Dear Collegues

I just want to ask about the other units practice of "Golden Hour " practice of Preterm babies. My question is basically how you are managing and what exactly you are practicing in Golden hour.

I will appreciate your input.

Hello Naveed: I am new to these forums but would like to respond to your question. I assume by "Golden Hour" you refer to the care given during the first hour (or hours) of life. Your question is quite broad as this care encompasses so many considerations and possible interventions. It also very likely will vary with just how premature an infant is. However, I think your question is extraordinarily important since having a protocol for these interventions is likely to guarantee a better outcome, assuming the protocol is well thought out and evidence based. I would like to refer you to a document which is available on line at www.yorkshireneonet.org.uk/guidelines_folder/GoldenHour.htm . It was published by Bradford Teaching Hospitals in the past several years and is an excellent starting point for many NICUs. It can serve as a template and then could be modified to suit the needs and abilities of each unit. Perhaps questions regarding specific interventions could then be addressed through this forum. I hope that helps.

Hi Imlang

Welcome to this site, i hope you will gain a lot from this site. Many thanks for your reply and an excellent reference and guideline which helped me a lot in re drafting our guidelines for golden hour. Initially I thought since no body is replying , I presumed that none of the NICU are practicing this golden hour for preterm babies but with this document which you sent a link is an excellent one, I really appreciate it.

Thankyou once again

the first hour in the life of preterm infant is the most important hour in life

if pretm delivery is anticipated, the following is the advisable proceedures /action in first hour

1- early antenatal discussion with parents regarding the expectation of the baby and the provisional decision regarding resuscitation

2- an experienced person in intubating those preterm babies to attend the delivery (a neonatologist may attend all deliveries less than 28 wks)

3-preheat the radiant warmer in the delivery room,aiming to avoid both hypothermia and hyperthermia

4-once the baby is born and less than 28 weeks he/she would be wrapped by glad rap or polyetheline bag

4-immediately after birth ;a baby is less than 28 weeks , he may be candidate for bhylactic surfactat( survanta) depends on the policy of the unit

5- immediately after birth ;a baby is 31-28weeks , he may be candidate for INSURE (Intubate, surfactant, extubatwe to CPAP) -depend upon the policy onf the unit

5- to apply pulse oximeter immediately after birth, AND to follow the expected saturation / age table by the AAP 2010 guidelines

6-if the baby is breathing to apply early CPAP of 5-6 cm H2O by T -peice" Neopuff "

7-if the baby is apneic or gasping ;to use the least required positive pressure ventilation just to push the heart rate above 100/min , with just noticable chest movement ,to use least fio2 as needed to reach sats/age as per the AAP guide line

8-in NICU keep the glad wrap until the lines are secured, Xrays are done and other intervention finished and the baby temperature in the needed range

9-Early insersion of double lumen UVC( in babaies<1 kg),and UAC, and early start of

D/W10% 80-100ml/ in order to avoid hypoglycemia

10 - early X-ray to ensure good position of ETT and umbilical catheters

11- flat positioning of the bed and gentle handling all the time

peace be upon you all .I'm in bad need for an article about NEONATAL SURICAL INTENSIVE CARE UNITS AND THE PROGRESS IN NEONATAL CARE IN SURGICAL NICU,coz i need it for my master degree in neonatology.i wish you can help me .thxs alot

hi i am interested in the golden hour protocol. can anyone send me a link. 

@marycam - wished I could share something with you in English, but I googled and found two good lectures (slides as PDF) and one document from somewhere in the UK

https://www2.aap.org/sections/perinatal/PDF/PerinatalWorkshop2010/DunnGolden.pdf

http://angels.uams.edu/files/2013/10/Neonatal-Golden-Hour.pdf

https://www.networks.nhs.uk/nhs-networks/staffordshire-shropshire-and-black-country-newborn/documents/golden hour 2011-13.pdf

 

If anyone has a clinical protocol that could be shared - please do!

Hi Everyone,

Regarding Golden Hour, if IV access is proving difficult would you consider IM Abx to ensure they have been given within the hour?

 Thanks 

Al