Written by Kimiko Dunbar
Spoon Feed
Standardization of procedures in the first hour of life of premature infants improves temperature stability and decreases rates of severe intraventricular hemorrhage.
It’s all about the first impression
Transition of preterm infants from the intrauterine to extrauterine environment has a significant impact on both short- and long-term outcomes. The concept of the “Golden Hour” (GH) has recently emerged in neonatology, emphasizing the importance of management in the first hour of life. Some hospitals have implemented GH protocols to streamline care in the first hour of life; however, they are quite diverse, and the efficacy is not well understood.
This meta-analysis assessed whether standardized GH protocols improve outcomes in premature infants. Most protocols included creation of a multidisciplinary team, simulation training, checklists for resuscitation equipment, and streamlined communication. Eighteen cohort studies (n=5,104) showed GH reduced hypothermia (OR 0.40), time to IV access (MD –27.5 min), and severe intraventricular hemorrhage (OR 0.65). Bronchopulmonary dysplasia showed a non-significant decrease (OR 0.69, 95%CI 0.47-1.02). No mortality benefit was found. Limitations include heterogeneity of studies and absence of RCTs. GH protocols modestly enhance early stability but require higher-quality studies for definitive clinical guidance.
How does this change my practice?
I’m not a neonatologist, but I appreciate the importance of standardization of care during critical times, which is underscored in this study. For those who do resuscitate premature infants, I think this calls for a review of one’s institutional protocols to ensure thoughtful planning around this especially critical time in such a high-risk population.
Source
Standardized Management of the First Hour of Premature Infants: A Meta-Analysis. Pediatrics. 2025 Apr 1;155(4):e2024068606. doi: 10.1542/peds.2024-068606. PMID: 40132650
