Implementation of a Golden Hour protocol for initial management of preterm infants: a quality improvement study

Purpose
This study implemented and evaluated a systematic approach for managing preterm infants <31 weeks of gestational age (wGA) and/or estimated fetal weight (EFW)<1300 g during their first hour of life. The primary focus was organizational efficiency, thermal regulation, and hypoglycemia prevention, with secondary assessment of clinical outcomes and team perception.

Methods
A prospective observational study was conducted from January 2022 to July 2023 in a tertiary neonatal intensive care unit (NICU). Infants meeting inclusion criteria were compared with a retrospective 2019 control cohort. The Golden Hour (GH) protocol emphasized anticipation, role assignment, and early interventions, including umbilical venous catheterization (UVC), and parenteral nutrition (PN) initiation. Outcomes included procedural metrics (e.g., time to incubator closure, UVC placement) and clinical outcomes (e.g., hypothermia, hypoglycemia, mortality, and major comorbidities of prematurity). Team perception was assessed via survey.

Results

77 infants were included in the GH group and 72 infants in a retrospective control group. GH infants experienced less hypothermia (23/77 vs. 36/72 -
p
 = 0.03) and first blood glycemia evaluation was significantly earlier [43 (35–50) vs. 63 (53–77) min -
p
 < 0.001]. The median incubator closure time was 64 (58–71) min, close to the GH target of 60 min. Rates of hypoglycemia, mortality, and major comorbidities of prematurity (e.g., bronchopulmonary dysplasia, necrotizing enterocolitis) were similar between groups. Team members reported improved anticipation, communication, and job satisfaction following protocol implementation.

Conclusion
The GH protocol improved thermal regulation and team efficiency without altering clinical outcomes. Its positive effect on teamwork supports further evaluation in larger studies.