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Implementation of a Golden Hour protocol for initial management of preterm infants: a quality improvement study
Sarah Dénes1,2, Estelle Stockis2, Vincent Rigo1,2
1Neonatology Division, University Hospital of Liège, Belgium.
Insights
The Golden Hour protocol improved thermal regulation and team efficiency in preterm infants, leading to better outcomes without increasing risks. This approach enhances care for premature newborns and supports teamwork.
Area of Science:
- Neonatal Intensive Care
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Preterm infants (<31 weeks gestational age/estimated fetal weight <1300g) require specialized management in their first hour of life.
- Organizational efficiency, thermal regulation, and hypoglycemia prevention are critical for improving outcomes in extremely premature neonates.
- Existing care protocols may not fully address the complex needs of these vulnerable infants during the immediate postnatal period.
Purpose of the Study:
- To implement and evaluate a systematic "Golden Hour" (GH) protocol for managing preterm infants (<31 wGA and/or <1300g EFW) during their first hour of life.
- To assess the impact of the GH protocol on organizational efficiency, thermal regulation, and hypoglycemia prevention.
- To secondarily evaluate clinical outcomes and team perception following the implementation of the GH protocol.
Main Methods:
- Prospective observational study comparing a GH protocol group (n=77) with a retrospective control cohort (n=72) in a tertiary NICU.
- The GH protocol focused on anticipation, role assignment, and early interventions like umbilical venous catheterization (UVC) and parenteral nutrition (PN) initiation.
- Outcomes measured included procedural metrics (time to incubator closure, UVC placement), clinical outcomes (hypothermia, hypoglycemia, mortality, comorbidities), and team perception via survey.
Main Results:
- GH infants showed significantly less hypothermia (23/77 vs. 36/72, p=0.03) and earlier first blood glucose evaluation (43 vs. 63 min, p<0.001).
- Median incubator closure time was 64 minutes, approaching the 60-minute GH target.
- Rates of hypoglycemia, mortality, and major prematurity comorbidities were similar between groups; team members reported improved anticipation, communication, and job satisfaction.
Conclusions:
- The Golden Hour protocol effectively improved thermal regulation and team efficiency in the management of extremely preterm infants.
- The protocol did not negatively impact key clinical outcomes, suggesting a safe and beneficial approach.
- Positive effects on teamwork warrant further investigation in larger studies to confirm broader clinical benefits.
Purpose:
This study implemented and evaluated a systematic approach for managing preterm infants <31 weeks of gestational age (wGA) and/or estimated fetal weight (EFW)<1300 g during their first hour of life. The primary focus was organizational efficiency, thermal regulation, and hypoglycemia prevention, with secondary assessment of clinical outcomes and team perception.
Methods:
A prospective observational study was conducted from January 2022 to July 2023 in a tertiary neonatal intensive care unit (NICU). Infants meeting inclusion criteria were compared with a retrospective 2019 control cohort. The Golden Hour (GH) protocol emphasized anticipation, role assignment, and early interventions, including umbilical venous catheterization (UVC), and parenteral nutrition (PN) initiation. Outcomes included procedural metrics (e.g., time to incubator closure, UVC placement) and clinical outcomes (e.g., hypothermia, hypoglycemia, mortality, and major comorbidities of prematurity). Team perception was assessed via survey.
Results:
77 infants were included in the GH group and 72 infants in a retrospective control group. GH infants experienced less hypothermia (23/77 vs. 36/72 -p = 0.03) and first blood glycemia evaluation was significantly earlier [43 (35-50) vs. 63 (53-77) min -p < 0.001]. The median incubator closure time was 64 (58-71) min, close to the GH target of 60 min. Rates of hypoglycemia, mortality, and major comorbidities of prematurity (e.g., bronchopulmonary dysplasia, necrotizing enterocolitis) were similar between groups. Team members reported improved anticipation, communication, and job satisfaction following protocol implementation.
Conclusion:
The GH protocol improved thermal regulation and team efficiency without altering clinical outcomes. Its positive effect on teamwork supports further evaluation in larger studies.
