Golden hour management practices for infants <32 weeks gestational age in Canada

Vibhuti Shah; Kate Hodgson; Mary Seshia; Michael Dunn; Georg M Schmölzer

doi:10.1093/pch/pxx175

Golden hour management practices for infants <32 weeks gestational age in Canada

Paediatr Child Health. 2018 Jul;23(4):e70-e76. doi: 10.1093/pch/pxx175. Epub 2017 Nov 24.

Authors

Vibhuti Shah^{1

2}, Kate Hodgson^{2

3}, Mary Seshia⁴, Michael Dunn^{2

5}, Georg M Schmölzer^{6

7}

Affiliations

¹ Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario.
² Department of Paediatrics, University of Toronto, Toronto, Ontario.
³ Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario.
⁴ Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba.
⁵ Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario.
⁶ Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta.
⁷ Department of Pediatrics, University of Alberta, Edmonton, Alberta.

Abstract

Objectives: To determine 'Golden Hour' resuscitation and stabilization practices for infants <32 weeks gestational age in Canadian neonatal intensive care units (NICUs).

Methods: A survey was distributed to investigators of the Evidence-based Practice for Improving Quality study within the Canadian Neonatal Network in June 2014. The questionnaire was designed to obtain information on antenatal counselling, resuscitation environment, resuscitation and management practices, including respiratory and nutritional practices in the first hour of life. Responses to these categories were stratified into gestational age groupings: 23^0/7-23^6/7, 24^0/7-25^6/7, 26^0/7-27^6/7 and 28^0/7-31^6/7 weeks. Findings were summarized using descriptive statistics.

Results: Investigators from 14 of the 23 (61%) NICUs responded. Antenatal counselling was provided to >75% of expectant parents by Staff Neonatologists and Neonatal Fellows. Most NICUs (78%) provided resuscitation in a room adjacent to the high-risk delivery room or the NICU, while few (36%) resuscitated in the delivery room only. Twelve (86%) NICUs practiced delayed cord clamping while two practiced milking of the cord (14%) and 100% used thermal wrap for infants <28 weeks' gestation. All, with the exception of three NICUs used fraction of inspired oxygen ≤0.3 for initial resuscitation and 12/14 (86%) centres applied continuous positive airway pressure for spontaneously breathing infants <25^6/7 weeks' gestation.

Conclusions: Participating Canadian NICUs reported that they generally follow Neonatal Resuscitation Program recommendations for stabilization of preterm infants; however, considerable variation exists in the application of evidence-based interventions. Our findings can be used to inform quality improvement initiatives to improve clinical outcomes for this vulnerable population.

Keywords: Golden hour; Infant-newborn; Preterm; Resuscitation.