Thermoregulation and golden hour practices in extremely preterm infants: an international survey

Abstract

Background Are thermoregulation and golden hour practices in extremely preterm (EP) infants comparable across the world? This study aims to describe these practices for EP infants based on the neonatal intensive care unit’s (NICUs) geographic region, country’s income status and the lowest gestational age (GA) of infants resuscitated. Methods The Director of each NICU was requested to complete the e-questionnaire between February 2019 and August 2021. Results We received 848 responses, from all geographic regions and resource settings. Variations in most thermoregulation and golden hour practices were observed. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission, and having local protocols were the most consistent practices (>75%). The odds for the following practices differed in NICUs resuscitating infants from 22 to 23 weeks GA compared to those resuscitating from 24 to 25 weeks: respiratory support during resuscitation and transport, use of polyethylene plastic wrap and servo-control mode, commencing ambient humidity >80% and presence of local protocols. Conclusion Evidence-based practices on thermoregulation and golden hour stabilisation differed based on the unit’s region, country’s income status and the lowest GA of infants resuscitated. Future efforts should address reducing variation in practice and aligning practices with international guidelines. Impact A wide variation in thermoregulation and golden hour practices exists depending on the income status, geographic region and lowest gestation age of infants resuscitated. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission and having local protocols were the most consistent practices. This study provides a comprehensive description of thermoregulation and golden hour practices to allow a global comparison in the delivery of best evidence-based practice. The findings of this survey highlight a need for reducing variation in practice and aligning practices with international guidelines for a comparable health care delivery.

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

“…Following the international recommendations, the protocol elaborated in this study was organized under four main pillars: cardiopulmonary stabilization, and prevention of hypothermia, hypoglycemia and infection. Actions such as setting the ambient temperature, using a heated field, equipment for fractional oxygen supply and agility in obtaining venous access are important to meet these pillars, as observed in other studies ( 3 - 4 , 9 - 10 ) .…”

“…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 ) .…”

“…The Golden Hour strategy focuses on specific goals, developed in Neonatology ( 2 - 3 ) . The Golden Hour strategy proposes a more efficient service based on evidence, structuring multidisciplinary teamwork and effective communication; reinforcing integrated work through standardization of care and the use of clinical protocols ( 4 - 5 ) . During the Golden Hour, care team actions are carried out to effectively stabilize the health of premature newborns, via preparation for delivery, timely umbilical cord clamping, maintenance of normothermia, monitoring and provision of adequate respiratory support, transfer to the neonatal unit, vascular access and prevention of hypoglycemia, among other clinical care measures ( 3 - 5 ) .…”

Improving Golden Hour Care Coordination

“…Because of the complexity of care that needs to be delivered within the Golden Hour, many neonatal units rely on evidence-based bundles of care, based on specific needs of the unit, for example, improving admission temperatures, or reducing rates of bronchopulmonary dysplasia or intraventricular hemorrhage 12–14…”

“…10,11 Because of the complexity of care that needs to be delivered within the Golden Hour, many neonatal units rely on evidence-based bundles of care, based on specific needs of the unit, for example, improving admission temperatures, or reducing rates of bronchopulmonary dysplasia or intraventricular hemorrhage. [12][13][14] Although having the right equipment available is critical to completing a quick and effective admission, emerging research suggests that teamwork may be more important than previously suggested. 5,6,15 It is critical that all members of admission teams understand their role and operate on a shared mental model.…”