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MOP 350218

REVIEW

C URRENT
OPINION Neonatal Golden Hour: a review of current best
practices and available evidence
Michelle Lamary a, C. Briana Bertoni b, Kathleen Schwabenbauer b
and John Ibrahim b

Purpose of review
Recommendations made by several scientific bodies advocate for adoption of evidence-based interventions
during the first 60 min of postnatal life, also known as the Golden Hour, to better support the fetal-to-
neonatal transition. Implementation of a Golden Hour protocol leads to improved short-term and long-term
outcomes, especially in extremely premature and extreme low-birth-weight (ELBW) neonates. Unfortunately,
several recent surveys have highlighted persistent variability in the care provided to this vulnerable
population in the first hour of life.
Recent findings
Since its first adoption in the neonatal ICU (NICU) in 2009, published literature shows a consistent benefit
in establishing a Golden Hour protocol. Improved short-term outcomes are reported, including reductions in
hypothermia and hypoglycemia, efficiency in establishing intravenous access, and timely initiation of fluids
and medications. Additionally, long-term outcomes report decreased risk for bronchopulmonary dysplasia
(BPD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP).
Summary
Critical to the success and sustainability of any Golden Hour initiative is recognition of the continuous
educational process involving multidisciplinary team collaboration to ensure coordination between
providers in the delivery room and beyond. Standardization of practices in the care of extremely premature
neonates during the first hour of life leads to improved outcomes.
Video Abstract
: http://links.lww.com/MOP/A68.
Keywords
extremely low-birth-weight neonates, extremely premature neonates, Golden Hour, outcomes

INTRODUCTION by Reynolds et al. [4] in 2009. This concept includes

Prematurity is the leading cause of neonatal mortal- evidence-based interventions during the first 60 min
ity and contributes to
50% of childhood disabil- of postnatal life to better support the fetal-to-neonatal
ities in the United States [1]. Extremely premature transition, leading to better short-term and long-term
(<27 weeks’ gestation) and extremely low-birth- outcomes, particularly for EP-ELBW and very-low-
weight (<1000 g) (EP-ELBW) infants’ mortality rates birth weight (VLBW) infants. Evidence-based inter-
are 30–50%. Resuscitation in the delivery room and ventions address predelivery planning, delivery
stabilization during neonatal ICU (NICU) admission room management, and neonatal resuscitation on
involves a series of interdependent tasks and proce- NICU admission. Despite recommendations from
dures that must be done efficiently and systemati-
cally. Due to the complexity of care required at a
Division of Newborn Medicine, UPMC Magee-Womens Hospital and
birth, protocols including evidence-based practices b
Division of Newborn Medicine, UPMC Magee-Womens Hospital/
with standardized application in the first hour of life Children's Hospital of Pittsburgh, United States of America
have been applied to improve the quality and ensure Correspondence to John Ibrahim, MD, FAAP, Assistant Professor of
the consistency of care for EP-ELBW infants. Pediatrics, Division of Newborn Medicine, UPMC Magee-Womens
Hospital/Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pitts-
burgh, PA 15224, USA. Tel: +1 412 692 6851; fax: +1 412 537 6907;
BACKGROUND ON THE GOLDEN HOUR e-mail: ibrahimjw@upmc.edu
The ‘Golden Hour’ adopted from the adult trauma Curr Opin Pediatr 2023, 35:000–000
literature [2,3] was first introduced in neonatology DOI:10.1097/MOP.0000000000001224

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Neonatology and perinatology

