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

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Quality Improvement in Healthcare

Background:

• Extremely premature infants (<27 weeks gestation) face high risks of hypothermia and hypoglycemia post-delivery.
• Standardizing care during the first hour after birth is crucial for mitigating these neonatal morbidities.
• A multidisciplinary team developed the Golden Hour protocol to address these vulnerabilities.

Purpose of the Study:

• To implement and evaluate the effectiveness of the Golden Hour protocol.
• To reduce the incidence of hypothermia and hypoglycemia in extremely premature infants.
• To standardize evidence-based care practices during the initial hour of life for vulnerable neonates.

Main Methods:

• Quality improvement methodology was employed for protocol implementation.
• The Golden Hour protocol was applied to all inborn infants <27 weeks' gestation.
• Data collection occurred over three phases: pre-protocol, Phase I, and Phase II (2012-2017).

Main Results:

• Significant reductions in hypothermia rates were observed (59% vs 26% vs 38%; p=0.001).
• Hypoglycemia rates also decreased significantly (18% vs 7% vs 4%; p=0.012).
• Time to completion of stabilization improved, particularly in Phase II (median 92 vs 110/111 minutes; p=0.0035).

Conclusions:

• The evidence-based Golden Hour protocol is an effective intervention for extremely premature infants.
• Protocol implementation successfully reduced rates of hypothermia and hypoglycemia.
• Standardized care during the first hour post-delivery significantly benefits vulnerable neonatal populations.