Amuji Nalina, Appaji Rao Shashidhar, Yemmethimmanahalli Nagaraju Prashantha, Gautham Suresh Kanekal, Steven Sofia, Bada Shekharappa Chandrakala
Neonatology, St John's Medical College Hospital, Bangalore, Karnataka, India.
Pediatrics, Nemours Children's Hospital, Orlando, Florida, USA.
BMJ Open Qual. 2025 Mar 23;14(1):e002277. doi: 10.1136/bmjoq-2023-002277.
The quality of care provided during the first golden hour after birth in preterm neonates significantly impacts both short- and long-term outcomes. However, implementation of these care processes varies across centres, is not standardised and affects the quality of care.
To improve the quality of care provided during the first golden hour in neonates born at <34 weeks' gestation.
This quality improvement initiative was conducted in a 30-bedded tertiary care teaching hospital in southern India over 28 months (April 2019-July 2021). Evidence-based interventions to improve admission temperature, respiratory care and administering parenteral nutrition and antibiotics during the golden hour were implemented through Plan-Do-Study-Act cycles in four phases for eligible neonates. The effect of these practice changes on clinical outcomes, including intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and survival ratewere studied.
A total of 311 eligible neonates were included in the study. Admission hypothermia significantly reduced from 79% to 22% (p=0.003), and adherence to the respiratory bundle improved from 13% to 77% (p<0.001). The time taken for administration of parenteral nutrition improved from 102±23 min to 62.5±26.7 min (mean±SD) (p<0.001). The median time for administration of antibiotics improved from 162 (135, 173) min to 74 (69, 102) min (median±IQR) (p=0.001) and improvement in mean blood glucose from 35 (12) mg/dL to 54 (14) mg/dL (mean±SD) (p<0.001) at neonatal intensive care unit (NICU) admission, and admission time to NICU from 66.4±16 min to 41±13.8 min (p<0.001).
Quality improvement project of improving care in the golden hour after birth in < 34 weeks neonates reduces admission hypothermia and hypoglycaemia and improves the time of admission to NICU, and time of administration of parenteral nutrition and antibiotics.
早产儿出生后首个黄金小时内提供的护理质量对短期和长期预后均有显著影响。然而，这些护理流程在各中心的实施情况各不相同，缺乏标准化，进而影响护理质量。
提高孕周小于34周的新生儿出生后首个黄金小时内的护理质量。
这项质量改进举措在印度南部一家拥有30张床位的三级护理教学医院开展，为期28个月（2019年4月至2021年7月）。通过计划-执行-研究-行动循环分四个阶段，对符合条件的新生儿实施基于证据的干预措施，以改善黄金小时内的入院体温、呼吸护理以及肠外营养和抗生素的使用。研究了这些实践改变对包括脑室内出血、坏死性小肠结肠炎、早产儿视网膜病变、支气管肺发育不良和存活率等临床结局的影响。
共有311名符合条件的新生儿纳入研究。入院时体温过低的情况从79%显著降至22%（p=0.003），对呼吸综合护理措施的依从性从13%提高到77%（p<0.001）。肠外营养的给药时间从102±23分钟缩短至62.5±26.7分钟（均值±标准差）（p<0.001）。抗生素给药的中位时间从162（135，173）分钟缩短至74（69，102）分钟（中位数±四分位间距）（p=0.001），新生儿重症监护病房（NICU）入院时平均血糖从35（12）mg/dL提高到54（14）mg/dL（均值±标准差）（p<0.001），且从出生到入住NICU的时间从66.4±16分钟缩短至41±13.8分钟（p<0.001）。
改善孕周小于34周新生儿出生后黄金小时护理的质量改进项目可降低入院时体温过低和低血糖的情况，并缩短入住NICU的时间以及肠外营养和抗生素的给药时间。
