The Golden Hour:

Care of the LBW Infant

During the First Hour of Life
One Unit's Experience
Regina D. Reynolds. RNC-NIQ BSN
Jokth Pilcher, RNC-NIQ MS
Ashley Ring, RNC-NIC
Rose Johnson, RNC-NIC
Pamela McKinley, RN, BSN

IP

The Neonatal Resuscitation Program (NRP) is designed

to teach providers how to care for infants after delivery. The
^ infants born in the U.S. continues to increase each
fifth edition of the NRP incoryear. LBW infants made up 8.2
porated additional guidelines for
percent of all births in 2005, and
care of the premature inf^int.^
ABSTRACT
very low birth weight (VLBW)
A study, published in 2000 by
Cnrc practices during rlic first hour of life, the Golden
infants (<l,500 g) accounted tor
Carbine and colleagues, identiHour., can have a signilicaiit impact on outcomes of
1.49 percent of all U.S. births.'
fied sliortcomings in adherence
low
birth
weight
infants.
Although
the
latest
edition
of
Lower birth weight and delivery
to NRP guidelines, includthe Neonatal Resuscitation Program added guidelines
before 28 weeks gestation are
ing improper technique with
for prctcrni infants, additional care is often indicated.
key predictors of mortality and
Complications that eoiild potentially he impacted hy
procedures such as suctioning
long-term morbidities sueh as
care in the Hrst hour of lite include tliermoreguhition,
and positive pressure ventilaintravententricular hemorrhage
intraventrieular hemorrhage, ehronic lung disease, and
tion as well as missed steps,
(IVH), chronic, lung disease
retinopathy of prematurity. Our unit has implemented
such as re-evaluation.'* Another
(CLD)., and retinopathy of preand revised a Golden Hour evidence-based care process
study demonstrated that varithat includes the use of realistic videotaped simulations,
maturity (ROP).ance from guidelines was often
followed by team debriefing sessions. Early results of
The first hour of life plays a
associated w ith teamwork issues
the revised proeess show reductions in the targeted
critical role in the outcomes of
such as communication and
complications.
LBW infants. In our work at tiie
leadership.^
Vermont Network to improve
^^"^^
We describe an approach
patient outcomes by focusing on
to
care during the Golden
interventions in the first hour of
Hour
that
encourages
consistency
and collaboration with
life, we began using the phrase "the Golden Hour," taken
the
overall
goal
of
minimizing
long-term
complications.
from literature on adult trauma about the critical first hour
Objectives
of
the
Golden
Hour
process
are
to implement
of treatment. Care practices during this first hour should
consistent
care
practices.
Goals
of
the
education
and implefocus on minimizing complications. Teamwork, consistent
mentation
process
include
enhanced
clinical
judgment
and
care, and application of evidence-based practices can improve
teamwork.
quality of care during the Golden Hour.'"*'
I

HE NUMBEROF PRETERM AND LOW BIRTH WEIGHT ( L B W )

Accepted tor publication July 200S. Revised August 2008.

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TABLE 1 Heat Loss and Preventative Strategies

Mechanism
of Heat Loss
Conduction

Convection

Radiation

Evaporation

Definitions

Preventative Strategies

Heat is lost from internal organs

to the skin surface, and heat
is lost from the skin to cool
surfaces it comes in contact
with.

Preheat warmer

Heat is lost when moving air or

water carry it away from the
body.

Prewarm delivery room

Prewarm linens
Use thermal mattress
Place two caps on infant's head
Move bed away from drafts
Warm inspired air

Heat is lost in the form of

electromagnetic waves as it
disperses to nearby cold walls,
windows, or other surfaces.

Provide radiant warmer

Heat is lost from wet skin and the

respiratory tract due to vapor
pressure gradient loss.

Dry infant

Locate bed away from coot

windows
Prewarm transport incubator
Remove wet linens
Use plastic bags or wraps over
infant's body

hypothermia due to their thin skin, high ratio of

body surface area to weight, increased insensible
water loss, lack of insulating and brown fat, and
extended positioning."*"^'
Studies have demonstrated that 66-93
percent of VLBW infants are admitted to the
NICU with hypothermia.^^'^^ A primary goal in
care of LBW infants is to maintain a stable temperature, and associated practices in the delivery
room include increasing the ambient temperature, prewarming the bed and linens, using a
chemical mattress for additional heat, immediately drying the infant and removing wet linens,
using a plastic bag to reduce evaporati\e cooling,
applying two caps to the head, and promoting
a tucked position.^^'^*"^^ These practices are
listed in Table 1 along with the mechanisms by
w hich they prevent heat loss in infants.

