The Golden Hour: a quality improvement initiative for extremely premature infants in the neonatal intensive care unit

Croop, Sarah E. W.; Thoyre, Suzanne M.; Aliaga, Sofia; McCaffrey, Martin J.; Peter-Wohl, Sigal

doi:10.1038/s41372-019-0545-0

Cited by 35 publications

(81 citation statements)

References 31 publications

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“…A low 5-min Apgar score and intubation at DR may be associated with increased resuscitation efforts, an increased resuscitation time and inadequate thermal measures [8,33]. Therefore, heat preservation measures should be included in the management of premature infant resuscitation and the "golden hour" after birth [34].…”

Section: Discussionmentioning

confidence: 99%

Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study

Wang

Huang

et al. 2020

BMC Pediatr

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Background: The objective of this prospective, multicentre, observational cohort study was to evaluate the association between admission hypothermia and neonatal outcomes in very low-birth weight (VLBW) infants in multiple neonatal intensive care units (NICUs) in China. Methods: Since January 1, 2018, a neonatal homogeneous cooperative research platform-Shandong Neonatal Network (SNN) has been established. The platform collects clinical data in a prospective manner on preterm infants with birth weights (BWs) < 1500 g and gestational ages (GAs) < 34 weeks born in 28 NICUs in Shandong Province. These infants were divided into normothermia, mild or moderate/severe hypothermia groups according to the World Health Organization (WHO) classifications of hypothermia. Associations between outcomes and hypothermia were tested in a bivariate analysis, followed by a logistic regression analysis.

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Section: Discussionmentioning

confidence: 99%

Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study

Wang

Huang

et al. 2020

BMC Pediatr

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“…A low 5-min Apgar score and intubation at DR may be associated with increased resuscitation efforts, an increased resuscitation time and inadequate thermal measures [8,32]. Therefore, heat preservation measures should be included in the management of premature infant resuscitation and the "golden hour" after birth [33].…”

Section: Discussionmentioning

confidence: 99%

Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study

Wang

et al. 2020

Preprint

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Abstract Background The objective of this study was to evaluate the association between admission hypothermia and neonatal outcomes in very low-birth weight (VLBW) infants in multiple neonatal intensive care units (NICUs) in China. Methods Since January 1, 2018, a neonatal homogeneous cooperative research platform has been established. The platform collects clinical data in a prospective manner on preterm infants with birth weights (BWs)<1500 g and gestational ages (GAs)<34 weeks born in 28 NICUs in Shandong Province. These infants were divided into normothermia, mild or moderate/severe hypothermia groups according to the World Health Organization (WHO) classifications of hypothermia. Associations between outcomes and hypothermia were tested in a bivariate analysis, followed by a stepwise logistic regression analysis. Results A total of 1247 VLBW infants were included in this analysis, of which 1100 infants (88.2%) were included in the hypothermia group, 554 infants (44.4%) in the mild hypothermia group and 546 infants (43.8%) in the moderate/severe hypothermia group. Small for gestational age (SGA), caesarean section, a low Apgar score at 5 min and intubation in the delivery room (DR) were related to admission hypothermia (AH). Mortality was the lowest when their admission temperature was 36.5~37.5°C, and after adjustment for maternal and infant characteristics, mortality was significantly associated with AH. Compared with infants with normothermia (36.5~37.5°C), the adjusted ORs of all deaths increased to 4.148 (95% CI 1.505-11.437) and 1.806 (95% CI 0.651-5.009) for infants with moderate/severe hypothermia and mild hypothermia, respectively. AH was also associated with a high likelihood of respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH), and late-onset neonatal sepsis (LOS). Conclusions AH is still very high in VLBW infants in NICUs in China. SGA, caesarean section, antenatal steroid use, a low Apgar score at 5 min and intubation in the DR were associated with increased odds of hypothermia. Moderate/severe hypothermia was associated with mortality and poor outcomes, such as RDS, IVH, LOS, etc.

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“…International surveys have highlighted variation in early stabilisation practices for preterm infants, 13,14 resulting in quality improvement projects aiming to bundle and standardise Golden Hour practices, often using thermoregulation or glycaemic control as short‐term surrogates of effective early care 15,16 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

Neonatal Golden Hour: A survey of Australian and New Zealand Neonatal Network units' early stabilisation practices for very preterm infants

Hodgson

Owen

Lui

et al. 2021

J Paediatrics Child Health

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Aim To identify current ‘Golden Hour’ practices for initial stabilisation of very preterm infants <32 weeks' gestational age (GA) within tertiary neonatal intensive care units (NICUs) in the Australian and New Zealand Neonatal Network (ANZNN). Methods A 76‐question survey regarding delivery room (DR) and NICU stabilisation practices was distributed electronically to directors of tertiary perinatal NICUs in the ANZNN in January 2019. Responses were categorised into GA subgroups: 23–24, 25–27 and 28–31 weeks' GA. Results The response rate was 100% (24/24 units). Delayed cord clamping (DCC) was practised ‘always’ or ‘often’ by 21 units (88%). All units used oximetry to target oxygen saturations, and 23/24 (96%) commenced resuscitation in <40% oxygen. Ten units (42%) routinely used DR electrocardiography monitoring. CPAP was preferred as primary respiratory support in one‐third of units for infants born 23–24 weeks' GA, compared with 19 units (79%) at 25–27 weeks' GA and 23 units (96%) at 28–31 weeks' GA. DR skin‐to‐skin care was uncommon, particularly at lower GAs. Five units (21%) used minimally invasive surfactant therapy for non‐intubated infants at 23–24 weeks' GA, 13 units (54%) at 25–27 weeks' GA and 16 units (67%) at 28–31 weeks' GA. Conclusions Most Golden Hour stabilisation practices align with international guidelines. Consistency exists with respect to DCC, oxygen saturation targeting and primary CPAP use for infants 25 weeks' GA and above. Where evidence is less certain, practices vary across ANZNN NICUs. Time targets for stabilisation measures may help standardise practice for this population.

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The Golden Hour: a quality improvement initiative for extremely premature infants in the neonatal intensive care unit

Cited by 35 publications

References 31 publications

Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study

Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study

Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study

Neonatal Golden Hour: A survey of Australian and New Zealand Neonatal Network units' early stabilisation practices for very preterm infants

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