The Golden Hour: Providing Very Premature Infants a Favorable Beginning

The first hour of life in a very premature neonate is a critical period of transition requiring extra-uterine adaptation of multiple organ systems for which the vulnerable neonate is ill prepared. Medical interventions provided to the neonate during this golden first hour of life can have significant implications on immediate survival and long term morbidities. Delayed cord clamping, delivery room temperature stabilization, strategies to establish functional residual capacity and gentle ventilation, early administration of dextrose and amino acid infusions, antibiotics when indicated and timely successful placement of peripheral or umbilical venous catheters are areas of focus during golden hour care. Premature infants born and resuscitated at tertiary and quaternary care centers have improved survival chances and outcomes when compared to similar “outborn” infants which highlight the role of experienced and skilled resuscitation teams in the golden hour. Strategies to standardize the various elements used in the resuscitation and stabilization of the very premature neonate that utilize quality improvement measures such as a golden hour protocol may help improve timeliness and efficacy of care provided in the first hour of life.