(1122) A Quality Improvement Initiative to Standardize Cord Blood Gas Collection for High-Risk Deliveries

Objective:
Umbilical cord gases are often essential for guiding neonatal management, yet national and international guidance about when and how to obtain this blood test remains variable. We aimed to improve cord gas collection rates in NICU-attended deliveries, due to their inherent higher risk factors, with overall collection assessed as a secondary outcome.

Study Design:
At a tertiary academic center, a multidisciplinary quality improvement (QI) initiative was implemented in December 2024 to standardize umbilical cord blood gas collection. Interventions included clinician education, training on processing and measuring, as well as audit and feedback cycles. Monthly cord gas collection metrics were tracked from September 2024 to July 2025 and are on-going. Pre-implementation (Sep–Nov 2024) and post-implementation (Dec 2024–Jul 2025) rates were compared using independent t-tests.

Results:
Cord gas collection in NICU-attended deliveries increased from 51% to 92% between pre- and post-implementation periods (p < 0.001). Overall collection rates rose from 29% to 55% reflecting a 25.8-point improvement (p < 0.001) (Table and Figure 1). We saw a rapid improvement sustained across eight months, and it was accompanied by strong stakeholder buy-in. Improvements were quick, sustained across eight months, and accompanied by positive interdisciplinary feedback.

Conclusion:
This QI project significantly and sustainably improved cord gas collection in high-risk deliveries. These findings directly support the 2025 American Academy of Pediatrics recommendation to use postnatal cord blood sampling in neonates requiring admission and demonstrate how obstetric-led implementation can be synergistic with neonatology priorities.