Adapted from: Cuyton, A., & Hall, J. (2006). Textbook of medical physiology (11 th
ed.). Philadelphia: Saunders; and Nadel, E. (2003). Regulation of body temperature.
In W. Boron & E. Bouipaep (Eds.), Medical physiology {pp. 1231-1241). Philadelphia:
Saunders.

Intraventricular Hemorrhage
The incidence of germinal matrix hemorrhage and IVH increases with decreasing gestational age and birth weight. The highest
incidence occurs in infants weighing less than
1,000 g.-'''-'" Infant condition and care pracWe begin by addressing neonatal complications that may be affected by care practices tices during the first minutes of life may trigger
during the first hour of life: complications of a cascade of events that can result in altered
neurologic status."^' Although the precise time
hypothermia, IVH, CI.D, and KOW Incltidcd
are evidence-based practices as they can be that IVH occurs is not known, as many as 50
applied during the Golden Hour. We also percent of cases are evident on the first day of
provide a detailed description of our unit's iife.-'2-^*
experience with developing, implementing, and
Onset of IVH has been associated with
updating a Golden Hour process of care.
hypoxia, respiratory distress, and mechanical ventilation.^^ Of particular interest arc the
deleterious effects of oxidative stress on the
NEONATAL COMPLICATIONS AND
brain.^^'"' Additional factors associated with
EVrDENCE-BASED PRACTICES
IVH include fluctuations in cerebral perfusion
FOR THE GOLDHN HOUR
pressure triggered by changes in blood pressure,
Hypothermia
Thermorgulation has been described as the blood transfusion and replacement, cold stress,
cornerstone of neonatal care."* Hypothermia head positioning, and pain.-^'''***
can have deleterious effects on the premature
In 2003, Carteaux and colleagues recominfant including altered pulmonary vast)motor mended potentially better practices to minitime, altered cerebral bloodfltiw,hypoglycemia, mize IVH during the first hour of life. These
hypoxia, acid-base imbalances, hypotension, and
include having an experienced team in the
hypovoiemia.""''^ Lactic acid accumulation can delivery room, maintaining body temperature
lead to permanent tissue and brain damage as at or above 36''C, maintaining cardiovascuweil as increased mortality.^^-'^
lar stability during surfactant administration,
Attaining and maintaining an adequate tem- optimizing respiratory support by avoiding
perature for premature infants in the first hour hypocapnia and routine suctioning, using
of life can be a challenge. Newly born infants intravenous volume replacement judiciously,
are at risk for heat loss through evaporation, maintaining a neutral head position, and
convection, radiation, and conduction mecha- implementing developmental care practices to
nisms. '^'^'' Without measures to prevent heat loss, minimize stress and pain."*'
hypothermia and cold stress can ensue. Preterm
More recent evidence focuses on minimizing
infants are at higher risk than term infants for effects of oxidative stress on IVH."'*^ Studies

NEONATAL
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of resuscitation comparing 100 percent oxygen

ro room air"*"' or 40 percent oxygen** suggest
that initial use ot" pure oxygen may not be
optimal. Use of pulse oximetry in the delivery
room can assist clinicians in decisions regarding
oxygen adjustments in tiie period immediately
after birth. Although optimal oxygen saturation limits have not been determined, a\'oiding
hyperoxia has been associated w ith improved
outcomes.*^
Chronic Lung Disease
CLD has been dcfmed as infants needing
supplemental oxygen beyond 36 weeks postconccptionai age, It occurs most commonly in
premature infants who have needed mechanical ventilation and oxygen therapy for acute
respiratory distress."*^ Even minimal exposure
to oxygen and mechanical ventilation has been
demonstrated to contribute to CLD.*^
The initial breaths administered in the delivery room may have a significant effect on development of CLD. Delivery of an LBW or VLBW
infant can be a stressful situation, during which
time excessive ventilation can inadvertently
occur. One animal study demonstrated that even
six manually deli\ered breaths can cause lung
damage in lambs."^' This finding challenges the
practice of vigorous manual ventilation during
neonatal resuscitation.
The Vermont Oxford Network improvement
collaborative recommended practices that may
decrease the incidence of CLD.*** Several of
these should occur in the delivery room,, including permissive hypercapnia, early surfactant
.administration, use of a T-piece resuscitator,
and titration of oxygen. Studies also indicate
the importance of each unit evaluating its own
practice and developing standardized protocols
for the delivery team.'*^
Retinopathy of Prematurity
Although multiple factors have been associated with ROP, the known risks include prematurity and low birth weight/'''' Neonatal hyperoxia
has also been described as playing a signifiicant
role in the development of ROP.^''^^ One study
demonstrated a decreased incidence in ROP by
changing practices with oxygen administration
and monitoring: Pulse oximetry was initiated
ill the delivery room., the maximum saturation
limit for LBW infants was set at 93 percent, and
oxygen concentration {FO2) was adjusted in
small increments.^-^ These findings suggest that

