Golden Hour Final Handout

GOLDEN HOUR
Dr. Shyama Basnayake MBBS, MD,DCH

Consultant Neonatologist
Lady Ridgway Hospital
Introduction
"Golden Hour" of neonatal life is defined as the first hour of post-natal
life in both preterm and term neonates.
The care received to babies within first few hours of life will produce
significant impact for their long term outcome
Aim-
stabilize and perform all procedures required within first hour after
birth for better long term outcome.
Components of Golden Hour (GH)
1. Antenatal counseling, team briefing

2. Delivery - delayed cord clamping (DCC)
3. Prevention of Hypothermia
4. Support to respiration
5. Support to cardiovascular system
6. Support for nutrition
7. Prevention of sepsis
8. Laboratory investigations
9. Monitoring/Record
10.Communication and counseling of family
11.Stabilization and transportation in the Golden Hour
1. Antenatal counseling and team briefing
• Gestational age and weight of delivery has shown strong association

with neuro-developmental outcome
• When a preterm delivery is planned, it is important that the

mothers/parents should be counselled prior to delivery to educate
them (regarding risks and possible complications of the preterm baby
to be born)
2. Delivery - delayed cord clamping (DCC)
•Delayed cord clamping (DCC) - defined as clamping of cord after stoppage

of placental circulation.
•The factors that determine the placental transfusion include cord clamping
time, uterine contractions, umbilical blood flow, newborn respiration and
gravity.
•The placental flow to fetus decreases rapidly after the neonatal birth;
• after three minutes of birth, placental blood flow becomes insignificant, by 5
minutes it absolutely ceases.
•There are multiple benefits of DCC
3. Prevention of Hypothermia
• Hypothermia is defined as temperature < 36.5 °C

• It is a dangerous problem in newborns especially in VLBW /ELBW
babies.
• Admission temperature in NICU is a strong predictor for neonatal
outcome & mortality.
• The highest risk of neonatal hypothermia is within the first minutes
to hours after birth as there is wide difference between in-utero and
environmental temperature.
4. Support of respiration
•goal of providing respiratory support - to help in smooth transition of

gas exchange from placenta to baby’s lung.
• Support of the respiratory system forms an important part of ‘Golden
Hour’ management.
• Resuscitation of preterm newborns should be started with 21 to 30% oxygen.
•At the delivery, resuscitate using room air in the absence of blended O2.
•Use of pulse oximetry is recommended .
•The goal of oxygen therapy is to achieve pre-ductal oxygen saturation as per the time
specific interquartile range recommended : at one minute 60-65%, two minutes 65-
70%, three min 70-75%, 4 min 75-80%, 5 min 80-85% and 10 min 85 -95%).
•Prophylactic CPAP commencing from the delivery room using T piece
devise(eg.neopuff) is beneficial for babies with mild to moderaterespiratory
distress.
• 5. Support of the cardiovascular system
• The goal of giving support to the cardiovascular system is to have a
• • capillary refill time of less than 3 seconds(<3 secs)
• • heart rate (100 -180/min)
• • acceptable Mean Blood Pressure; (MAP =gestational age), in all newborns.
• The first parameter that shows effectiveness of resuscitation is improvement in heart rate.
• Drugs - In situations where drug administration is needed (normal saline and adrenaline),
venous access should be established at the earliest, the umbilical vein being the easiest vein
to be cannulated.
• Investigations - blood lactate measurement .

