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Sheng L, Zhong G, Xing R, Yan X, Cui H, Yu Z. Quality improvement in the golden hour for premature infants: a scoping review. BMC Pediatr 2024; 24:88. [PMID: 38302960 PMCID: PMC10832117 DOI: 10.1186/s12887-024-04558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Evidence-based research has shown that golden hour quality improvement (QI) measures can improve the quality of care and reduce serious complications of premature infants. Herein, we sought to review golden hour QI studies to evaluate the impact on the outcome of preterm infants. METHODS A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and SinoMed databases from inception to April 03, 2023. Only studies describing QI interventions in the golden hour of preterm infants were included. Outcomes were summarized and qualitative synthesis was performed. RESULTS Ten studies were eligible for inclusion. All studies were from single centers, of which nine were conducted in the USA and one in Israel. Seven were pre-post comparative studies and three were observational studies. Most included studies were of medium quality (80%). The most common primary outcome was admission temperatures and glucose. Five studies (n = 2308) reported improvements in the admission temperature and three studies (n = 2052) reported improvements in hypoglycemia after QI. Four studies (n = 907) showed that the incidence of bronchopulmonary dysplasia (BPD) was lower in preterm infants after QI: 106/408 (26.0%) vs. 122/424(29.5%) [OR = 0.68, 95% CI 0.48-0.97, p = 0.04]. CONCLUSIONS Our study showed that the golden hour QI bundle can improve the short-term and long-term outcomes for extremely preterm infants. There was considerable heterogeneity and deficiencies in the included studies, and the variation in impact on outcomes suggests the need to use standardized and validated measures. Future studies are needed to develop locally appropriate, high-quality, and replicable QI projects.
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Affiliation(s)
- Lijuan Sheng
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Guichao Zhong
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Ruirui Xing
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Xudong Yan
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Huanjin Cui
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Zhangbin Yu
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
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Hemingway M, Raju M, Vora N, Raju V, Mallett LH, Govande V. Improving delivery room and admission efficiency and outcomes for infants < 32 weeks: ELGAN+ (Extremely Low Gestational Age Neonate). J Neonatal Perinatal Med 2022; 16:33-37. [PMID: 36591661 DOI: 10.3233/npm-210881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the implementation of a systematic approach to improve the resuscitation, stabilization, and admission of infants < 32 weeks gestation and also to ascertain its effect on organization, efficiency, and clinical outcomes during hospitalization. METHODS Retrospective study involving a multidisciplinary team with checklists, role assignment, equipment organization, step by step protocol, and real time documentation for the care of infants < 32 weeks gestation in the delivery room to the neonatal intensive care unit. Pre-data collection (cases) period was from Aug, 2015 to July, 2017, and post-data collection(controls) period was from Aug, 2017 to Aug, 2019. RESULTS 337 infants were included (179 cases; 158 controls). Increase surfactant use in the resuscitation room (41% vs. 27%, p = 0.007) and reduction in median time to administer surfactant (34 minutes (range, 6-120) vs. 74 minutes (range, 7-120), p = 0.001) observed in control-group. There was a significant reduction in incidence of bronchopulmonary dysplasia (27% vs. 39%), intraventricular hemorrhage (11% vs. 17%), severe retinopathy of prematurity (3% vs. 9%), and necrotizing enterocolitis (4% vs. 6%), however these results were not statistically significant after controlling for severity of illness. CONCLUSIONS A systematic approach to the care of infants < 32 weeks gestation significantly improved mortality rates and reduced rates of comorbidities.
