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Golden hour(s) quality improvement protocols and their effect on outcomes in preterm infants ≤ 32 weeks of gestation:
Leonore M C Wever1, Vilya Nous2, Marije Hogeveen2
1Department of Pediatrics and Neonatology, UZ Brussel, Brussels, Belgium. Leonore.Wever@vub.be.
Insights
Golden Hour (GH) protocols for preterm infants improve survival and reduce complications. However, variations in protocol components and outcomes necessitate standardized guidelines for optimal neonatal care.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Evidence-Based Practice
Background:
- Prematurity is a leading global cause of mortality in children under five.
- The initial hours post-birth (Golden Hours) are critical for preterm infant stabilization and impact long-term outcomes.
- Existing Golden Hour protocols show variability in components and reported results.
Purpose of the Study:
- To systematically review Golden Hour (GH) protocols for preterm infants.
- Identify common elements, implementation variations, and clinical outcomes associated with GH protocols.
- Inform best practices and highlight knowledge gaps in GH protocol implementation.
Main Methods:
- Systematic review following JBI and PRISMA-ScR guidelines.
- Three-step search strategy including database and reference screening.
- Data extraction on study characteristics, GH protocol components, and outcomes; quality assessed using QI-MQCS checklist.
Main Results:
- 34 studies included preterm infants (24.4-30.2 weeks GA).
- Common GH protocol elements included respiratory support, cardiovascular support, thermoregulation, and team-based interventions.
- GH protocols were associated with reduced mortality, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, and increased delayed cord clamping.
Conclusions:
- GH protocols show benefits for preterm infant morbidity and mortality but exhibit significant variability.
- Differences in populations, resources, and methods limit cross-study comparisons.
- Standardized guidelines and outcome measures are crucial for refining GH protocols and improving neonatal outcomes.
Objective:
Prematurity is the leading cause of under-five mortality worldwide. The first hours after birth (Golden Hours, GH), are critical for preterm infants, as early interventions impact morbidity and mortality. While GH-protocols aim to optimize stabilization and NICU admission, their components and outcomes vary. This study systematically reviews GH-protocols to identify common elements, implementation differences, and clinical outcomes, informing best practices and highlighting knowledge gaps.
Study Design:
JBI and PRISMA-ScR guidelines were followed to map GH-protocol content and outcomes for preterm infants. Three-step search strategy included database searches and reference screening. Two reviewers extracted data on study characteristics, GH-protocol components, and outcomes. Study quality was assessed using the QI-MQCS checklist.
Results:
Of 2,656 records, 34 studies were included, mostly from the USA (n=17). Infants had gestational ages from 24.4-30.2 weeks, and birth weights from 670-1,418 grams. GH-protocol content varied, with respiratory support (31/34 studies), cardiovascular support (26/34), thermoregulation (24/34), and team-based interventions (24/34) being most common. Improved protocol adherence was reported, yielding decreased mechanical ventilation, and quicker GH completion. Clinical outcomes showed improvements in mortality, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis. Additionally, 7/9 studies observed significant increase in delayed cord clamping.
Conclusion:
GH-protocols for preterm infants demonstrate beneficial effects on morbidity and mortality, yet exhibit variability. Differences in populations, hospital resources, and methodologies hinder cross-study comparisons. Standardized guidelines and outcome measures are needed to refine GH-protocols and identify effective interventions. Future research should evaluate short- and long-term effects of GH-protocols across diverse healthcare settings to enhance neonatal outcomes.
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