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Golden Hour Protocol for Preterm Infants

A Quality Improvement Project

Harriman, Tiffany L., DNP, RN, NNP-BC, RNC-NIC; Carter, Brigit, PhD, MSN, RN, CCRN; Dail, Robin B., PhD, RN, FAAN; Stowell, Katherine E., DNP, RN, AACNS-N, RNC-NIC; Zukowsky, Ksenia, PhD, APRN, NNP-BC; Section Editors

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC;

doi: 10.1097/ANC.0000000000000554
Clinical Issues in Neonatal Care

Background: Preterm infants are a vulnerable patient population, especially during the first hours of life. Hypothermia, hypoglycemia, and early-onset sepsis are common problems related to prematurity. Implementation of a Golden Hour protocol has been shown to improve outcomes for preterm infants.

Purpose: To evaluate the effectiveness of a Golden Hour protocol for infants born at less than 32 weeks' gestation on improving the admission process in a military care facility. Specific aims focused on temperature, time to initiation of intravenous (IV) fluids, time to administration of antibiotics, and time to close of the incubator top.

Methods: A pre-/postdesign was used to compare outcomes from preimplementation to postimplementation. Predata were collected using electronic health record chart review and postdata were collected from the Neonatal Intensive Care Unit admission worksheet.

Results: Although we did not find statistical significance, we found that more infants had a temperature greater than 36.5°C within 1 hour of birth and decrease in time to initiation of IV fluids and antibiotics from preimplementation to postimplementation, which is clinically significant. Time to close of the incubator top remained greater than 1 hour.

Implications for Practice: Implementation of a Golden Hour protocol provides a guide to caring for preterm infants during the first hour of life to improve patient outcomes. Involvement of key stakeholders and staff education are key to successful implementation.

Implications for Research: Researchers should examine long-term outcomes related to implementation of a Golden Hour protocol in future studies. Future quality improvement projects should include the effectiveness of similar protocols and address possible barriers.

Duke University School of Nursing, Durham, North Carolina (Drs Harriman and Carter); College of Nursing, University of South Carolina, Columbia (Dr Dail); and Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Stowell).

Correspondence: Tiffany L. Harriman, DNP, RN, NNP-BC, RNC-NIC, Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710 (

This work was conducted at Walter Reed National Military Medical Center, Bethesda, Maryland.

The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. LT Harriman and LCDR Stowell are military service members (or employees of the US Government). This work was prepared as part of their official duties. Title 17, USC, §105 provides that “Copyright protection under this title is not available for any work of the US Government.” Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties.

The authors declare no conflicts of interest.

© 2018 by The National Association of Neonatal Nurses