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Affiliation(s)
- M Hemingway
- Department of Neonatology, Baylor Scott and White Health, Temple, Texas, USA
| | - M Raju
- Department of Neonatology, Baylor Scott and White Health, Temple, Texas, USA
| | - N Vora
- Department of Neonatology, Baylor Scott and White Health, Temple, Texas, USA
| | - V Raju
- Department of Neonatology, Baylor Scott and White Health, Temple, Texas, USA
| | - L H Mallett
- Department of Neonatology, Baylor Scott and White Health, Temple, Texas, USA
| | - V Govande
- Department of Neonatology, Baylor Scott and White Health, Temple, Texas, USA
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Jeong SH, Jeong MH, Park SJ, Lee N, Bae MH, Han YM, Park KH, Byun SY. Implementing the Golden Hour Protocol to Improve the Clinical Outcomes in Preterm Infants. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: Since premature infants are sensitive to the changes in blood glucose levels and body temperature, maintaining these parameters is important to avoid the risk of infections. The authors implemented the Golden Hour protocol (GHP) that aims to close the final incubator within one hour of birth by implementing early treatment steps for premature infants after birth, such as maintaining body temperature, securing airway, and rapidly administering glucose fluid and prophylactic antibiotics by securing breathing and rapid blood vessels. This study investigated the effect of GHP application on the short- and long-term clinical outcomes.Methods: We retrospectively analyzed the medical records between 2017 and 2018 before GHP application and between 2019 and 2020 after GHP application in preterm infants aged 24 weeks or older and those aged less than 33 weeks who were admitted to the neonatal intensive care unit.Results: Overall, 117 GHP patients and 81 patients without GHP were compared and analyzed. Peripheral vascularization time and prophylactic antibiotic administration time were shortened in the GHP-treated group (P=0.007 and P=0.008). In the short-term results, the GHP-treated group showed reduced hypothermia upon arrival at the neonatal intensive care unit (P=0.002), and the blood glucose level at 1 hour of hospitalization was higher (P=0.012). Furthermore, the incidence of neonatal necrotizing enteritis decreased (P=0.043). As a long-term result, the incidence of BPD was reduced (P=0.004).Conclusion: We confirmed that applying GHP improved short- and long-term clinical outcomes in premature infants aged <33 weeks age of gestation, and we expect to improve the treatment quality by actively using it for postnatal treatment.
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Aydon L, Gill A, Zimmer M, Sharp M, Woods P, Seeber C, Mooney D, Murdoch J. Observational study using video recordings to explore the first hour after admission to a neonatal intensive care unit. J Paediatr Child Health 2021; 57:1621-1626. [PMID: 34021938 DOI: 10.1111/jpc.15573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/28/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
AIM To explore the admission process to our neonatal intensive care unit. METHODS A first phase quality improvement initiative was conducted. We utilised observational video recording of a convenience sample of inborn admissions. Two remote GoPro cameras were placed, one giving an overview of activity and the other focussed on the infant. Recordings captured the first hour after admission including transfer to the neonatal intensive care unit by the birthing team. The video footage of each case study was reviewed by a multidisciplinary panel using an agreed semi-quantitative analysis of events. RESULTS Ten admissions to the neonatal intensive care unit were video recorded between June and October 2018. Gestational age 282 -401 . A focus on maintaining airway support was inconsistent as was the ability to provide continuous monitoring of vital signs. Overall leadership of the process was lacking and handover often appeared fragmented. Median temperature on admission was 362 (354 -373 ) °C. Vascular access and fluid management occurred at a median of 36 (13-67) minutes. CONCLUSIONS Planning and approval for this study were protracted, particularly negotiating the use of video recording. Anecdotally, this delay is thought to have contributed to an improvement in managing admissions, particularly when maintaining airway support and monitoring. However, our baseline data have highlighted a lack of leadership, fragmented handover, low admission temperatures and broad time frames to achieve vascular access. A guideline to streamline handover and nursery transition is currently being implemented; a subsequent evaluation cycle is planned.
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Affiliation(s)
- Laurene Aydon
- Department of Nursing Research, Child and Adolescent Health Service, Perth, Western Australia, Australia.,Neonatalogy Directorate, King Edward Memorial and Perth Children's Hospital, Perth, Western Australia, Australia.,Centre for Research and Neonatal Education, School of Child and Paediatric Health, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Gill
- Neonatalogy Directorate, King Edward Memorial and Perth Children's Hospital, Perth, Western Australia, Australia.,Centre for Research and Neonatal Education, School of Child and Paediatric Health, University of Western Australia, Perth, Western Australia, Australia
| | - Margo Zimmer
- Department of Nursing Research, Child and Adolescent Health Service, Perth, Western Australia, Australia.,Neonatalogy Directorate, King Edward Memorial and Perth Children's Hospital, Perth, Western Australia, Australia
| | - Mary Sharp
