What does the “golden hour” mean in the NICU?
What do NICU nurses do in the “golden hour”?
In healthcare, the phrase “golden hour” refers to a period of time during which interventions are made to improve the outcomes of a patient. In the NICU, “golden hour” refers to the first hour of an infant’s life after birth.
THE GOLDEN HOUR
Preterm infants are a particularly vulnerable patient population, especially during the hour immediately after delivery. During this period, they are at high risk of complications like:
Hypothermia
Hypoglycemia
Breathing challenges
Early-onset sepsis
Clinicians are responsible for intervening early during an infant’s life to prevent these complications and ensure they get the care and treatment they need. When hospitals around the country recognized that they weren’t meeting benchmarks for early intervention, many perinatal teams developed lean methodologies and process improvement techniques to standardize the care that infants receive immediately after birth.
Studies show that facilities that incorporate the concept of the “golden hour” into their perinatal practices see significant decreases in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) diagnoses. To give you a better understanding of the type of care provided during the “golden hour” we’ll discuss what occurs during this period from the NICU nurse’s perspective.
The phrase “golden hour” is used to raise awareness of the risks of birth complications and explain how intervening early can make a significant impact on an infant’s expected outcomes.
What Conditions Are Treated in the NICU?
Patients are admitted and treated for all sorts of conditions, depending on their gestational age. These include but aren’t limited to:
Complex birth defects or abnormalities
Gastroesophageal reflux (GERD)
Metabolic diseases (hypoglycemia, hypothyroidism, etc.)
Seizures/Epilepsy
Sepsis
What Tasks Do Nurses Complete During the “Golden Hour”?
NICU nurses have a checklist of things that need to get done to ensure the health and wellbeing of their newborn patients. Generally speaking, this involves preparing for infant delivery, completing a thorough newborn assessment, and ensuring the family is updated on the health of their new baby. Five critical areas are assessed: respiratory status, cardiovascular function, neurological response, fluid and glucose levels, and body temperature.
Based on the nurses assessments in these categories, the infant’s health status and acuity is determined: the red (acute) zone requires immediate interventions, the yellow zone requires close monitoring, and the green zone requires minimal intervention outside of the basic newborn screening.
I review the NICU nurse checklist for the golden hour that I go through below, but be aware that each facility may tailor their golden hour checklist to their unique department and patient population.
Prior to Infant Delivery:
1. Ensure an isolette is present at the bedside.
2. Turn on the isolette warmer to heat the mattress and incubator air.
3. Attach ECG electrodes, pulse-ox probe, and temperature probe to the patient monitor
After Infant Delivery:
4. Collect vital signs (heart rate, respiratory rate, temperature, blood pressure).
5. Intubate or place on oxygen, if necessary
6. Collect newborn measurements (head circumference, length, weight, and abdominal girth).
7. Suction the nose and mouth.
8. Perform a thorough newborn physical assessment.
9. Check for nare/throat patency, the presence of a sacral dimple, and anal patency.
10. Place an IV (UVC/UAC or peripheral IV).
11. Collect labs, if necessary (CBC, Type & Cross, MRSA, Blood Cultures).
12. Draw a blood glucose.
13. Start antibiotics or vasoactive medications, if necessary.
Once the Infant Is Stabilized:
14. Review the patient’s maternal history.
15. Review and acknowledge any new orders.
16. Orient the infant’s mother & father to the unit and their infant’s condition.
17. Administer eyes & thighs (Erythromycin and Vitamin K).
18. Document all interventions in the medical record.
Are there Any Additional Care Recommendations for Extremely Premature Newborns?
Neonatologists recommend performing the following interventions for extremely premature newborns (before 28 weeks gestational age) during the first 72 hours of life:
Keep their head in a midline position.
Elevate the head of the bed at least 30 degrees.
Complete assessments and cares with two nurses (one person completing tasks, the other keeping the baby contained and warm).
Do not raise legs with diaper changes.
No daily weights or abdominal girths (usually hospitals will opt to record these measurements weekly).
Minimize handling, suctioning & movement.
With UAC lab draws, 40 second pull/40 second push per 1ml (set a timer!).
No peripheral BP’s if UAC line present.
No prone positioning or skin-to-skin holding (encourage “hand hugs”).
Swab the infant’s mouth with colostrum.
Administer surfactant to assist with lung development and maturity.
Infuse a loading dose of caffeine in the first 24 hours of life, then a maintenance dose starting the following day.
For additional resources on providing safe newborn care, check out the following articles:
Complex decisions are based on Diagnoses, Age, & Weight!
NICU Nurse Essential Resources
March of Dimes! Resources for parents & providers
Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, Sponsored Capella University MSN student, a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com