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Neonatal Golden Hour: a review of current best practices and available evidence
Michelle Lamary1, C Briana Bertoni2, Kathleen Schwabenbauer2
1Division of Newborn Medicine, UPMC Magee-Womens Hospital.
Insights
Implementing the Golden Hour protocol in neonatal intensive care units (NICUs) improves outcomes for premature infants. Standardization and multidisciplinary collaboration are key to its success.
Area of Science:
- Neonatal Medicine
- Evidence-Based Practice
Background:
- Scientific bodies recommend evidence-based interventions during the first hour after birth (Golden Hour) to support fetal-to-neonatal transition.
- Golden Hour protocols improve outcomes, particularly for extremely premature and low-birth-weight neonates, yet care variability persists.
Approach:
- Review of published literature since 2009 on Golden Hour protocol implementation in Neonatal Intensive Care Units (NICUs).
- Analysis of reported short-term and long-term outcomes associated with Golden Hour protocols.
Key Points:
- Consistent benefits observed, including reduced hypothermia and hypoglycemia.
- Improved efficiency in IV access and timely medication/fluid administration.
- Decreased incidence of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP).
Conclusions:
- Multidisciplinary team collaboration and continuous education are crucial for successful Golden Hour initiatives.
- Standardized care practices for extremely premature neonates in the first hour lead to better outcomes.
Purpose Of Review:
Recommendations 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 Findings:
Since 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).
Summary:
Critical 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 Abstract:
http://links.lww.com/MOP/A68 .
