text: Manuscript (3.092Mb)
  Poster (185.8Kb)
  Behring, Nicole
  Problem: The first 60 minutes of life are crucial moments. This time period is when an infant shifts from intrauterine life, where the mother and the placenta are in control of the infant's body, to the outside world where the infant's body takes over. Evidence based protocols, such as the "Golden Hour" protocol, may help support the effectiveness and coordination in delivering high quality of care through effective teamwork at the time of delivery.
  The purpose of this scholarly project was to explore and assess the need for implementing a consistent neonatal "Golden Hour" protocol. Through discovering areas that need greater focus on admission, we can discover ways to improve and increase the use of a standardized care protocol within the first 60 minutes of a premature infant's life.
  Methods: A retrospective chart review was conducted at three Midwestern community-based level IIIA Neonatal Intensive Care Units (NICUs) where high-risk deliveries are attended. Approximately 100 charts of infants born less than or equal to 30 weeks and/or less than or equal to 1500 grams from the years 2012-2014 were reviewed. The data gathered assessed the need for initiating a "Golden Hour" protocol in the delivery room and during admission.
  Results: Data were collected on 95 infants from 3 Level III NICUs across the Midwest; 49 female and 46 male. The mean gestational age was 28 0/7 weeks, the minimum gestation 23 and maximum gestation 33 4/7 weeks. Sixty-one infants (64%) had an initial blood glucose that did not require a bolus of dextrose 10%. Nearly all infants (91%) had a normal blood pressure reading within the first 2 hours of life. About half the infants (51%) had an initial temperature reading between 36.5 – 37.5 degrees Celsius (normothermia); 36 infants had either hyperthermia or cold stress within the first 2 hours. Seventy infants (74%) received their first dose of surfactant within 2 hours; 25 infants (26%) received a second dose of surfactant. The average oxygen days were 45 with a range of 0 to 192 days.
  Conclusions: Both hypothermia and hypoglycemia appear to be problems in this population of infants after delivery. Nearly all infants had IV access and thus received their first dose of antibiotics, and dextrose as needed, within the first two hours of life. Improvement will need to be made by providing nurses with education on temperature importance and stabilization in the NICU. Another quality improvement project with a goal of admission temperature of 36.4-37˚ C. will be re-evaluated each month for improvement.