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Standardized Management of the First Hour of Premature Infants: A Meta-Analysis
Sophie Tribolet1, Sarah Dénes1, Vincent Rigo1
1Neonatology Division, University Hospital of Liège, Liège, Belgium.
Insights
The Golden Hour (GH) protocol for preterm infants significantly reduced hypothermia and time to IV infusion. This standardized approach improved early clinical outcomes without impacting glycemic control or mortality.
Area of Science:
- Neonatology
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Postnatal management of preterm infants significantly impacts their short, medium, and long-term clinical course.
- The Golden Hour (GH) concept aims to standardize immediate postnatal care for preterm newborns.
- Standardized care protocols are crucial for optimizing outcomes in vulnerable preterm populations.
Purpose of the Study:
- To conduct a meta-analysis evaluating the impact of the Golden Hour (GH) protocol on early clinical outcomes in preterm infants.
- To assess the effect of GH implementation on the incidence of prematurity-related comorbidities.
- To synthesize evidence from diverse study designs regarding GH effectiveness.
Main Methods:
- A comprehensive literature search was performed across major databases (PubMed, Embase, Scopus, Cochrane Library) without restrictions.
- Included studies comprised randomized, prospective, and retrospective designs comparing GH protocol implementation versus no GH protocol.
- Data extraction and eligibility assessment were conducted by two independent reviewers.
Main Results:
- Meta-analysis of 18 studies (5104 patients) revealed a significant reduction in hypothermia on admission and at 1 hour.
- GH protocol implementation led to decreased time to intravenous infusion and surfactant administration.
- A significant reduction in severe intraventricular hemorrhage was observed, with a trend towards decreased bronchopulmonary dysplasia.
Conclusions:
- The Golden Hour protocol effectively reduces hypothermia and expedites critical interventions like IV fluid administration in preterm infants.
- While GH shows benefits in reducing specific morbidities, its impact on glycemic control and overall mortality was not statistically significant.
- The certainty of evidence for these findings was graded as low to very low, highlighting the need for high-quality research.
Context:
The postnatal management of preterm infants at birth may influence their clinical course in the short, medium, and long term. The concept of the "Golden Hour" (GH) has emerged in neonatology, aiming to standardize this management.
Objective:
We conducted a meta-analysis to assess GH's impact on early clinical outcomes and on the comorbidities of prematurity.
Data Sources:
Pubmed, Embase, Scopus, and Cochrane Library were searched without any restriction.
Study Selection:
We included randomized, prospective, and retrospective studies comparing periods with and without the application of a GH protocol for preterm birth.
Data Extraction:
Two independent reviewers screened titles and abstracts and assessed full texts for eligibility.
Results:
Twelve prospective and 6 retrospective studies were included, for a total of 5104 patients. There was a significant reduction in hypothermia both on admission and at 1 hour (odds ratio [OR], 0.40 [95% CI, 0.27-0.60] and OR 0.39 [95% CI, 0.18-0.85]), with increased temperature (mean difference [MD], +0.57 °C [95% CI, 0.07-1.07]). Mean blood glucose and hypoglycemia rates on admission were not statistically affected. However, time to intravenous infusion was reduced (MD, -27.51 minutes [95% CI, -49.40 to -5.56]). There was a significantly lower rate of severe intraventricular hemorrhage (OR, 0.65 [95% CI, 0.47-0.89]) and a trend toward decreased bronchopulmonary dysplasia (OR, 0.69 [95% CI, 0.47-1.02]). Time to administration of surfactant was statistically reduced (MD, -23.6 minutes [95% CI, -42.2 to -5]). Mortality and other comorbidities of prematurity were not different.
Limitations:
Four studies were judged to be of poor quality, and certainty for evidence was graded as low or very low.
Conclusions:
The application of a GH at birth reduced the rate of hypothermia and the time required for intravenous infusion without statistically significant impact on glycemic control.
