The neonatal Golden Hour--intervention to improve quality of care of the extremely low birth weight infant.

Introduction: The "Golden Hour," the first 60 minutes following the birth of an extremely premature infant, are perhaps the most important of his or her life. Specific attention to respiratory management, temperature regulation, and vascular access, undertaken via a standardized approach may have immeasurable long-term benefits, and make the difference between life and death.

Methods: We present our new approach to the extremely premature infant during the Golden Hour, a protocol to improve the initial body temperature, length of hospital stay, and incidence of bronchopulmonary dysplasia of the extremely low birth weight infant.

Results: We did not find statistically significant differences in minimum temperature during resuscitation, length of hospital stay or rate of bronchopulmonary dysplasia after implementation of the Golden Hour. We observed a decrease in the incidence of intraventricular hemorrhage (IVH) (18 versus 46 percent). The placement of umbilical catheters was much faster during the Golden Hour (35 versus 56 minutes) but arrival in the NICU was significantly delayed (80 versus 15 minutes).

Conclusions: We were not able to detect differences in temperature management, bronchopulmonary dysplasia or average length of hospital stay following implementation of the Golden Hour protocol. However, we observed a marked decrease in intraventricular hemorrhage and faster time for umbilical catheter insertion than prior to the protocol. Long-term follow-up of these infants is critical to assess neurodevelopmental benefits gained from use of the protocol.