TABLE 2 Golden Hour Temperature Outcomes

Pre-Golden Hour

Initial Golden Hour

Revised Golden Hour

January 1999 to
December 2000

February 2001 to
July 15, 2007

July 16, 2007, to

January 31, 2008

n = 245

n ^ 1,091

n = 103

Mean birth weight

(g)

988.56 286.56

972.85 299.36

1,022.23 382.7

Mean gestational
age (weeks)

27.50 2.39

27.22

27.48

Mean initial
admission
temperature ( X )

36.04

36.56

36.68

Median initial
admission
temperature (C)

36.15

36.65

36.70

Standard deviation
initial admission
temperature CQ

0.81

0.82

0.65

Infant
Characteristics

Statistical
significance

2 8 , N O ,4 .J U L Y / A U G U S T

2009

,0001 = yes

.0001 = yes

Extremely significant

Extremely significant

avoiding hyperoxia may result in improved ROP

outcomes.
DEVELOPING AND
IMPLEMENTING A GOLDEN HOUR
TEAM: ONE UNIT'S EXPERIENCE
Building on a literature review, our own
experience, and input from our participation in
the Vermont Oxford Network Collaborative, we
created a stepwise approach to the management
of infants during the Golden Hour in 2000.
A flow chart was developed to highlight key
thermorgulation and ventilatory management
processes., including permissive hypercarbia.
A dedicated resuscitation team was formed to
attend all inborn deliveries of infants less than
32 weeks completed gestation or l.,500 g. The
team included neonatologists, neonatal nurse
practitioners, nurses, and respiratory therapists.
Education on role expectations, responsibilities,
and the Golden Hour process was completed.
All infants less than 32 weeks completed gestation or 1,SOO g were delivered in one of two
operating rooms with access to the newborn
stabilization room. The newborn stabilization
room w as kept at a consistent \\ arm temperature
and had all supplies needed for the resuscitation
process. The first flow chart was implemented
in February 200L Data collected after implementation was favorable, and our most significant improvement was admission temperature
(Table 2).

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FIGURE 1 Delivery attendance algorithm.

NICU Delivery Attendance

LssB than 35 iveeks gestation

Emergency C section
Multiple gestation greater
than 2
Msconium (Ihick)
Major oongenital anomalies
(ijiaphragrrratic riemia. CHD,
hydrops)
NonreasBudng fetal heart
pattems
RequoBtof LDRN, or
attending 0 8

V 35 iivaeks gestation
or greater bul less Ihan
37 weeks gestauon

C-sections wiltioul
complications

i * Twin delivery
> Meconium (thin)
'/ Breech
> PROM
'f Chonoamnioitis
j " Forceps/vacuum
' Fetal arrhythmia
i - Polyhydrarrnios
" Oligohydramnios
> Maternal MGSO,

