscoiated with higher DCC rates. Cesarean delivery (aOR 0.39, 95% CI 0.33–0.47), <26 weeks GA (aOR 0.25, 95% CI 0.21–0.30), and small-for-gestational-age status had lower DCC odds. Singleton birth, preterm labor, and fetal indications for delivery increased DCC likelihood. Hospital size and QI efforts did not impact DCC compliance.ConclusionExtreme preterm neonates or cesarean delivery are actionable QI targets to improve DCC compliance and neonatal outcomes.