Methods:
This review was conducted using the methodology described by Whittemore and Knaff (2015) and Brown (2018), suggested by the question, “Does delayed cord clamping help reduce the incidence of intraventricular hemorrhage in premature infants?” A systematic research of the peer-review literature was completed using the following databases: Cochrane, PubMed, CINAHL Plus, complete: Nursing Academic Edition and bibliography mining. Key words used in searching were: "delayed cord clamping", "intraventricular hemorrhage or ivh", "preterm or infant." Search Criteria was limited to articles published between the year of 2013-2018 for all databases. Inclusion criteria included studies which identified intraventricular hemorrhage as a primary or secondary outcome in preterm infants with delayed cord clamping. The original search identified a total of 66 articles. Contained within the 66 articles were 15 duplicates and 39 were excluded due to pertaining to cord milking, term infants, comparing twins, or not related to the research topic. Twelve articles were appraised using, Long & Gannaway (2015). EBR Tool, Step 2: one article was a level 6, two level 5, two level 4, one level 3, and six level 1. All articles were critically appraised using evaluated checklists and the EBR Tool (Brown, 2018; Long & Gannaway, 2015).
Results:
Premature infants who received DCC had better admission Hgb, reduced rates of late onset sepsis, higher admission blood pressure and less need for blood transfusion during their hospital stay (Bayer, 2016; Brocato et al., 2016; Chiruvolu et al., 2015; Fenton et al., 2018; Ghavam et al., 2014; Jelin et al., 2016; Kazemi et al., 2017; Vesoulissa et al., 2018). DCC provides an increase in initial blood pressure which help maintain good cardiac output without the need for volume expanders which in turn helps reduce the incidence of IVH. Studies suggest that DCC achieves an increase in blood volume that provides improved hemodynamic stability without compromising resuscitation in premature infants (Chapman et al., 2016; Ghavam et al., 2014). Maintaining higher hemoglobin levels in the newborn period improves neurodevelopmental outcome (Bayer, 2016; Brocato et al., 2016; Ghavam et al., 2014; Kazemi et al., 2017). No difference was noted in the incidence of IVH Grade 3 and 4 between DCC and immediate cord clamping groups (Jelin et al., 2016).
Conclusion:
The American College of Obstetricians and Gynecologists, American Academy of Pediatrics, World Health Organization and Neonatal Resuscitation Guidelines to DCC for 30 to 60s (Brocato et al., 2016, Chapman et al., 2016, Chiruvolu et al., 2015, Kazemi et al., 2017). Review of literature suggest that, despite studies that show benefits of DCC some still believe that DCC delays immediate resuscitation and its benefits do not outweigh the risks (Bayer, 2016; Ghavam et al., 2014). Due to premature infants increase risk for disability long-term follow up is needed to evaluate long-term benefits of DCC (Bayer, 2016; Fogarty et al., 2018). Results of the integrative research review strongly suggest that delayed cord clamping significantly reduces the incidence of intraventricular hemorrhage (Bayer, 2016; Brocato et al., 2016; Chiruvolu et al., 2015; Fenton et al., 2018; Fogarty et al., 2018; Jelin et al., 2016; Kazemi et al., 2017; Vesoulisa et al., 2018). However, research suggest that further studies are needed to determine the correct timing needed to DCC to accomplish the most benefits for preterm infants (Brocato et al., 2016; Chapman et al., 2016; Chiruvolu et al., 2015; Kazemi et al., 2017).