' L&D lo aocument order for

neonatoiogy consuilallon In
patient's chart

In 2003, the team received updated education on use of the T-piece resuscitator, chemical
warming mattress, earlier dosage of surfactant,
and improved developmental interventions.
During 2004, the NICU experienced substantial growth. As a result, the management team
decided to transition from a dedicated team
of staff members to all Level III staff attend
ing these high-risk deliveries. New physicians,
nurse practitioners, and nurses did not receive
the focused training that the original team
had, and compliance tell. The introduction of
new evidence-based practices and updated NRP
guidelines necessitated that the Golden Hour
flow chart be revised and an updated education
component be offered to all Level III staff

for newer nurses. For these reasons, the task

force resolved to continue w Ith all Level III staff
members attending these deliveries.
The original Golden Hour process was
designed for delivery of infants who were less
than 32 weeks gestation in the operating room
with aecess to the newborn stabilization room
and all the supplies that the NIC^U team needed.
However, this limited family support for miither
and baby. In an effort to provide family-centered
care, many of the obstetricians in our facility
wanted to deliver VLBW infants in the labor
and delivery riioms. The neonatologists agreed
that more of our infants could be safely cared
for in these rooms. The task force decided that
infants 28 weeks or greater could be delivered in
the labor and delivery rooms. To ensure availability of equipment in all of our 18 labor and
delivery rooms, team members identified items
that would be added to all rooms and items that
could be made mobile to move into the room as
needed. As the current NRP reeommends, an
oxygen blender and pulse oximeter were added
to all labor and delivery rooms for care of infants
less than 32 weeks. Equipment and supplies
needed for immediate resuscitation and surfactant administration were placed in tackle boxes
that team members could bring to the rooms
for use during the delivery. A T-piece resuscitator was mounted on a pole with wheels to easily
move to the dcli\'cry room.
The team made neeessary changes to the flow
chart to reflect current NRP guidelines as well
as new evidenee-based care.
The task force also developed a delivery attendance guideline and decision chart to clarify who
should attend specific deli\eries (Figure 1). This
deli\ery attendance guideline is also meant to
provide consistency in the delivery room, with a
transport team nurse at every high-risk delivery.

With a multidisciplinary, multi-unit approacli

in mind, our NICU leadership developed a task
Simulation-Based Learning
force to revise our Golden Hour process. The
The task force members wanted to ensure that
goal of the revision w as to pro\ ide evidence-based all NIC;U staff had the neccssar)' preparation to
care for these high-risk patients while still sup- implement the new Golden Hour flow chart.
porting the facility's family-centered approaeh. Our facility admits an average of one to three
This is especially challenging in an 83-bed
VLBW infants per month. This does not present
NICU with over 200 staff members and 1,000 enough opportunities to allow staff to observe
admissions annually. Our original approach to new techniques bcfi)re using them on a patient.
the Golden Hour process was to train a select With approximately 200 staff to train, the team
team of our most experienced nurses to attend agreed that a short didactic session accompanied
high-risk deli\eries. Although this approach was by simulation-based learning v^'ould be optimal.
successful in meeting certain (>bjecti\es, it conSimulation-based learning invilves the use of
tributed to poor staff morale, was problematic mannequins in a realistic setting and scenario to
for unit scheduling, and did not foster growth improve behavioral and technical skills.*^* The

NEONATAL
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FIGURE 2 m The Golden Hour resuscitation flow chart.

L&cD staff places call to NICU for 23 to 32-week gestation delivery
23-27 weeks gestation
OR for delivery

28-32 weeks gestation

OR/LDR for delivery

1. Intubate, if indicated. Insert ETT to cm marking that equals 6 +

estimated weight in kg
2. Weigh infant on bed scale (if in resuscitation room)
3. Attach T-piece resuscitator (Neopuff) to ETT and begin ventilation,

NICU unit assistant activates NICU team via cell phone with OR/LDR #
of delivery

generally at a rate of 40
4. Wean FO2 for oxygen saturation (85-92)
5. Use visual signal for heart rate
6. Place hydrocolloid barrier on cheeks prior to securing ETT

NICU team (NNP/MD, RN, RT) responds to cell phone notification;

reports to appropriate OR/LDR.

7. Verify equal breath sounds

8. Place fresh, warm blanket on warmer
9. Place 2 caps (layered effect) on infant's head

L&D team ensures that the room is set as close to 80 degrees as

possible. NICU team verifies.

