6229 Maintaining excellence during change: implementing optimal cord management without compromising other perinatal outcomes

Objectives The National Neonatal Audit Programme sets a standard that 60% of babies born at less than 34 weeks gestation should have their cord clamped at or after one minute.1 Since September 2022 local Trust guidelines were introduced with the aim that all babies born at Portsmouth Hospitals University NHS Trust ≥30 weeks gestation should receive deferred cord clamping (DCC) providing there are no contraindications. We examined factors that affect the rates of DCC achieved. Secondly, we outlined the effects of DCC on neonatal morbidities. Methods The inclusion criteria were preterm infants born between the gestations of 30+0 to 33+6 weeks inclusive, from the 1st of September 2022 to the 31st of September 2023 at Portsmouth Hospitals University NHS Trust. Maternal and perinatal risk factors for failure of DCC were assessed using logistic regression. Unpaired t tests were used to compare mean admission temperatures, peak haemoglobin (Hb) and haematocrit (Hct). Chi square tests were used to compare rates of normothermia (admission temperature between 36.5–37.5°C) and need for phototherapy or blood transfusions. Results 114 infants met the inclusion criteria. Two infants were excluded due to unknown DCC status. Babies who at the time of analys is were still inpatients were excluded from the peak Hb, Hct, blood transfusion and phototherapy analysis (n=7). One baby was excluded from Hb and Hct analysis as they received a blood transfusion within the first 24 hours of life. Although higher mean Hb and Hct were observed in those who received DCC this was not statistically significant. Similarly, no differences were seen in admission temperature (p=0.33), normothermia rates (p=0.10), need for phototherapy (p=0.87) or blood transfusions (p=0.50) during admission in NICU, as shown in table 1 1. Logistic regression revealed that DCC was less likely in cases of multiple pregnancy (odds ratio of DCC vs singleton: 0.27, 95% CI 0.095–0.73, p=0.012), category 1 caesarean section (OR vs normal delivery: 0.18, CI: 0.029–0.88, p=0.045) and birth out of hours (OR vs 9am-5pm: 0.19, CI 0.073–0.48, PConclusion DCC was not associated with an increased risk of hypothermia, phototherapy, or blood transfusion. Being born out of hours, via category 1 caesarean section and multiple pregnancy were all risk factors for not having DCC conducted. Future quality improvement work will focus on understanding and overcoming these barriers to DCC. Reference National Neonatal Audit Programme (NNAP): A guide to the 2023 audit measures. Royal Society of Paediatrics and Child Health 2023.