6422 Could neonatal polycythaemia be a consequence of prolonged delayed cord clamping in neonates?

Objectives British association of Perinatal medicine (BAPM) recommends optimal cord management in all preterm babies 1Royal College of Obstertrics and Gynaecology (RCOG) recommends deferred cord clamping as part of active management of 3rd stage of labour. 2 WHO recommends cord clamping after the pulsations after stopped between 1–3 mins3 without any GA restrictions. Proponents of physiological-based cord clamping oppose specified time-based cord clamping and favour a baby-led approach, where the timing is determined by the behaviour and onset of spontaneous respiration of the baby as well as cessation of cord pulsations, hence the timing of delayed cord clamping has varied among midwives. The objective of the audit was to identify the timings of delayed cord clamping in babies >34 weeks with polycythaemia and standardize our practice of delayed cord clamping. Methods We identified babies admitted to the NICU with polycythaemia in our hospital over the last 5 years. We sourced data from badger records and documentation in the patients' notes. A proforma was used for data collection and data collected included gestational age, risk factors for polycythaemia, timing of DCC, duration of hospitalization, identified symptoms and complications. The data were later analyzed. Results There were a total of 31 babies admitted to the NICU with polycythaemia over a 5-year period. Average duration of stay was 7 days and average time to resolution of polycythaemia was 56 hours. Twenty-seven (87%) of them had DCC but 14 (45%) of them had DCC as the only identifiable risk factor for polycythemia. The duration of DCC ranged between 40 seconds and 14 minutes. The mean haematocrit level increased with the duration of DCC with the highest mean haematocrit of 74. 3 in babies with DCC > 5 minutes. The commonest complication was jaundice with two of them needing partial exchange transfusion. Conclusion A significant number of babies admitted to NICU with polycythaemia had DCC at birth. There is a variation in the practice of DCC. The longer the duration of DCC, the higher the Haematocrit levels. References BAPM. Optimal cord management in preterm babies – a quality improvement toolkit 2020. RCOG. Clamping of the Umbilical Cord and Placental Transfusion. https: //www. google. com/url? sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwizxbaLlZqCAxX-VkEAHZTpBMYQFnoECBsQAQ&url=https%3A%2F%2Fwww. rcog. org. uk%2Fmedia%2Fahppgoek%2Fsip-14. pdf&usg=AOvVaw2tlSgKGmU91c3GpPil22Tk&opi=89978449 WHO Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes Geneva. 9789241508209ₑng. pdf (who. int).