1. Set transport ventilator settings

2. Place infant in prewarmed transport incubator
3. Close incubator and close all portholes

1. Preheat warmer (37Q

4. Transport to NICU

2. Ensure transport ventilator is securely mounted and tank is full

3. Activate chemical warming mattress and place in warmer

5. Complete Golden Hour tracking form for internal quality

improvement
6. Place completed form in "mail safe" in the NICU

4. Place 2 infant hats under chemical mattress

5. Obtain warm blankets from warmer
6. Place warm blanket and warm blanket roll/nest on chemical
mattress
7. Check/prepare resuscitation equipment
8. Set blender at 40% (adjust per O2 saturation: 85-92)
9. Set up T-piece resuscitator (Neopuff) to blenderpreset desired
settings
10. Cut hydrocolloid barrier

1. Receive infant from OB in warm blanket

Monitor Outcome Measurement/Process Assessment

1. CO2 40-60 mmHg
2. Oxygen saturation 85-92%
3. Admission temperature 97-99 F
4. Surfactant administration within 1 hour
Administer surfactant if infant is <27 weeks gestation when
HR >100 beats per minute
Instill surfactant in a quick, steady bolus
Split the dose in half; administer by tilting infant to each side
5. Decreased incidence of Grade 3 or Grade 4 IVH

2. Place infant under preheated radiant warmer

3. Dry infant thoroughly and remove wet linen
4. Apply pulse oximeter probe and temp probe and place on servo
control

foundation of simulation-based learning is active participation in realistic scenarios that are video recorded and immediately reviewed by participants with constructive debriefing.^^
Several team members visited the Center for Advanced
Pdiatrie Education in Stanford, California, to gain experience with simulation-based learning.
Simulation-based learning was new to our facility. Task
toree members took care to assure that all participants were
informed about the proeess, especially the aspect of construe
tive debriefing. The task force wanted to introciuce this type
of learning to the staff as a sate, nontlircatening approach to
skill acquisition. Participants were video recorded onlyforthe
purposes of their training, and no recordings were saved or
\ iewed by other staff. Participants completed self-evaluations

:NEONATAL
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to curtail feelings of being serutinized by facilitators. All

Level III staff members were required to complete one neonatal Golden Hour scenario as part of clinical competencies.
Our goal was to move from the lowest levels of learning to
the highest using Bloom's taxonomy of the cognitive domain.
This learning theory states that critical thinking begins with
comprehension, application, and knowledge, which are part
of the lowest levels. From the lowest levels, one adds evaluation, analysis, and synthesis skills to progress to the higher
levels of cognitive thinking.^^ Previously, our staff had participated in mock codes, but they had not been video recorded
and little was done to suspend disbelief The plan for our
new Golden Hour simulation scenarios was quite the opposite. Simulation-based learning is effective only when the

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215

FIGURE 3 The Golden Hour tracking form.

(Internal Ql form^place in NICU mail safe by assignment board).
For all infants <32 weeks, born at.
Delivery Location:

Golden Hour Team:

LDR Room #

MD

0R#

RN

Other:

ANP

.RT_
Debriefing Documentation

Room temperature set as close to 80F as possible

Warmer preheated at 37C

Barriers to effective delivery room management:

Chemical mattress activated & placed in bed

Two hats under chemical mattress
Warm blankets placed in nest position
Resuscitation equipment checked/ready
Preset NeoPuff and set blender at 40%
Dried infant thoroughly and removed wet linen

What went really well?

Applied pulse oximeter probe St temp probe

Bed changed to servo control
Applied FO2 for oxygen saturation 85-92%
Hydrocolloid adhesive on upper lip prior to
securing ETT
Two caps placed on infant's head
Infant placed in prewarmed transport incubator
Team debriefing before transport
NICU delivery nurse to complete above checklist and summarize debriefing discussion. Please place completed form
in the mail safe prior to the end of your respective shift. If any item is not checked on checklist, elaborate on back of
page.
NICU delivery nurse completing above checklist:
Courtesy of Baylor University Medical Center.

participants are made to think and feel as if they

are working in a real environment.'^'* Acting in a
realistic emt)tional and cognitive setting allows
them to make mistakes and see the outcomes of
their actions. DebricHng by reviewing the \ ideo
recording is done immediately, allow ing participants to see themselves in real time and evaluate their chosen actions in a safe and supportive
environment. This type of active participation
has been shown to increase skills and optimize
retention of the gained knowledge.^*
GOLDEN HOUR FLOW CHART
Our current Golden Hour ilow ehart is shown
in Figure 2. The first section added our familycentered focus of delivering infants at or greater
than 28 weeks completed gestation in the labor
and delivery rooms. This is followed by activation of team and equipment/supply preparation.
The remaining sections focus on inter\entions

