726 - Provider Perceptions Regarding Collection of Umbilical Cord Blood Gases

Publication Number: 1703.726

Isabella Eiler, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Jessica Chung, Medical College of Wisconsin, Milwaukee, WI, United States; Susan Cohen, CW HOPE Developmental Follow Up Clinic, Milwaukee, WI, United States; Avantika Singh, Medical College of Wisconsin, Milwaukee, WI, United States; Brock E.. Polnaszek, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Umbilical cord blood gas (UCBG) sampling is a valuable tool for assessing neonatal status and guiding postnatal management. Despite clinical utility for high-risk deliveries, no standardized guidelines or criteria exist resulting in inconsistent implementation. At a level IV delivery hospital in Milwaukee, WI, missed opportunities for neurologic assessments due to absent UCBG sampling prompted a quality improvement effort initiative for NICU-attended deliveries.

Objective: To examine provider perceptions of delivery factors prompting UCBG sampling and identify barriers leading to practice variability in the absence of standardized guidelines.

Design/Methods: An eight-question REDCap survey was distributed at a single center to obstetric and neonatology providers. Questions assessed provider certainty in identifying deliveries requiring UCBG sampling, perceived delivery factors that indicate collection, and barriers to consistent implementation. Quantitative responses were analyzed by provider group while qualitative responses were analyzed thematically.

Results: Overall, 82 providers completed the survey with notable differences in roles between obstetricians and neonatology providers (Table 1). Obstetricians were more likely to report no uncertainty in determining which deliveries required UCBG sampling (79% versus 51%, p = 0.01), while most providers agreed that ACOG/SMFM should establish standardized criteria for collection (Table 2). Nearly all providers identified delivery factors such as placental abruption, category III fetal heart tracings, and cesarean section for non-reassuring fetal status as clear indications for UCBG sampling. The minority of providers, regardless of specialty affiliation, supported universal UCBG sampling. Thematic analysis revealed role ambiguity between groups, inconsistent technical proficiency, communication gaps, and limited education or feedback on UCBG processes as on-going barriers (Figure 1).

Conclusion(s): In the absence of national guidelines, variability in provider perceptions and practice persists despite targeted, multidisciplinary QI initiatives. Establishing standardized criteria for UCBG sampling through national organizations such as ACOG and SMFM could reduce institutional variation, define provider responsibility, and promote more consistent neonatal assessments after high-risk deliveries.

Table 1: Survey Respondent Demographics
p-value calculated through chi-square analysis.

Table 2: Survey Responses Stratified by Provider Specialty
Abbreviations: UCBG- Umbilical Cord Blood Gas; ACOG- American College of Obstetricians and Gynecologists; SMFM- Society for Maternal Fetal Medicine; FHT- Fetal Heart Tracing; NRFHT- Non-Reassuring Fetal Heart Tracing. p-value calculated with Pearson's chi-square test with Yates continuity correction when all expected cell counts were ≥5. For comparisons involving small cell sizes (expected counts <5 or zero values), the Fisher's exact test was applied to ensure accurate estimation of significance levels. All p-values were two-tailed, with p < 0.05 considered statistically significant.

Figure 1: Identified Themes for Barriers to UCBG Collection