Outcomes of Infants Admitted Under the Golden Hour: A Quality Improvement Initiative
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Authors
Dunlap, Alison
Issue Date
2018-05-12
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Abstract
Background: The “golden hour” refers to the first hour of a premature infant’s life. Golden hour protocols focus on thermoregulation, prompt initiation of intravenous fluids, prompt initiation of antibiotics, and timely completion of the admission process. The goal is to reduce long-term morbidities in this vulnerable population.|Purpose: To implement and evaluate a “Golden Hour Protocol” for infants less than 32 weeks of gestation and assess the impact on chronic lung disease (CLD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP).|Methods: A golden hour protocol was developed and implemented in a Midwest Level III NICU which included debriefing of staff. A chart review included temperature, glucose level, time of initiation of antibiotics, intravenous glucose, and closing of the isolette.|Results: There were 79 infants in the pre-intervention group and 75 infants in post-intervention group. Gestational age (29 weeks), weight (~1200 grams), temperature (98.6 degrees Fahrenheit), and blood sugar (49) were similar in both groups. Improvement was seen in the post-intervention group with decreased length of time to IV fluid start, antibiotic initiation and closing of the isolette top. Reduction of all degrees of intraventricular hemorrhage occurred in post-intervention group (N=74) when compared to the pre-intervention group (N=79). Reduction in ROP in post-intervention group (N=64) compared to pre-intervention group (N=69). There was also reduction in the incidence of CLD diagnosed at 28 days in the pre-protocol intervention group (N=64) when compared to the pre-intervention group (N=69).|Implication for Practice & Research: These infants will continue to be monitored and adaptations to the protocol will be made as needed. The Golden Hour process has taken effort among many departments and within the NICU team. There has been ongoing education, monitoring, communication and teamwork that has made the process successful.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University