• Bed side functional echocardiography (FE) when possible
6. Supporting nutrition
• This is a priority
• After admission to neonatal unit VLBW /ELBW babies should be
started on total parenteral nutrition (TPN) (dextrose, lipids and
protein) within the first hour of post-natal life
• Enteral feeding with mothers’ milk should be started within the
Golden Hour in the absence of contraindications (e.g. surgical
conditions).
7. Prevention and treatment of infection
• most important intervention - hand washing and using aseptic

precautions while handling the newborn
Minimal handling
sterile procedures
skin to skin contact and breast feeding soon after birth also help
• In a baby with risk factors for sepsis, blood culture should be drawn
(using aseptic precautions) and the first dose of antibiotic (as per unit
policy) needs to be commenced ideally during the golden hour.
8. Laboratory investigations
• needs individualization according to risk factors

• list includes complete blood count, blood culture, blood glucose and
blood gas analysis.
• In case of perinatal asphyxia cord blood arterial blood gas(cABG) or
ABG within the first hour will help us to decide on starting of
therapeutic hypothermia.
9. Monitoring/Record keeping
Following vital parameters should be monitored during the golden hour;
• Temperature ,heart rate, respiratory rate,

• capillary refill time(CRT),
• invasive/ non-invasive blood pressure,
• where applicable - oxygen saturation, blood sugar, venous blood gas analysis
• These should be monitored and recorded in the newborn case record.
• interventions done should be recorded with their timing .
• Record keeping includes Apgar score, interventions done during resuscitation, birth
weight, axillary temperature (at time of admission to nicu), and timing of all
interventions done during the golden hour.
10.Stabilization and transportation in Golden
Hour
• In Golden hour, the neonate should be first stabilized prior to transportation;

• Establish and maintain respiratory support
• Establish and maintain circulation
• Check blood oxygenation (by O2 saturation monitor and/or blood gas analysis)
• maintain normal temperature by resuscitating under a warmer .
• check & maintain normal sugar levels
• necessary interventions should be done to support heart, lungs and brain.
• All sick/preterm newborns should be transported in a pre-warmed, well-
equipped TRANSPORT INCUBATOR with a T-piece .
11. Handing over baby and stabilization at NICU
• At NICU, a brief clinical history of mother & baby’s birth history should
be noted
• This information should be given by the transporting team(doctor and
a nurse) accompanying the baby to the NICU.
• It is important to note, the baby may become destabilized during
transport
• Stabilization at NICU - if the baby has respiratory distress, respiratory
support should be instituted immediately.
• Body temperature, blood sugar & blood pressure should also be
checked & interventions done when needed
Communication and counseling of family
• This is an important aspect of the Golden Hour

• includes talking with parents/relatives of newborn to updatehe
postnatal condition of newborn
• should be done by the senior most medical officer available at the
time
• consultant should be involved in complicated scenarios as soon as
possible.
Summary
• Parents should be counseled regarding imminent delivery of preterm/high risk baby

• At Delivery – perform DCC if neonate does not require resuscitation
• use plastic wrap/bag for ELBW babies
• Keep baby warm- dry thoroughly, use cap to cover head
• initiate breast feeding within the first hour of life (if baby does not require intervention)
• record all vital signs and procedures done during resuscitation
• perform blood sugar and blood pH (from UVC sample if available), if resuscitation needed
• Stabilize baby before transfer to the NICU
• start CPAP in labour ward for ELBW babies and also for babies in respiratory distress
• hand over baby to NICU staff with proper records and communication
• communicate with parents regarding baby’s condition

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GOLDEN HOUR

Dr. Shyama Basnayake MBBS, MD,DCH

1. Antenatal counseling, team briefing

• Gestational age and weight of delivery has shown strong association

• When a preterm delivery is planned, it is important that the

•Delayed cord clamping (DCC) - defined as clamping of cord after stoppage

• Hypothermia is defined as temperature < 36.5 °C

•goal of providing respiratory support - to help in smooth transition of

• Investigations - blood lactate measurement .

• most important intervention - hand washing and using aseptic

• needs individualization according to risk factors

Following vital parameters should be monitored during the golden hour;

• Temperature ,heart rate, respiratory rate,

• In Golden hour, the neonate should be first stabilized prior to transportation;

• This is an important aspect of the Golden Hour

• Parents should be counseled regarding imminent delivery of preterm/high risk baby

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