Implementation and Evaluation of "Golden Hour" Practices in Infants Younger Than 33 Weeks' Gestation

Brenda Wallingford, DNP, APRN-NP, NNP-BC; Lori Rubarth, PhD, APRN-NP, NNP-BC; Amy Abbott, PhD, RN; Linda J. Miers, DSN, RN, APRN-CNS


NAINR. 2012;12(2):86-96. 

In This Article

Abstract and Introduction


Upon review of Vermont Oxford Network data, a Midwest level III neonatal intensive care unit noted increased levels of chronic lung disease (CLD) in infants born at less than 33 weeks gestation. Initial analysis of delivery room practices with these infants showed great variance based on each provider's experience and knowledge. In an effort to standardize processes and to reduce the level of CLD within this subpopulation of infants, providers adopted "golden hour" practices focused on providing respiratory support (use of an inspiratory hold, early continuous positive airway pressure, and intubation criteria), oxygen targeting, thermal regulation, and teamwork. Compliance was tracked via delivery room documentation. Although this is an ongoing quality improvement project, examination at 3 and 6 months postpractice shows increasing compliance with the golden-hour practices. Furthermore, after 6 months of using golden-hour practices, there is a decreased incidence of CLD.


Prematurity is a leading cause of infant mortality. The cost of care for infants born prematurely in the United States is more than 26 billion dollars annually.[1] Prematurity is associated with long-term morbidities that include chronic lung disease (CLD), neurodevelopmental impairments (cognitive and motor delays), and visual disturbances. A review of Vermont Oxford Network (VON) data for a Midwest level III neonatal intensive care unit (NICU) revealed increased levels of CLD in very-low-birth-weight (VLBW) infants, defined as birth weight less than 1500 g (Table 1). A quality improvement project was developed to evaluate practices that could potentially reduce the incidence of CLD, to format and implement an educational plan, and to evaluate compliance with the established protocol.

Use of the Clinical Excellence Through Evidence-Based Practice model guided this quality improvement project.[2] In step 1, the clinical practice questions were identified from the VON data. To analyze the problem, an assessment of key components was undertaken (step 2). This assessment included evaluation of patient factors and clinical setting factors including an assessment of key stakeholders who were essential to the project's success. Furthermore, research into the potential causes of CLD and evidence-based practices to reduce its incidence was evaluated. This appraisal process led to the decision to promote "golden hour" stabilization practices and guided the process for protocol development, implementation, and evaluation.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.