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Quality improvement programme to increase the rate of deferred cord clamping at preterm birth using the Lifestart trolley
  1. Emily Suzanne Hoyle,
  2. Sunaya Hirani,
  3. Sally Ogden,
  4. Jenna Deeming,
  5. Charles William Yoxall
  1. Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Charles William Yoxall, Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool L8 7SS, UK; bill.yoxall{at}


Aim To increase the documented use of the Lifestart trolley to allow premature infants’ (<32 weeks’ gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.

Design A 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance.

Results Documented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001).

Implications and relevance By undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.

The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.

  • neonatology
  • paediatric practice
  • resuscitation
  • evidence based medicine

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  • Contributors All authors contributed to the collection of data and analysis and review of the manuscript. Preparation of this manuscript has been the responsibility of ESH and CWY.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data taken from Badgernet only. A spreadsheet of all data collected for this project was created and, from this, tables and figures included within this manuscript were produced.

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