Neonatal Golden Hours Project

Background: Preterm infants are a vulnerable population that require specialized care to achieve optimal outcomes. Preterm infants are at an increased risk of developing sepsis, temperature instability, and hypoglycemia during the first few hours of life. Studies have shown that implementing an evidence-based golden hours protocol with clear role assignments and a team-based approach can improve short- and long-term outcomes.Methods: A quality improvement project was initiated to develop and implement a unit-specific golden hours protocol. A multidisciplinary team evaluated current resuscitation and stabilization practices and developed a golden hours protocol for preterm infants less than 32 weeks' gestation. In-person education was presented to the providers and charge nurses. Also, educational PowerPoint via email was sent to all the nursing and respiratory therapy staff. Pre- and post-implementation chart reviews were conducted to evaluate the effectiveness of the protocol on admit temperatures, time to vascular access, time to initiation of antibiotics, and admit blood sugars.Results: Small improvements were made in time to vascular access, admission, and initiation of antibiotics and dextrose fluids. The percentage of infants with admission blood glucose levels higher than 40 increased from 90% (n=9) pre-implementation to 100% (n=7) post-implementation. There was no change in admit temperatures, as 100% of the infant in both groups were admitted with a temperature greater than 36.5C. Although improvements were made, none were found to be statistically significant. Limited sample-size and short time frame most likely impacted the statistical significance. Conclusion: The quality improvement project was successful at developing and implementing a unit-specific golden hours protocol. However, a limited sample size and a short time frame impacted the statistical significance of the outcomes. More substantial sample size, increased evaluation time, and additional education are needed to evaluate the impact of the protocol on short- and long-term outcomes of preterm infants