Golden Hour(s)
Alta Kendall MN ARNP NNP-BC
Candidate, Doctor of Nursing Practice
Mednax Medical Group of WA
In service to the Neonatal Intensive Care Unit
at Multicare Tacoma General Hospital
May, 2015
Disclosures
• I am honored to be with you today
• No financial or product affiliations
• No off-label usage
Objectives
• Define neonatal golden hour(s)
Objectives
• Compare and contrast:
transition to extrauterine life for
the term and preterm infant
Objectives
• Discuss:
better practices to facilitate
teamwork during resuscitation
and transition and promote
optimal outcomes
Ancillary Goal
• Staying awake for the LAST presentation
of the day….
• You will use this content in your practice every
day, and that is a
We are not reviewing...
• NRP
• S.T.A.B.L.E.
• Unit-specific practices or protocols
Promoting Critical
Thinking
9
Golden Hours
Conceptual Basis
Adult Trauma
Neonatal Golden Hours
First hours of life set the stage for
short and long-term outcomes
Golden Hours
• Term infant
• Late preterm
infant
Golden Hours
• Preterm infant
• LBW
• VLBW
• ELBW
Transition
Reminder:
birth at any gestational age
Transition
involves the greatest number
of critical physiologic changes
Transition
in the smallest period of time
Transition
an individual will experience
in their entire lifetime.
Transition
Totally new experiences!
~ lungs begin gas exchange
~ fetal circulatory pathways
~ metabolic processes
~ sensory inputs
Born at Term
Early cries → lung expansion
Relaxation → awakening → activity
Breast crawl → exploring → suckling
Sleep
Born at Term
The term neonate experiences:
warmth and calm
comfort
familiar maternal heartbeat
bonding
Born Preterm
Resuscitation → maternal separation
Admission → maternal separation
Procedures → maternal separation
Born Preterm
The preterm neonate experiences:
loss of warmth
loss of comfort
loss of familiar heartbeat sound
No time for bonding!
The Care Team
Urgency to do everything
NOW
~ Resuscitation
~ The ABCs
~ THERMOREGULATION
~ Glucose/metabolic support
~ Infection prevention
Potential Failures
~ Succumbing to the chaos
~ Lack of effective teamwork
~ Miscommunication
~ Preventable Error
Performance Impacts
Immediate and long-term sequelae
Optimal outcomes
Resuscitation
Notification – coordinate - standardize
Who responds?
Available assets – who maintains?
Resuscitation
Ongoing communication
Repeating orders
Recorder – identify upon entry
Stabilization
Resist the temptation to grab and run
Remember all components of care
Update family – even briefly
Stabilization
Warmth: exception - suspected HIE
Reduce stimulation
Update family – even briefly
Family Support
Time of high stress
Manage our own responses to stress
Recognize stress-mediated responses
Family Support
Positive affirmation of new life
Empathetic acknowledgement
Explain everything, but be brief!
The Whole Package
Plan ahead for Golden Hours
communicatecommunicatecommunicate
collaboratecollaboratecollaborate
The Whole Package
Establish checklists, procedures
Understand individual roles
Team evaluation and debriefing
How do we measure?
Infant response
Feedback from family
Care Team functioning
What is Needed
Coordinated, high quality care
DURING
the critical hours following birth
TO ENSURE
Optimal outcomes
What is Needed
Standardized approach to Golden
Hour
Practice and procedures based on
Best Available Evidence!
What is Needed
Strive for minimal intervention on
each admission
BUT
Be prepared for maximal response
No Substitute For
Clear, precise communication
Coordinated, collaborative teamwork
Accurate assessment skills
Strong and efficient clinical approach
We did it!
As you leave today...
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Be grateful for the country
where we live
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Cherish the privilege
of caring for our
future
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Go Hawks!
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