The Golden Hour: Care of the LBW Infant During the First Hour of Life One Unit’s Experience

Reynolds, Regina D; Pilcher, Jobeth; Ring, Ashley; Johnson, Russell; McKinley, Pamela

doi:10.1891/0730-0832.28.4.211

Cited by 60 publications

(49 citation statements)

References 34 publications

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“…40,41 Using GRN, it should also be possible to set the duration of the post-asphyxia P O 2 overshoot to enhance brain oxygenation immediately after birth. 42,43…”

Section: Introductionmentioning

confidence: 99%

Endogenous responses in brain pH andP_O2in a rodent model of birth asphyxia

Puskarjov

Kaila

et al. 2019

Preprint

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Aim:To study brain-sparing physiological responses in a rodent model of birth asphyxia which reproduces the asphyxia-defining systemic hypoxia and hypercapnia.Methods: Steady or intermittent asphyxia was induced for 15-45 min in anesthetized 6 and 11 days old rats and neonatal guinea pigs using gases containing 5% or 9% O2 plus 20% CO2 (in N2).Hypoxia and hypercapnia were induced with low O2 and high CO2, respectively. Oxygen partial pressure (PO2) and pH were measured with microsensors within the brain and subcutaneous ("body") tissue. Blood lactate was measured after asphyxia.Results: Brain and body PO2 fell to apparent zero with little recovery during 5% O2 asphyxia and 5% or 9% O2 hypoxia, and increased more than twofold during 20% CO2 hypercapnia. Unlike body PO2, brain PO2 recovered rapidly to control after a transient fall (rat), or was slightly higher than control (guinea pig) during 9% O2 asphyxia. Asphyxia (5% O2) induced a respiratory acidosis paralleled by a progressive metabolic (lact)acidosis that was much smaller within than outside the brain. Hypoxia (5% O2) produced brain-confined alkalosis. Hypercapnia outlasting asphyxia suppressed pH recovery and prolonged the post-asphyxia PO2 overshoot. All pH changes were accompanied by consistent shifts in the blood-brain barrier potential. Conclusion:Regardless of brain maturation stage, hypercapnia can restore brain PO2 and protect the brain against metabolic acidosis despite compromised oxygen availability during asphyxia. This effect extends to recovery phase if normocapnia is restored slowly, and it is absent during hypoxia, demonstrating that exposure to hypoxia does not mimic asphyxia.

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“…40,41 Using GRN, it should also be possible to set the duration of the post-asphyxia P O 2 overshoot to enhance brain oxygenation immediately after birth. 42,43…”

Section: Introductionmentioning

confidence: 99%

Endogenous responses in brain pH andP_O2in a rodent model of birth asphyxia

Puskarjov

Kaila

et al. 2019

Preprint

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“…Studies have demonstrated that standardized scripts can lead to improvements in care and outcomes. In 2009, Reynolds et al demonstrated that use of resuscitation checklists, videotaped simulations and team debriefing sessions resulted in improvements in rates of chronic lung disease, intraventricular hemorrhage and retinopathy of prematurity [37].…”

Section: Delivery Room Considerationsmentioning

confidence: 99%

“…One of the most successful interventions is to increase the ambient temperature of the delivery room or operating room to 77-78.8°F (25-26°C) before the delivery occurs [71,72]. Some authors have described success by increasing the delivery room temperature to 80°F [37]. Since very preterm and very low birthweight infants are at increased risk of hypothermia, various risk-minimization strategies may be needed, including: covering the infant with heat-resistant plastic wrap, covering the infant's head with a cap, use of exothermic mattresses, stabilization under a radiant warmer, and the use of warmed, humidified resuscitation gases [58,73].…”

Section: Strategies To Maintain a Thermoneutral Environmentmentioning

confidence: 99%

“…Level III/IV centers also should provide leadership and support for regional hospitals and nurseries that make up their referral base, and it is our hope that this publication can be used as a means of enhancing the flow of information to that end [94][95][96]. Strategies such as the use of checklists, collaboration/teamwork, consistent approach to care, minimizing variation, [37,97] simulation-based learning with debriefing; [37] development of steps and checklist in Golden Hour protocol, [85] immediate skin to skin in eligible infant [98] have been described in literature to be effective in providing the caregivers ability to remain organized, aware of time management and provide effective Golden Hour resuscitation measures.…”

Section: Quality Improvement and Sustained Outcomesmentioning

confidence: 99%

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Golden Hours: An Approach to Postnatal Stabilization and Improving Outcomes

Fathi¹,

Bapat²,

Shepherd³

et al. 2019

Neonatal Medicine

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The "Golden Hour" model of care originated in adult trauma medicine. Recently, this concept has been applied to premature neonates and the care they receive immediately after birth. This is not limited to the first hour of life, however, as this approach encompasses the first hours and days after birth. While no universal description defines the Golden Hour model, critical domains include initial delivery room management, thermoregulation, ventilation and oxygenation, glycemic control and prevention of infection. Strong evidence favors standardization of care to improve short-and long-term outcomes. This approach to care for the most at-risk premature infant is typically institution-specific; thus, team-building and quality improvement are critical to the care of these vulnerable patients.

