The golden hour: improving the stabilization of the very low birth-weight infant.

A term borrowed from emergency and cardiovascular medicine, the phrase "Golden Hour" refers to the first hour of an infant's life following delivery. The impact of implementation of a Golden Hour Protocol in a level III neonatal intensive care unit (NICU) for infants delivered at less than 28 weeks gestation was examined, with a focus on admission temperature, admission glucose, and time to the initiation of an intravenous glucose and amino acid administration. As part of a quality initiative project, data were collected before and after the implementation of the Golden Hour Protocol for infants born at less than 28 weeks gestational age from May 2008 through December 2011. Desired outcomes were admission axillary temperature within a range of 36.5°C to 37.4°C, admission glucose more than 50 mg/dL, and the initiation of a glucose and amino acid infusion within 1 hour of birth. Key components of the Golden Hour included the use of a protocolized script, which clearly defined the roles of the delivery room personnel, placing the infant in a polyethylene bag to prevent heat loss, the application of the isolette skin temperature probe within 10 minutes of age, and insertion of umbilical catheters before moving the infant from the resuscitation area to the NICU. Data were collected on 225 infants born less than 28 weeks gestation: 106 in the preprotocol group and 119 in the postprotocol group. Differences between the 2 groups were not statistically significant for birth weight and gestational age. There was a statistically significant difference in the number of infants with an admission temperature in-range (36.5°C-37.4°C) between the preprotocol and postprotocol infants (28.3% vs 49.6%; P = .002). There was a statistically significant difference in the incidence of admission glucose greater than 50 mg/dL between the pre- and postprotocol groups (55.7% vs 72%; P = .012). There was a highly statistically significant difference in the number of post-Golden Hour Protocol infants who received an intravenous administration of glucose and amino acids within 1 hour of life compared with the preprotocol group (61.3% vs 7%; P = 0.001). Our results suggest that the implementation of the Golden Hour Protocol can significantly improve the stabilization of infants delivered less than 28 weeks gestation.