management of ELBW infants [14]. The neonatal

KEY POINTS resuscitation team leader should facilitate a prede-
 The Golden Hour, adopted from the adult trauma livery huddle to discuss any significant antenatal
literature, was first introduced in neonatology by history and assign roles and responsibilities for
Reynolds et al. in 2009. team members. Whenever delivery is expected,
required delivery room equipment should be
 Published literature shows a consistent benefit in
checked and prepared.
establishing a Golden Hour protocol, improving short-
term and long-term outcomes.
Delayed cord clamping
 This concept includes evidence-based interventions The total amount of whole blood in the fetal–pla-
during the first 60 min of postnatal life to better support
the fetal-to-neonatal transition.
cental circulation is 110–115 ml/kg of fetal body
weight with about 30 ml/kg of this residing in the
 Despite recommendations from the International Liaison placenta. In 2015, the NRP guidelines began recom-
Committee on Resuscitation (ILCOR) and evidence for mending delayed cord clamping (DCC), cord clamp-
improved outcomes with standardized Golden Hour ing after 30–180 s, for all premature infants not
practices, recent surveys highlight persistent variability
in the care within the first hour of life provided to this
requiring immediate resuscitation [15]. Although
vulnerable population. DCC vs. early cord clamping is associated with need
for fewer red blood cell transfusions, less intraven-
tricular hemorrhage (IVH), and decreased necrotiz-
ing enterocolitis [16], umbilical cord milking has
the International Liaison Committee on Resuscita- been shown to increase IVH rates in infants less than
tion (ILCOR) and evidence for improved outcomes 32 weeks [17]. Confirmation of the plan to perform
with standardized Golden Hour practices [5 ,6 ,
&& && DCC should be communicated with the obstetrical
&& &
7 ,8 ], recent surveys highlight persistent variability team in the delivery room [18]. Ongoing research in
in the care within the first hour of life provided to this this area seeks to address feasibility, benefits, and
vulnerable population [9,10 ].
& safety of bedside neonatal resuscitation with an
intact umbilical cord [19].

REVIEW OF GOLDEN HOUR COMPONENTS Prevention of hypothermia

AND EVIDENCE
The incidence of hypothermia, defined as rectal
Predelivery planning temperature less than 36.5 8C, at NICU admission
in VLBW infants is 31–78% [20–22]. Extremely
premature infants are prone to hypothermia
Antenatal counseling
because of:
Antenatal counselling, first introduced in the Neo-
natal Resuscitation Program (NRP) algorithm in (1) Large body surface area to body mass ratio
2015, is critical prior to an EP-ELBW infant delivery. (2) Very large area of the head
The team leader, who may be the neonatal fellow in (3) Decreased subcutaneous fat
an academic setting, should meet with the parents (4) Low levels of thermogenin and 50 30 mono-
to counsel them on outcomes, potential short-term deiodinase
and long-term complications related to extreme (5) Lower surge of thyrotropin
prematurity and anticipated NICU course [11]. (6) Lack of shivering thermogenesis
Antenatal counselling can reduce parental anxiety
&
and stress and increase satisfaction [12 ,13]. A
shared decision-making (SDM) approach should After birth, the wet newborn may lose enough
be utilized for anticipated periviable deliveries. heat to decrease body temperature by 2–4 8C, with
Additionally, communication with the obstetrics most heat lost in the first 10–20 min unless
team is critical in preparing for such deliveries. appropriate measures are taken. Heat loss in EP-
ELBW infants occurs by four mechanisms: evap-
Neonatal resuscitation team role oration, radiation, conduction, and convection
assignment [23–25].
In 2006, the Vermont Oxford Network (VON) The ILCOR Neonatal Task Force systematic
Neonatal Intensive Care Quality Improvement review, including evidence from 36 observational
Collaborative recognized the importance of deliv- studies, reported increased risk of mortality associ-
ery room teamwork and communication for ated with hypothermia at NICU admission. Eight

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Neonatal Golden Hour Lamary et al.

