Castrodale Val, Rinehart Shannon
Department of Neonatology, St Vincent Hospital (Ms Castrodale), and Newborn Intensive Care Unit, St Vincent Women's Hospital, Indianapolis, Indiana (Mrs Rinehart).
Adv Neonatal Care. 2014 Feb;14(1):9-14; quiz 15-6. doi: 10.1097/ANC.0b013e31828d0289.
A term borrowed from emergency and cardiovascular medicine, the phrase "Golden Hour" refers to the first hour of an infant's life following delivery. The impact of implementation of a Golden Hour Protocol in a level III neonatal intensive care unit (NICU) for infants delivered at less than 28 weeks gestation was examined, with a focus on admission temperature, admission glucose, and time to the initiation of an intravenous glucose and amino acid administration. As part of a quality initiative project, data were collected before and after the implementation of the Golden Hour Protocol for infants born at less than 28 weeks gestational age from May 2008 through December 2011. Desired outcomes were admission axillary temperature within a range of 36.5°C to 37.4°C, admission glucose more than 50 mg/dL, and the initiation of a glucose and amino acid infusion within 1 hour of birth. Key components of the Golden Hour included the use of a protocolized script, which clearly defined the roles of the delivery room personnel, placing the infant in a polyethylene bag to prevent heat loss, the application of the isolette skin temperature probe within 10 minutes of age, and insertion of umbilical catheters before moving the infant from the resuscitation area to the NICU. Data were collected on 225 infants born less than 28 weeks gestation: 106 in the preprotocol group and 119 in the postprotocol group. Differences between the 2 groups were not statistically significant for birth weight and gestational age. There was a statistically significant difference in the number of infants with an admission temperature in-range (36.5°C-37.4°C) between the preprotocol and postprotocol infants (28.3% vs 49.6%; P = .002). There was a statistically significant difference in the incidence of admission glucose greater than 50 mg/dL between the pre- and postprotocol groups (55.7% vs 72%; P = .012). There was a highly statistically significant difference in the number of post-Golden Hour Protocol infants who received an intravenous administration of glucose and amino acids within 1 hour of life compared with the preprotocol group (61.3% vs 7%; P = 0.001). Our results suggest that the implementation of the Golden Hour Protocol can significantly improve the stabilization of infants delivered less than 28 weeks gestation.
“黄金一小时”这一术语借用于急救医学和心血管医学领域，指婴儿出生后的首个小时。本研究考察了在三级新生儿重症监护病房（NICU）对孕周小于28周的婴儿实施“黄金一小时”方案的影响，重点关注入院体温、入院血糖水平以及开始静脉输注葡萄糖和氨基酸的时间。作为一项质量改进项目的一部分，收集了2008年5月至2011年12月期间孕周小于28周的婴儿在实施“黄金一小时”方案前后的数据。预期目标是入院腋温在36.5°C至37.4°C范围内，入院血糖高于50mg/dL，且在出生后1小时内开始输注葡萄糖和氨基酸。“黄金一小时”的关键要素包括使用规范化脚本，明确产房人员的职责；将婴儿置于聚乙烯袋中以防止热量散失；在婴儿出生后10分钟内应用暖箱皮肤温度探头；以及在将婴儿从复苏区转运至NICU之前插入脐静脉导管。研究收集了225例孕周小于28周的婴儿的数据：方案实施前组106例，方案实施后组119例。两组在出生体重和孕周方面的差异无统计学意义。方案实施前和实施后的婴儿中，入院体温在目标范围内（36.5°C - 37.4°C）的婴儿数量存在统计学显著差异（28.3%对49.6%；P = 0.002）。方案实施前和实施后组之间入院血糖高于50mg/dL的发生率存在统计学显著差异（55.7%对72%；P = 0.012）。与方案实施前组相比，“黄金一小时”方案实施后在出生后1小时内接受静脉输注葡萄糖和氨基酸的婴儿数量存在高度统计学显著差异（61.3%对7%；P = 0.001）。我们的结果表明，实施“黄金一小时”方案可显著改善孕周小于28周的分娩婴儿的稳定情况。