- Neonatalogy Directorate, King Edward Memorial and Perth Children's Hospital, Perth, Western Australia, Australia.,Centre for Research and Neonatal Education, School of Child and Paediatric Health, University of Western Australia, Perth, Western Australia, Australia
| | - Patricia Woods
- Neonatalogy Directorate, King Edward Memorial and Perth Children's Hospital, Perth, Western Australia, Australia.,Centre for Research and Neonatal Education, School of Child and Paediatric Health, University of Western Australia, Perth, Western Australia, Australia
| | - Carly Seeber
- Neonatalogy Directorate, King Edward Memorial and Perth Children's Hospital, Perth, Western Australia, Australia
| | - Deb Mooney
- Neonatalogy Directorate, King Edward Memorial and Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jamee Murdoch
- Neonatalogy Directorate, King Edward Memorial and Perth Children's Hospital, Perth, Western Australia, Australia
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The Golden Hour: a quality improvement initiative for extremely premature infants in the neonatal intensive care unit. J Perinatol 2020; 40:530-539. [PMID: 31712659 PMCID: PMC7222905 DOI: 10.1038/s41372-019-0545-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Following delivery, extremely premature infants are vulnerable to rapid development of hypothermia and hypoglycemia. To reduce local rates of these morbidities, a multidisciplinary team developed a protocol standardizing evidence-based care practices during the first hour after birth. METHODS Using quality improvement methodology, the Golden Hour protocol was implemented for all inborn infants <27 weeks' gestation. Data were collected (2012-2017) over three phases; pre-protocol (n = 80), Phase I (n = 42), and Phase II (n = 92). RESULTS There were no significant differences in infant characteristics. Improvements in hypothermia (59% vs 26% vs 38%; p = 0.001), hypoglycemia (18% vs 7% vs 4%; p = 0.012), and minutes to completion of stabilization [median (Q1,Q3) 110 (89,138) vs 111 (94,135) vs 92 (74,129); p = 0.0035] were observed. CONCLUSIONS Implementation of an evidence-based, Golden Hour protocol is an effective intervention for reducing hypothermia and hypoglycemia in extremely premature infants.
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Lambeth TM, Rojas MA, Holmes AP, Dail RB. First Golden Hour of Life: A Quality Improvement Initiative. Adv Neonatal Care 2016; 16:264-72. [PMID: 27391563 DOI: 10.1097/anc.0000000000000306] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Very low birth-weight (<1500 g) infants are vulnerable to their environment during the first hour after birth. We designed an evidence-based golden hour protocol (GHP) with a goal to stabilize and perform admission procedures within 1 hour of birth at a level IIIB neonatal intensive care unit (NICU). PURPOSE The aim of this quality improvement project was to ascertain whether an evidence-based GHP would improve care efficiency and short-term outcomes. METHODS Rapid cycles of change using Plan Do Study Act were utilized to document progress and gain knowledge during the quality improvement project. Measures were plotted with statistical process control methods (SPC), which analyzed improvement over time. RESULTS Both admission temperature and glucose-level means were within reference range throughout the project and predicted a stable process. We observed significantly decreased time to initiation of intravenous fluids and antibiotics. An upward trend of surfactant administration within the first 2 hours of life was also observed. IMPLICATIONS FOR PRACTICE The use of a GHP provided an organized approach to admission procedures and care. By using a checklist and recording intervention times, NICU caregivers were more aware of time management for each intervention and were able to decrease time to initiation of intravenous fluids and antibiotics. IMPLICATIONS FOR RESEARCH Future research should focus on establishing normal blood pressure ranges and safe pain management during the "golden hour" and beyond. Future quality improvement should focus on improving subsequent temperature and blood glucose levels after admission umbilical artery and venous catheter placement.
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Ashmeade TL, Haubner L, Collins S, Miladinovic B, Fugate K. Outcomes of a Neonatal Golden Hour Implementation Project. Am J Med Qual 2014; 31:73-80. [PMID: 25194002 DOI: 10.1177/1062860614548888] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to implement and evaluate a quality improvement project (the golden hour pathway [GHP]) aimed at improving the quality and efficiency of care delivered to extremely low birth weight (ELBW) infants <28 weeks gestation and/or <1000 g birth weight during the first hour of life. Process improvement and patient data collected during the quality improvement cycles were compared with retrospective data for ELBW infants admitted to the study neonatal intensive care unit during the 2 years prior to GHP implementation. GHP implementation resulted in improvements compared with past internal performance in time to surfactant administration, time to administration of dextrose and amino acids, body temperature at admission, odds of developing chronic lung disease, and odds of developing retinopathy of prematurity. A standardized interdisciplinary approach to the care of ELBW infants in the first hour of life can lead to more efficient care delivery and contribute to improved outcomes.
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Affiliation(s)
- Terri L Ashmeade
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Laura Haubner
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Sherie Collins
- University of South Florida Morsani College of Medicine, Tampa, FL
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