studies showed that a temperature less than 36 8C in [34]. A Cochrane metaanalysis concluded that plas-
preterm infants was independently associated with tic wraps or bags were effective in reducing heat
an increased IVH risk; nine studies showed an asso- losses in extreme premature infants (less than
ciation with respiratory disease; seven studies 28 weeks) but not in infants from 28 to 31 week’s
showed a significant association with hypoglyce- gestation [35]. Plastic caps were also effective in
mia; and two studies reported an association reducing heat losses in infants less than 29 weeks’
between admission hypothermia and development gestation.
of late-onset sepsis [26]. The associated risks directly
correlate with the degree of hypothermia and pre- Thermal mattress
maturity. Laptook et al. concluded that admission Thermal mattresses contain sodium acetate gel that
temperature was inversely related to mortality (28% crystallizes exothermically when activated, reach-
increase in mortality per 1 8C decrease in temper- ing 38–42 8C in approximately 90 s and maintaining
ature). The chance of early neonatal death was 1.64- that temperature for up to 2 h. Guidelines have
fold higher in infants with admission temperatures recommended that thermal mattresses be used as
less than 36 8C [21]. an adjunct at the discretion of the stabilizing team
In 2012, the American Academy of Pediatrics/ to prevent hypothermia in infants born less than
American College of Obstetricians and Gynecolo- 32 weeks gestation. Although exothermic mattresses
gists guidelines recommended maintaining an axil- combined with polyethylene wraps may decrease
lary temperature of approximately 36.5 8C for the rate of hypothermia, they may also increase
newborns in the delivery room [27]. To avoid hypo- hyperthermia incidence, therefore, making close
thermia in the delivery room, it has been recom- temperature monitoring a necessity whenever used
mended to set the room temperature at 75–79 8F. [36,37].
The WHO advocates maintaining temperature in
the delivery room at 25–28 8C (77–82 8F) [28,29].
Heated humidified gas source
The 2015 ILCOR recommendation is to maintain an
environmental temperature for newly born nonas- Another important source of hypothermia in neo-
phyxiated infants, born ‘less than 32 weeks of ges- nates is the respiratory tract. Heated humidified gas
tation between 23 and 25 8C (73–77 8F) [26]. The has been shown to support normothermia, presum-
European Resuscitation guidelines recommend ably by decreasing evaporative loss from respiratory
keeping the delivery room 23–25 8C (73–77 8F) for tract epithelium and convection losses that occur in
babies at least 28 weeks’ gestation and more than infants inspiring cold air [38].
25 8C (>77 8F) for preterm infants less than 28 weeks’
gestation [30]. Prewarmed incubator
As soon as possible after birth, the newborn should
Use of polyethylene bags and wraps be placed in a prewarmed double-walled incubator,
Beginning in 2005, ILCOR recommended placing having high air humidity (70–80%) and ambient
extremely premature neonates immediately after temperature to mimic the fetal environment [39].
birth in a polyethylene plastic wrap or a vinyl Ideally, infant transfers between beds should be
bag, without drying. All resuscitation procedures limited. Whenever feasible, initial resuscitation
should be performed while the infant is in the may occur in a convertible isolette, with adjustable
plastic bag, including intubation and umbilical lid to facilitate access to the infant, while limiting
catheterization. Literature shows that use of these subsequent bed transfers and infant exposure. A
bags can significantly decrease the hypothermia neonatal transport shuttle may be used to power
incidence for EP-ELBW infants [31,32]. Total body the isolette and move from the labor room to the
wrapping was comparable to covering the body up NICU; however, these items are costly and require a
to the shoulders in preventing postnatal thermal significant investment. Additionally, depending on
losses in very preterm infants [32]. One analysis institutional volume and acuity, bed transfers may
concluded that the use of a polyethylene plastic still need to take place despite having access to this
bag immediately after birth prevents one case of equipment, when multiple EP-ELBW infants deliver
hypothermia for every six wrapped infants [33]. in a short span of time.
Attention should be paid to monitoring for hyper-
thermia, as this has been shown to increase with the Prewarmed intravenous fluids
use of polyethylene wraps [33]. Providing cool or room temperature intravenous
Additionally, use of plastic head coverings or fluids may lead to inadvertent cooling of neonates,
hats is recommended over stocking-knit caps alone resulting in an increased chance of hypothermia.
because of the superior ability to prevent heat loss Although there are many interventions that have

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Neonatology and perinatology

been studied to provide improved thermal care to the first 72–96 h. Catecholamines play a crucial role
LBW neonates, intravenous fluid warmers have not by stimulating alpha receptors that help utilize
received the attention it deserves, particularly in EP- brown fat and by promoting liver glycogenolysis
ELBW infants, during NICU admission and trans- and gluconeogenesis [44]. Hepatic glycogenolysis
&
port [40 ]. is the fastest mechanism that allows an increase
of blood glucose levels after birth. However, the
high rate of glycogenolysis leads to hastened deple-
Prevention of hypoglycemia tion of hepatic glycogen stores, especially in preterm
Hypoglycemia is common in growth-restricted and infants. In addition, gluconeogenesis is not imme-
premature neonates. It is recognized that 23–50% of diately effective after birth and reaches its matura-
infants admitted to the NICU have one or more tion capacity after 12 h [45]. In the meantime,
episodes of hypoglycemia [41]. With lower gesta- hepatic ketogenesis markedly increases during the
tional age, adaptive mechanisms are not adequately first hours after birth, to provide alternative fuels for
developed, which predisposes this vulnerable pop- brain metabolism in term infants. This metabolic
ulation to increased risk of hypoglycemia. pattern is severely limited in preterm infants
During pregnancy, about 70% of the maternal because of a lack of fat stores in adipose tissue, which
glucose is allocated to the fetus while approximately eventually results in failure of lipolysis [46].
30% is consumed by the placenta [42]. Fetal glucose There is no common consensus for defining
metabolism is regulated by fetal insulin production, euglycemia with different scientific organizations
which increases with pregnancy progression, adopting different thresholds for hypoglycemia in
enhancing glucose utilization by insulin-sensitive neonates as summarized in Table 1.
tissues, including skeletal muscle, liver, heart, and Clinically, the association of hypoglycemia and
adipose tissue [43]. neurodevelopmental abnormalities in preterm
After birth, the placental supply of glucose infants was defined as early as 1937 [53]. Many
ceases leading to a nadir in the first 2 h of life. This authors agree that severe, persistent hypoglycemia
triggers release of counter regulatory hormones, can cause seizures and brain injury; however, the
important for gluconeogenesis within the first 6– prognostic meaning of transient hypoglycemia
24 h. A transient reduction in blood glucose values remains controversial. Though studies have shown
immediately after birth as part of transitional meta- hypoglycemia was not associated with an increased
bolic adaptation generally resolves within the first risk of neurosensory impairment, it was associated
hours of life, and glucose levels gradually increase to with an increased risk of low executive function and
reach adult values (blood glucose >70 mg/dl) within visual motor function, with the highest risk in

