Neonatal Golden Hour: a review of current best practices and available evidence

Abstract

Purpose of reviewRecommendations made by several scientific bodies advocate for adoption of evidence-based interventions during the first 60 min of postnatal life, also known as the ‘Golden Hour’, to better support the fetal-to-neonatal transition. Implementation of a Golden Hour protocol leads to improved short-term and long-term outcomes, especially in extremely premature and extreme low-birth-weight (ELBW) neonates. Unfortunately, several recent surveys have highlighted persistent variability in the care provided to this vulnerable population in the first hour of life.Recent findingsSince its first adoption in the neonatal ICU (NICU) in 2009, published literature shows a consistent benefit in establishing a Golden Hour protocol. Improved short-term outcomes are reported, including reductions in hypothermia and hypoglycemia, efficiency in establishing intravenous access, and timely initiation of fluids and medications. Additionally, long-term outcomes report decreased risk for bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP).SummaryCritical to the success and sustainability of any Golden Hour initiative is recognition of the continuous educational process involving multidisciplinary team collaboration to ensure coordination between providers in the delivery room and beyond. Standardization of practices in the care of extremely premature neonates during the first hour of life leads to improved outcomes.Video Abstracthttp://links.lww.com/MOP/A68.

Elaboration and implementation of a protocol for the Golden Hour of premature newborns using an Implementation Science lens

“…A research study conducted in two Brazilian hospitals verified successful results in preventing hypothermia in very low birth weight preterm infants, using standardization of care in the delivery room and team training ( 7 ) . International studies report improvements in PTNB glycaemic and temperature control after implementation of the Golden Hour Protocol ( 3 - 6 , 10 , 23 ) , supporting the results of this study.…”

“…When evaluating the implementation, training was the main cited facilitator, while team adherence, mainly from other sectors, and lack of knowledge were the most cited barriers. The need for continuous training of the professionals, with the involvement of the multi-professional teams, was also mentioned in other studies as a facilitating component, capable of promoting active participation in processes and avoiding decline of the proposal (10,23,25) .…”

“…National and international research studies indicate that postpartum hypothermia poses a risk to the vitality of PTNBs and that it is a predictive factor of morbidity and mortality, regardless of gestational age. Heat loss cannot be overcome by heat production, mainly in premature infants, and the team must carry out interventions for thermal control while caring for the PTNB ( 4 , 6 , 22 - 23 ) .…”

“…Corroborating our findings, two international studies also found a prolonged time to obtain venous access, administration of fluids and antibiotics, routine use of umbilical catheter, and low use of peripheral venous catheter ( 3 , 5 ) . Considering the recommendation of peripheral venous access and subsequent umbilical catheterization to prevent hypoglycemia related to the delay in fluid supply ( 1 , 23 ) , the team adopted this approach in the protocol.…”

Hierarchical Predictors of Mortality in Neonatal Sepsis at Jimma Medical Center, Ethiopia: A Case–Control Study

“…The weaker immune systems, reduced fat stores, limited protective barriers as well as the lack of neonatal golden hour protocol and early initiation of breastfeeding make these infants more vulnerable to sepsis and its adverse effects. 32 , 38 …”