STUDY PROTOCOL article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1686362
Impact of Delayed Cord Clamping and Minimally Invasive Surfactant Administration on Outcomes in Premature Infants with Neonatal Respiratory Distress Syndrome at Less Than 30 Weeks Gestation: A NICU Quality Improvement Study
Provisionally accepted
- Peking University Third Hospital, Beijing, China
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Preventing early invasive mechanical ventilation (IMV) in preterm infants is critical for reducing bronchopulmonary dysplasia (BPD) and improving outcomes. While delayed cord clamping (DCC) enhances cardiopulmonary stability and minimally invasive surfactant administration (MISA) reduces IMV dependence, evidence on their combined efficacy in extremely preterm infants (<30 weeks gestation) with neonatal respiratory distress syndrome (NRDS) remains limited. We hypothesize that integrating DCC with MISA will synergistically reduce BPD incidence compared to immediate cord clamping (ICC) with either MISA or tracheal intubation-based surfactant delivery. Methods and Design: This is a single-center quality improvement study evaluating three treatment regimens for neonates with NRDS born at a gestational age of < 30 weeks:（1）Retrospective data collection of cases treated with the conventional approach of ICC + tracheal intubation between 2017 and 2020 (n=222);（2）Retrospective data collection of cases treated with ICC + MISA between 2021 and 2025 (n=222);（3）Planned collection of medical records of cases treated with DCC + MISA between 2025 and 2027 (n=74).The study aims to assess the incidence of BPD and survival outcomes associated with each regimen. Meanwhile, it will compare the short-term efficacy, safety, and long-term outcomes of these three treatment strategies, thereby providing valuable evidence for clinical treatment decision-making.
Keywords: Delayed cord clamping, minimally invasive surfactant administration, Respiratory Distress Syndrome, preterm infants, outcomes
Received: 15 Aug 2025; Accepted: 20 Oct 2025.
Copyright: © 2025 Zhang, Hui, Zhang, Li, Yan, 张, Zhang, Piao and Han. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yijia Zhang, ikakoikako@126.com
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