Table 1. Definition of hypoglycemia in neonates by different scientific organizations

Recommended glucose threshold(s)

Society Hour of life Recommended threshold

American Academy of Pediatrics (AAP) [47] 0--4 h 40 mg/dl

4--24 h 45 mg/dl postprandial
48 h 60 mg/dl

Recommend treating blood glucose
levels 40 mg/dl (mmol/l) parenterally
Pediatric Endocrine Society (PES) [48] 0--48 h <50 mg/dl
>48 h <60 mg/dl
Academy of Breastfeeding Medicine (ABM) [49] 0--2 h 28 mg/dl
4--24 h 40 mg/dl postprandial
48--72 h 48 mg/dl postprandial
British Association of Perinatal Medicine [50] 2--24 h 45 mg/dl postprandial if symptomatic or
36 if asymptomatic but with risk factors
Canadian Pediatric Society [51] 4--24 h 47 mg/dl postprandial
47 mg/dl postprandial
&
Swedish National Guidelines [52 ] 4--24 h
72 h 54 mg/dl

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Neonatal Golden Hour Lamary et al.

Table 2. Evidence from previous Golden Hour projects

Study Population and study characteristics Parameters studied

Reynolds et al. Inborn neonates <32 weeks or less than <1500 g Increase in the median admission temperature during
(2008) [4] Initial GH process: 2001--2007 both initial and revised processes (36.2 vs. 36.7 8C)
Revised GH process: 2007--2008 Decreased incidence of ROP and CLD in the revised GH
period
Reuters et al. Neonates <29 weeks or <1000 g or any neonate who Decreased IVH rate (46 vs. 18%)
(2014) [66] required considerable resuscitation (i.e. hydrops) Decreased time to vascular access (35 vs. 56 min)
40 GH resuscitations No difference in the minimum temperature reported,
incidence of BPD, or length of hospital stay
Castrodale et al. Level III NICU Increased infants with euthermia (36.5--37.4 8C) at
(2014) [67] Neonates <28 weeks admission (28.3 vs. 49.6%; P ¼ 0.002)
Total of 225 infants Increased admission glucose >50 mg/dl (55.7 vs. 72%;
106 preprotocol P ¼ 0.012)
119 postprotocol Increased administration of i.v. glucose and amino acids
within 1 h of life (7 vs. 61.3%; P ¼ 0.001)
Ashmeade et al. Neonates <28 weeks and/or <1000 g Decreased time from birth to surfactant administration
(2016) [45] (79.8  56.6 vs. 30.8  21.8 min; P < 0.001)
Improved admission temperature 97.6 8F
Decreased time to dextrose and amino acid
administration (78.9  43.3 vs. 27.4  12.7 min;
P < 0.001)
64% reduction in the odds of developing CLD
(OR ¼ 0.36; 95% CI 0.17--0.74)
48% reduction in the odds of developing ROP
(OR ¼ 0.52, 95% CI 0.17--0.74)
Lambeth et al. 56-bed level IIIB NICU Decreased time to i.v. fluid administration (104 vs.
(2016) [46] Neonates < 1000 g 73.6 min; stabilized at 85.3 min)
Decreased time to antibiotic administration (158.5 vs.
98.3 min)
Upward trend of surfactant administration within the first
2 h of life
Lapcharoensap California Perinatal Quality Care Collaborative: Decreased odds of developing BPD (OR 0.8; 95% CI
et al. (2017) 95 hospitals 0.65--0.99) and composite BPD-death (OR 0.83,
[68] 20 Collaborative QI 95% CI 0.69--1.00)
31 NICU QI Reduction in IVH, severe IVH, composite severe IVH-
44 nonparticipant hospitals death, severe ROP, and composite severe ROP-death
Compared baseline (January 2010 to May 2011; 4222 in collaborative QI and nonparticipant hospitals
infants) vs. postintervention (June 2012 to May 2013;
4186 infants) periods
Neonates 22 0/7--29 6/7 weeks and 500 g
Harriman et al. Large military hospital Time to initiation of glucose-containing i.v. fluids
(2018) [69] Inborn infants <32 weeks decreased by 23 min
Time to administration of ampicillin decreased by
14.6 min
Time to administration of gentamicin decreased by
27 min
Croop et al. Inborn infants <27 weeks Decreased hypothermia (59 vs. 26 vs. 38%; P ¼ 0.001)
Decreased hypoglycemia (18 vs. 7 vs. 4%; P ¼ 0.012)
&&
(2020) [70 ] Data from 2012 to 2017
Three phases: Decreased time (minutes) to completion of stabilization
Preprotocol (n ¼ 80) [110 (89,138) vs. 111 (94,135) vs. 92 (74,129);
Phase I (n ¼ 42) P ¼ 0.0035]
Phase II (n ¼ 92)
Dylag et al. 68-bed, level IV NICU Decreased rate of CLD from 33.5 to 16.5%
Neonates 29 weeks Percentage of infants born 28 weeks receiving
&&
(2021) [71 ]
prophylactic surfactant in the delivery room increased
from 80.8% to 98.1%

