Effective implementation of a protocol on initial stabilization of preterm neonates delivered at less than 32 weeks gestation through a simulation programme in a District General Hospital

Background: Effective initial stabilization of preterm neonates in the initial 60 minutes of life (termed neonatal golden hour) helps minimize complications such as intraventricular haemorrhage and chronic lung disease and leads to improved prognosis. Effective resuscitation, respiratory support, maintaining normal temperature and blood sugar, timely parenteral nutrition, timely treatment of sepsis and a completed admission within 60 minutes of delivery are identified as key components of the golden hour. High intensity and multitude of interventions necessary for initial stabilization, performed by a staff that lacks uniform training make golden hour a challenging task.  A protocol can provide a care pathway on the essential steps of the golden hour. Simulation-based learning to practise the protocol has been identified as way to create a cohesive team.

Objectives: To evaluate effective implementation of a protocol on initial stabilization of preterm neonates delivered at less than 32 weeks gestation through a simulation programme.

Study design: Prospective study

Method: The extent to which the key components of neonatal golden hour were achieved before and after implementation of the protocol were assessed using a checklist.

Results: In the post-protocol group a significant increase was seen in the number of infants resuscitated with optimal preparation and attended by a senior member of staff (p<0.05), the number of infants who received intravenous glucose infusion and antibiotics (p<0.01), the number of infants with blood sugar more than 2.6mmol/l in 1 hour (p<0.05) and the number of infants with completed admission within 1 hour (p<0.01). There was a statistically significant difference in adherence to thermo-protective measures during stabilization (p<0.01), and the number of neonates with temperature above 36.5⁰C on admission (p<0.01) in the post-protocol group. 

Conclusions: Implementation of the golden hour protocol through a simulation programme can significantly improve the stabilization of infants delivered at less than 32 weeks gestation.