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“…Throughout various fields of scientific investigation, including neonatology and trauma medicine, the idea of the golden hour of treatment has long been debated (1)(2)(3). Defined as an interval most critical for successful emergency treatment and improved patient outcomes, the golden hour(s) is contingent on the delivery of early and frequently, protocol-driven care.…”

mentioning

confidence: 99%

The Golden Hours of AKI

Koyner¹

2015

Clinical Journal of the American Society of Nephrology

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Throughout various fields of scientific investigation, including neonatology and trauma medicine, the idea of the golden hour of treatment has long been debated (1-3). Defined as an interval most critical for successful emergency treatment and improved patient outcomes, the golden hour(s) is contingent on the delivery of early and frequently, protocol-driven care. Although advances in medicine have improved outcomes in these fields, the concept of the golden hour remains loosely applied and increasingly investigated in the setting of AKI. With recent advances in critical care nephrology, including consensus definitions, improved risk stratification, and biomarkers, intensivists and nephrologists are ideally positioned to investigate how best to improve patient outcomes and decrease the severity of renal damage in the golden hours of early AKI (4-6).In the past, AKI research has focused on the earlier identification of AKI before the rise in serum creatinine or drop in urine output (7,8). Recently, investigators have shifted their focus beyond simply replacing serum creatinine with a new gold standard and have sought to augment the information provided by serum creatinine and urine output, combining them with biochemical biomarkers, functional assessment of urine-making capacity, or both (9-11). Although these studies and others have shown that functional and damage biomarkers with physiologic links to the kidney are useful tools in predicting the risk of progression of early AKI, they were part of observational studies and require additional investigation.Additionally, an increasing number of controlled trials has shown efficacy when attempting to prevent severe AKI. Judicious intravenous fluid selection of nonhyperchloremic solutions (12) and remote ischemic preconditioning (13) showed renoprotective effects, which decreased the incidence of severe AKI (regardless of the need for RRT). Similarly, a meta-analysis investigating perioperative hemodynamic optimization, Brienza et al. (14) showed that trials targeting both supranormal and normal hemodynamic targets decreased the risk of postoperative AKI. However, not every controlled trial targeting hemodynamics parameters has shown a clinical benefit in preventing AKI. Two recent large-scale multicenter investigations of resuscitation protocols in the setting of severe sepsis and septic shock showed relatively low severe AKI event rates (2.8%-13.5%) and no difference in the duration of treatment in those requiring RRT (15,16). Although the ideal resuscitation strategy, intravenous fluid selection, and hemodynamic parameters to prevent the development of AKI continue to take shape, much less is known about how best to treat and optimize the patient just entering the golden hours that follow a new diagnosis of AKI.For those with newly diagnosed AKI, there is a dearth of proven interventions to prevent AKI progression. Data surrounding the use of automated, electronic medical record alerts for those with new-onset AKI seemed promising at first (17,18), but when pati...

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The Golden Hour: Care of the LBW Infant During the First Hour of Life One Unit’s Experience

Cited by 60 publications

References 34 publications

Endogenous responses in brain pH andP_O2in a rodent model of birth asphyxia

Endogenous responses in brain pH andP_O2in a rodent model of birth asphyxia

Golden Hours: An Approach to Postnatal Stabilization and Improving Outcomes

The Golden Hours of AKI

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The Golden Hour: Care of the LBW Infant During the First Hour of Life One Unit’s Experience

Cited by 60 publications

References 34 publications

Endogenous responses in brain pH andPO2in a rodent model of birth asphyxia

Endogenous responses in brain pH andPO2in a rodent model of birth asphyxia

Golden Hours: An Approach to Postnatal Stabilization and Improving Outcomes

The Golden Hours of AKI

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Product

Resources

About

Endogenous responses in brain pH andP_O2in a rodent model of birth asphyxia

Endogenous responses in brain pH andP_O2in a rodent model of birth asphyxia