BPD, bronchopulmonary dysplasia; CI, confidence interval; CLD, chronic lung disease; i.v., intravenous; IVH, intraventricular hemorrhage; OR, odds ratio; QI,
quality improvement; ROP, retinopathy of prematurity.

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Neonatology and perinatology

Table 3. Timeline for Golden Hour interventions in our level III neonatal ICU
Fellow/attending RNs APPs Resident RT
www.co-pediatrics.com

Pre-delivery Notified of impending delivery by OB. Ensures admit preheated incubator is Gather umbilical line supplies and set If no APP available, second Check Neopuff, source, oxygen
Review maternal chart/history and ready. up tray resident remains in NICU supply, appropriate size mask and
inform the attending. - Ensures DR equipment is available. for orders suction.
Notifies team. Consult if needed. - Check delivery room temperature (73-- The RT should connect the bubble
Huddle with team (admit RN, advance 778 F). CPAP heater to the transport shuttle
practice providers (APP), resident - Turn radiant warmer on. prior to transport.
and respiratory therapist (RT)) to - Ensure warm blankets, activates thermal Ensure appropriate intubation and
assign roles. mattress on the bed. CPAP supplies are at bedside.
Notify the unit clerk of impending - Sterilely open the plastic bag and deposit Adjust pressures of Neopuff at PIP 20,
delivery it in the surgical filed at the direction of PEEP 5)
Discuss collection of admission labs the OB scrub nurse. RT in the NICU to setup respiratory
from cord blood: CBC, blood equipment in the NICU.
culture, blood gas, type and
Coombs)
0--10 min Head of bed for resuscitation. Place baby in the plastic bag. Available to attend delivery if Attend delivery Place pulse oximetry on the right wrist.
Leads resuscitation per NRP guidelines. Assess heart rate and inform the team until additional assistance is needed. Place plastic lined hat on Place EKG leads as per NRP.
stable. baby’s head. Adjust FiO2 to maintain saturations

MOP 350218
- Place skin temp probe. Performs neonatal resuscitation within target NRP ranges.
- Make sure silo bag is appropriately under supervision of the Monitor Neopuff pressures and ensure
covering baby fellow. adequate seal.
- Hat is in place Assign Apgar scores.
10--15 min Stabilize infant for transport to NICU. Prepare infant for transport to NICU. Calls the unit clerk to expedite entry of Calls weight and other Make sure ETT position is appropriate
Update family. - Obtain axillary temperature of the baby. the baby in the system. obtained measurements to Call for surfactant if infant is intubated
Make sure admission labs are - Confirm ID bands and communicate Enter weight. NICU after approval of the fellow (as per
collected from cord blood axillary temperature to the OB RN for Begin order set placement once weight unit respiratory guidelines)
documentation. is called from DR.
- Place identification bands prior to Orders and calls for CXR if infant is
transport. intubated.
Calls pharmacy to alert of Golden
hour admission
15--25 min Prepare for umbilical line if assigned to Perform immediate admission assessment. Prepare for umbilical line if assigned to Prepare to observe/assist with Administer surfactant s/p CXR if
place. - Place a note on the bed It is my golden place. - Back up to place PIV. line placement indicated.
Confirm appropriate ETT/line hour at bedside to remind providers. May initiate UA/UV placement at this Follow gentle ventilation strategies if
placement on X ray. - Administer Vitamin K and erythromycin. stage if unable to obtain PIV. invasive ventilation is required.
Monitor blood gases and make - Place peripheral i.v., obtain first blood
necessary adjustment/escalation sugar, axillary temperature and initiate
D10W.
Volume 35  Number 00  Month 2023

