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Quality improvement in the golden hour for premature infants: a scoping review
Lijuan Sheng1, Guichao Zhong1, Ruirui Xing1
1Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
Insights
Quality improvement (QI) measures during the golden hour significantly enhance outcomes for preterm infants, improving temperature, glucose levels, and reducing bronchopulmonary dysplasia. Further research is needed for standardized QI interventions.
Area of Science:
- Neonatal Medicine
- Pediatric Quality Improvement
- Evidence-Based Practice
Background:
- The initial hour after birth (golden hour) is critical for preterm infants.
- Quality improvement (QI) initiatives during this period can mitigate serious complications.
- Previous research supports the benefits of golden hour QI measures.
Purpose of the Study:
- To review existing studies on golden hour QI interventions.
- To evaluate the impact of these interventions on preterm infant outcomes.
Main Methods:
- A comprehensive literature search was performed across major databases (PubMed, Embase, Cochrane, SinoMed) up to April 2023.
- Included studies focused on QI interventions specifically within the golden hour for preterm infants.
- A qualitative synthesis of outcomes was conducted.
Main Results:
- Ten studies met the inclusion criteria, primarily from the USA and Israel.
- Most studies were of medium quality, employing pre-post or observational designs.
- QI interventions showed improvements in admission temperatures and glucose levels.
- A significant reduction in bronchopulmonary dysplasia (BPD) incidence was observed (OR=0.68, 95% CI 0.48-0.97).
Conclusions:
- The golden hour QI bundle positively impacts both short-term and long-term outcomes for extremely preterm infants.
- Heterogeneity and limitations in study designs necessitate standardized and validated outcome measures.
- Future research should focus on developing high-quality, replicable, and locally adaptable QI projects.
Background And Objective:
Evidence-based research has shown that golden hour quality improvement (QI) measures can improve the quality of care and reduce serious complications of premature infants. Herein, we sought to review golden hour QI studies to evaluate the impact on the outcome of preterm infants.
Methods:
A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and SinoMed databases from inception to April 03, 2023. Only studies describing QI interventions in the golden hour of preterm infants were included. Outcomes were summarized and qualitative synthesis was performed.
Results:
Ten studies were eligible for inclusion. All studies were from single centers, of which nine were conducted in the USA and one in Israel. Seven were pre-post comparative studies and three were observational studies. Most included studies were of medium quality (80%). The most common primary outcome was admission temperatures and glucose. Five studies (n = 2308) reported improvements in the admission temperature and three studies (n = 2052) reported improvements in hypoglycemia after QI. Four studies (n = 907) showed that the incidence of bronchopulmonary dysplasia (BPD) was lower in preterm infants after QI: 106/408 (26.0%) vs. 122/424(29.5%) [OR = 0.68, 95% CI 0.48-0.97, p = 0.04].
Conclusions:
Our study showed that the golden hour QI bundle can improve the short-term and long-term outcomes for extremely preterm infants. There was considerable heterogeneity and deficiencies in the included studies, and the variation in impact on outcomes suggests the need to use standardized and validated measures. Future studies are needed to develop locally appropriate, high-quality, and replicable QI projects.
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