Golden Hour Protocol for Preterm Infants

Abstract

Background: Preterm infants are a vulnerable patient population, especially during the first hours of life. Hypothermia, hypoglycemia, and early-onset sepsis are common problems related to prematurity. Implementation of a Golden Hour protocol has been shown to improve outcomes for preterm infants. Purpose: To evaluate the effectiveness of a Golden Hour protocol for infants born at less than 32 weeks' gestation on improving the admission process in a military care facility. Specific aims focused on temperature, time to initiation of intravenous (IV) fluids, time to administration of antibiotics, and time to close of the incubator top. Methods: A pre-/postdesign was used to compare outcomes from preimplementation to postimplementation. Predata were collected using electronic health record chart review and postdata were collected from the Neonatal Intensive Care Unit admission worksheet. Results: Although we did not find statistical significance, we found that more infants had a temperature greater than 36.5°C within 1 hour of birth and decrease in time to initiation of IV fluids and antibiotics from preimplementation to postimplementation, which is clinically significant. Time to close of the incubator top remained greater than 1 hour. Implications for Practice: Implementation of a Golden Hour protocol provides a guide to caring for preterm infants during the first hour of life to improve patient outcomes. Involvement of key stakeholders and staff education are key to successful implementation. Implications for Research: Researchers should examine long-term outcomes related to implementation of a Golden Hour protocol in future studies. Future quality improvement projects should include the effectiveness of similar protocols and address possible barriers.

The Golden Hour: a quality improvement initiative for extremely premature infants in the neonatal intensive care unit

“…Following birth, EP-ELBW infants are susceptible to rapid development of hypothermia, hypoglycemia, hypotension, and respiratory failure [1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Resuscitation in the delivery room (DR) and stabilization during admission to the neonatal intensive care unit (NICU) involves a series of interdependent tasks and procedures.…”

“…Resuscitation in the delivery room (DR) and stabilization during admission to the neonatal intensive care unit (NICU) involves a series of interdependent tasks and procedures. These interventions must be performed quickly, proficiently, and systematically to minimize the short-term sequelae of prematurity, which contribute to the risk of long-term morbidity and mortality [1,[6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…The hour immediately following the birth of an EP-ELBW infant is referred to as the "Golden Hour" (GH) [6][7][8][10][11][12][13][14][15][16][17][18]. This term denotes the period of time in which medical care to prevent irreversible damage is most effective and represents the inverse relationship between elapsing minutes and likelihood of survival.…”

“…This term denotes the period of time in which medical care to prevent irreversible damage is most effective and represents the inverse relationship between elapsing minutes and likelihood of survival. Due to the complexity of the care required at birth, protocols that bundle evidence-based practices and standardize their application to the first few minutes after birth have been used to improve the quality and consistency of care for EP-ELBW infants during the GH [6][7][8][10][11][12][13][14][15][16][17][18].…”

Health-related quality of life of premature infants at 2 years in relation to breastfeeding and maternal emotional state: a retrospective cohort study

“…Considering our findings, we find it important to help mothers during the early days of motherhood regarding breastfeeding. Moreover, implementing interventions like the 'golden hour' protocol or the Kangaroo care after childbirth are also vital, since the early hours in life and skin-to-skin contact are critical in the later development of attachment (Harriman, 2018) and quality of life. Furthermore, it may also have an impact on the maternal mental health.…”