- Place NG if on bCPAP.
25--45 min Umbilical line placement. Obtain Prepare central line fluids. Umbilical line placement. Observe/assist with line Continue to wean oxygen and run first
ordered labs (type and screen, - Call for CXR Obtain ordered labs placement ABG/CBG
peripheral blood gas, CBC, blood Ensure antibiotics are available if ordered.
culture). NOT needed if sent from
cord blood
45--55 min Secure lines following confirmed Initiate line fluids and D/C PIV fluids. Secure lines following confirmed Perform check (ETT placement) prior to
placement. Administer antibiotics if ordered. placement. incubator closure.
Perform assessment if needed Administer indomethacin if appropriate
55--60 min Update family Finish any remaining tasks. Ensure checklist has been completed.
- Ensure proper servo and humidity
settings.
Obtain temperature and close incubator.
Fill out checklist

CXR, Chest X-ray; CPAP, continuous positive pressure ventilation; ETT, Endotracheal tube; OB RN, Obstetric registered nurse; PIV, Peripheral intravenous access.

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Neonatal Golden Hour Lamary et al.

children exposed to severe, recurrent, or clinically CONCLUSION

undetected hypoglycemia [54,55]. A coordinated focus on the Golden Hour in EP-
Timely establishment of intravenous access and ELBW neonates has been shown to improve short-
initiation of dextrose containing fluids in the first term and long-term outcomes. Critical to the suc-
few minutes of life, is critical in EP-ELBW to avoid cess of any Golden Hour initiative is recognition of
hypoglycemia. Establishing peripheral access as a the continuous educational process that involves
bridge prior to umbilical line placement can help collaboration between multidisciplinary teams to
avoid this complication. ensure coordination between different providers
in the delivery room and beyond. Adequately sup-
porting our extremely premature neonates in the
Respiratory management in the delivery
immediate postnatal period is the first step to
room
decrease morbidity and mortality in this vulnerable
Noninvasive ventilation in the form of continuous population.
positive pressure ventilation (CPAP) is currently
recommended in the delivery room by both the Acknowledgements
Committee on the Fetus and Newborn and NRP None.
[56,57]. CPAP leads to maintenance of the func-
tional residual capacity of the lung, which can Financial support and sponsorship
reduce the need for intubation, exogenous surfac-
None.
tant, postnatal corticosteroids, and total ventilator
days [58]. Large multicenter trials have supported Conflicts of interest
the initial use of CPAP in the delivery room within
There are no conflicts of interest.
the first 15 min after birth [59–63], with a Cochrane
review of 3201 babies from 24 to 32 weeks gestation
suggesting a reduction in BPD and mortality [64 ].
&
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A recent study looking at the value of establishing a small baby program including
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Our center Golden Hour protocol && infants born at 22 weeks’ gestation: the Iowa approach. Semin Perinatol
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level III NICU. In addition to a literature review, this outcomes in periviable neonates, a part of which is related to standardized
practices in the immediate delivery period and beyond.
project was developed in collaboration with our 8. Ricci MF, Shah PS, Moddemann D, et al. Neurodevelopmental outcomes of
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therapists, residents, advanced practice providers, for very preterm infants. J Paediatr Child Health 2021; 57:990–997.
Important survey highlighting the variation persistent in practices, despite strong
fellows, and attendings. Live reports are used for recommendations for adopting Golden Hour protocols in extremely premature
ongoing data collection to track progress (Table 3). neonates.

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Neonatal Golden Hour Lamary et al.

65. Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant 69. Harriman TL, Carter B, Dail RB, et al. Golden hour protocol for preterm infants:
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37:349–354. less than 25 weeks on decreased risk for BPD.

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