NEONATAL
2 16

to prevent hypothermia and support ventilation

and oxygnation.
Thermorgulation Aspects of the Flow Chart
Given its importance in netmatology., thermorgulation is included in many sections of the
flow chart. Linder the original Golden Hnur
process, if the patient was to be delivered in a
labor room, staff members increased the room
temperature to 80F when delivery was imminent. The radiant warmer was preheated and a
chemical warming mattress was activated. Warm
blankets \\'ere used to create a nest and double
hats were utilized. The infant was dried thor(Highly and wet linens were removed, and then
two layered hats were applied to the infant's
head. Because there are no bed scales in the
labor rooms, weight was not obtained until the
infant was placed in a bed in the NK^U. Infants
arc usually admitted to the NICU within

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VOL.

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15 minutes of life; therefore, the Golden Hour process continued in a different location.
Our data from the original Golden Hour process indicated that VLBW and LBW infants were being admitted to
the NTCU with an acceptable temperature. The task force
agreed that no change needed to be made during delivery
room management, but it agreed to consider the addition
of a plastic covering or bag for the infants if outcome data
changed.
Temperature after admission and during the first one to
two hours was less consistent under the original Golden Hour
process. The didactic education for staff focused on impro\ing thermorgulation after admission. Infants are admitted
to our NTCU into a prewarmed combination warmer/incubator bed. Historically, the hood was closed after umbilical
line insertion and radiology confirmation of line placement.
However, based on the manufacturer's guidelines, our practice changed, and the incubator was not closed until the
infant's temperature had been stable for a minimum of one
hour. During this time, we maintained temperature with the
continued use of a thermal mattress and plastic wrap on the
infant. Once the hood was closed, these items were left in
place until the incubator temperature rose.
Ventilatory Management Aspects of the Flow Chart
With a goal of decreasing CLD, IVH, and ROP, our unit
focused on ventilatory management and oxygnation. As part
of the Vermont Oxford collaborative, we implemented the
potentially better practices described by Carteaux and colleagues in the initial version of the Golden Hour flow chart.'*^
The current NRP guidelines state that ventilation with pure
oxygen may not be optimal and that physicians may choose
to resuscitate with less than 100 percent oxygen. Our neonatology physician group decided to begin with 40 percent.
The T-piece resuscitator was to be usedforventilation given
its ability to provide consistent pressures. A pulse oximeter
was used to guide oxygen adjustments and maintain O2 saturation between 85 and 92 percent.
Monitoring Outcomes
The resuscitation team completed the Golden Hour tracking form upon admission of the infant (Figure 3). The tracking form includes outcome data from the infant as well as
a short debriefing on team performance. Our initial results
in the first six months after the most recent changes in the
process indicate improved outcomes in the areas of CLD and
ROP.
LESSONS LEARNED CONTINUOUS
QUALITY IMPROVEMENT
This article describes one unit's experience of implementing a Golden Hour process. The primary focus was on training staff using simulation-based learning with debriefing.
Once the Golden Hour simulation scenarios were completed, we conducted a survey to determine the acceptability

:NEONATAL
VOL. 2 8 . N O . 4, JULY/AUGUST 2009

of simulation by our staff. We found that 81 percent of our

nursing staff had some knowledge of what simulation-based
learning was prior to the Golden Hour scenario. Some of our
newer nurses had experienced it in nursing school. The majority iJ7 percent) responded that they were easily able to apply
the knowledge gained in the Golden Hour scenario to their
practice. Although one-third of the nurses were uncomfortable with being %ideo recorded, most stated that the camera
faded into the background as the simulation proceeded. Onethird of the nurses were unable to debrief using the video
recording due to lack of time or camera malfunction.
Suspension of disbelief was accomplished for the majority
of the nurses. Most responded that the Golden Hour scenario
was far more realistic than any previous mock codes they had
participated in, citing that the scenarios were conducted in an
actual labor and delivery room with all equipment available
for use. Responses on the survey were generally positive and
revealed that the staff did progress along Bloom's taxonom\'
of cognitive domain. Staff is more able to reproduce learned
beha\ iors and skills in the clinical setting \\ ith this type of
training environment than after previous training sessions.
We have discovered that there is a need to upgrade our
audiovisual ec]uipment and improve the training on that
eciuipment. Our facilitators \\'ould also benefit from additional training on debriefing and creating a comfortable and
sate learning atmosphere. Our Women's & Children's Service
Line has formed a multidisciplinary group that has attencHed
a training course geared tt) teaching medical professionals
how to set up and etectively run a simulation lab. With that
team in place, our simulations should improve. LTltimately,
our service line will have a fully functioning simulation lab
that will address the above issues and those that arise in the
future.
SUMMARY
Research indicates that care practices during the first hour
of life can have a significant impact on outcomes of LBW and
VLBW infants. This article is a review of neonatal complicaticns and evidence-based care practices for this Golden Hour.
One unit's experience witli de\'eloping and revising a Golden
Hour care process based on the evidence has been outlined.
Simulation-based learning with debriefing was an important
factor in the implementation process. Input frt)ni nursing
staff indicated perceived improved ability to reproduce skills
after this type of learning. Additionally, initial patient data
results indicate decreased incidence of ROP and CLD after
implementation of the revised Golden Hour process. ^

