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Improving the quality of care for preterm infants in the golden hour
Nalina Amuji1, Shashidhar Appaji Rao1, Prashantha Yemmethimmanahalli Nagaraju1
1Neonatology, St John's Medical College Hospital, Bangalore, Karnataka, India.
Insights
Improving care during the first hour after birth for preterm neonates significantly reduced hypothermia and hypoglycemia. This quality improvement initiative also expedited the administration of vital treatments, improving outcomes for premature infants.
Area of Science:
- Neonatal Intensive Care
- Pediatric Quality Improvement
- Perinatal Medicine
Background:
- The initial hour post-birth is critical for preterm neonates (<34 weeks gestation), influencing short- and long-term health.
- Current care practices during this "golden hour" lack standardization, leading to variable quality.
Purpose of the Study:
- To enhance the quality of immediate postnatal care for neonates born before 34 weeks of gestation.
- Implement evidence-based interventions to standardize and improve "golden hour" care.
Main Methods:
- A 28-month quality improvement project in a tertiary care hospital utilized Plan-Do-Study-Act cycles.
- Interventions focused on improving admission temperature, respiratory support, parenteral nutrition, and antibiotic timing.
- Clinical outcomes were monitored to assess the impact of implemented changes.
Main Results:
- Significant reduction in admission hypothermia (79% to 22%) and hypoglycemia.
- Improved adherence to respiratory care protocols (13% to 77%).
- Decreased time for parenteral nutrition and antibiotic administration, and faster admission to the Neonatal Intensive Care Unit (NICU).
Conclusions:
- The quality improvement initiative successfully enhanced "golden hour" care for preterm neonates.
- Key improvements included reduced hypothermia and hypoglycemia, and more timely interventions.
- Standardized care in the first hour positively impacts critical care delivery and neonatal outcomes.
Background:
The quality of care provided during the first golden hour after birth in preterm neonates significantly impacts both short- and long-term outcomes. However, implementation of these care processes varies across centres, is not standardised and affects the quality of care.
Aim:
To improve the quality of care provided during the first golden hour in neonates born at <34 weeks' gestation.
Methods:
This quality improvement initiative was conducted in a 30-bedded tertiary care teaching hospital in southern India over 28 months (April 2019-July 2021). Evidence-based interventions to improve admission temperature, respiratory care and administering parenteral nutrition and antibiotics during the golden hour were implemented through Plan-Do-Study-Act cycles in four phases for eligible neonates. The effect of these practice changes on clinical outcomes, including intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and survival ratewere studied.
Results:
A total of 311 eligible neonates were included in the study. Admission hypothermia significantly reduced from 79% to 22% (p=0.003), and adherence to the respiratory bundle improved from 13% to 77% (p<0.001). The time taken for administration of parenteral nutrition improved from 102±23 min to 62.5±26.7 min (mean±SD) (p<0.001). The median time for administration of antibiotics improved from 162 (135, 173) min to 74 (69, 102) min (median±IQR) (p=0.001) and improvement in mean blood glucose from 35 (12) mg/dL to 54 (14) mg/dL (mean±SD) (p<0.001) at neonatal intensive care unit (NICU) admission, and admission time to NICU from 66.4±16 min to 41±13.8 min (p<0.001).
Conclusion:
Quality improvement project of improving care in the golden hour after birth in < 34 weeks neonates reduces admission hypothermia and hypoglycaemia and improves the time of admission to NICU, and time of administration of parenteral nutrition and antibiotics.
