![]() ![]() Īdaptation to extra-uterine life occurs during the early postnatal period and is a very high-risk period for premature infants, especially those born extremely preterm. Similarly, a national survey in the United Kingdom demonstrated marked variations in delivery room practice and differences persisted 1 year after publication of revised consensus guidelines. Units in the United Kingdom reported marked variations in practice between units with different designations, suggesting that either the level of care or the experience of clinical staff were factors in the quality of care delivered. identified several deviations from resuscitation guidelines, including deep oropharyngeal suctioning, excessive stimulation, poor communication of heart rate, and failure to troubleshoot during bag–mask ventilation. This is important because resuscitation teams frequently deviate from resuscitation algorithms. Standardization may be just as important as the specific clinical practice strategy being implemented. ![]() One report of a standardized protocol demonstrated a 67% reduction in mortality over the course of 10 years (1978–1988). While there are no randomized controlled trials evaluating any one comprehensive Golden Hour protocol, there is ample support for the use of evidence-based standards in several clinical domains unique to the early postnatal period. Among the most important of these are delivery-room practices such as teamwork, leadership, and communication, the use of oxygen and positive pressure ventilation, hemodynamic management, maintenance of a thermo-neutral environment, glycemic control, and identification and management of infectious risk factors. Early postnatal metrics are essential in the development of Golden Hour protocols, and there is strong evidence that improving specific components of care improves long-term outcomes as well. The outcomes improved by Golden Hour care are those most important to parents: survival, chronic lung disease, hearing and vision, and long-term neurodevelopment. One author described the Golden Hour as a “philosophical approach” that reinforces communications, evidence-based protocols and procedures, and standardizes as many elements as possible with the aim of improving care and outcomes. The care of each infant must be individualized, but the Golden Hour concept emphasizes preparedness and adherence to guidelines with the aim of improving the quality of care. ![]() While the term “Golden Hour” implies the first 60 minutes after birth, the first several hours to days are critical as well. The aim of a Golden Hour protocol in the NICU is to apply evidence to clinical practice as safely and efficiently as possible. Extremely preterm newborns are highly vulnerable to complications in the early postnatal period, and adherence to best-evidence standards or guidelines can improve both survival and neurodevelopmental outcomes. Here we discuss the Golden Hour concept for care of preterm infants, especially those born less than 28 weeks post-menstrual age (PMA). Golden Hour protocols generally include standards and guidelines based on available evidence that can decrease morbidity and mortality. High-quality, timely, and efficient care, initiated within the Golden Hour window, can mitigate at least some of the risks associated with high-risk newborn care. However, the Golden Hour conveys a slightly different meaning in the NICU. In the NICU, the term generally refers to the first few hours immediately after birth. Cowley’s research was instrumental in the study of shock and trauma in the United States, and his contribution has influenced the care of high-risk newborns as well.įor over a decade, neonatologists have been applying this concept to the care of high-risk newborns in the neonatal intensive care unit (NICU). According to Cowley, shock is a “momentary pause” in the pathway leading to death, and the “golden hour” is that period in which life-saving interventions can be initiated to prevent death or extreme morbidity. Cowley’s research was directed primarily at the management of post-traumatic shock. The term was first introduced by a military surgeon, R. Adams Cowley. The “Golden Hour” concept derives from the adult trauma literature, and generally describes the period after a traumatic injury during which prompt medical attention is needed to prevent death. ![]()
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