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4 L Carteaux, P., Cohen, H., Check,}., George, ]., McKinley, P., Lewis, W.,
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Jobeth Pilcher is the NICU nurse educator for Baylor University

Medical Center in Dallas. She received her BSN from Baylor University
and her MS from California College for Health Sciences. She has published several manuscripts and is currently enrolled in a doctorate of
education projjram.
Ashley Rini is a staff nune in the NICU at Baylor University
Medical Center in Dallas. She received her BSN from the University of
Missouri. Her experiences include unit supervisor, unit and housewide
pain couneil, neonatal PICC insertion team, and Baylor Simulation
Development Team.
Rose Johnson is the clinical manager of the NICU at Baylor
University Medical Center in Dallas. She received her BSN from the
University of Texas at Arlinjiton. Rose has many years of NICU manaement experience in both Level II and III units.
Patnela MeKinley is the data outcomes specialist for nconatolojfy,
Baylor Health Care System. She reeeived her BSN from Northwestern
Louisiana State University. Her career experiences include NICU
stain, neonatal transport, perinatal outreach, and various research
position.^:. She has published several manuscripts.
For Hirtlicr information, please contact:
Regina D. Reynolds, RNC:-NIC, BSN
Baylor University Medical Center
.^500 (.iaston Avenite
Dallas, TX 75246
E-mail: gina.reynolds@baylorhealth.edu

49. Hobar, I. D., Carpenter, J. H., Buzas, J., Soil, R. F., Suresh, G., Bracken,
M. B., et al. (2004). Timing of initial surfactant treatment for infants
23-29 weeks' gestation; Is r()utine practice evidence based? Pediatrics,
113, 1593-1602.
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Risk factors in retrolental fibroplasias. Pediati-ics, 65, 1096-1100.
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Landers, M. B. (1997). Supplemental oxygen may decrease progression
of prethreshold disease to threshold retinopathy of preEiiaturity. Journal
of Perinatohjiy, 17, 434-^r38.
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G., et al. (1977). PaOj levels and retrolentat fibroplasias: A report of the
cooperati\'e stitdy. Pediatrics, 60, 655-668.

go[ bflbies?

me gor onsiuers!

53. i:hcm\ L., Wright, K. W., & Sola, A. (2003). Can changes in clinical
practice decrease incidence of severe retinopathy of prematurity' in very
low birth weight infants? Pediatries, 111. 339-345.
54. Murphy, A. A., & Halamek, L. P. (2005). Simulation-based training in
neonatal resuscitation. NeoRcvicws, 6, e489-c492.
55. Yeager, K. A., Halamek, I.., Coyle, M., Murphy, A., Anderson, ]., Boyle,
K,, et al. (2004). High-fidelity simulation-based training in neonatal
nursing. Advanees in Neonatal Can; 4, 326-331.
56. Bioom, B. S., Krathwohl, V). R., Englehart, M., Frst, E., & Hill, W.
(1956). Taxonomy ofeducatianal objectives: The classification of educational
jjoals, by a committee of college and university examiners. Handbook 1:
Cognitive domain. New York: lAjngmans Green.

About the Authors

Rejjina D. Reynolds is the perinatal/neonatal outreach educator atid
neonatal transport coordinator at Baylor University Medical Center
in Dallas. She received her BSN from the University of Oklahoma. She
is a founding member of the Baylor Simulation Team for Women and
Children > Services.

NEONATAL
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2009

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