The Effect of Postnatal Golden Hour Practices on Preterm Morbidity and Mortality

Abstract

Aim: Although the survival rates of extremely premature babies have increased significantly in recent years, these babies have a high risk of morbidity. The period covering the process of the newborn leaving the mother's womb and moving to the neonatal unit with resuscitation is called golden minutes. Coordinated and multidisciplinary approach to extremely low birth weight babies who are open to sudden changes of blood pressure, blood sugar, body temperature and respiratory parameters will prevent many short and long-term complications. The aim of this study is to evaluate postnatal golden hour practices in our own center and to contribute to the literature by evaluating its effect on premature morbidity.

Methods: 105 very low birth weight (<1500 gram) neonates born in University of Health Sciences Zeynep Kamil Women and Children's Disease Training and Research Hospital Neonatal Intensive Care Unit between April 2021 and April 2022 were included in our study. The frequency of the antenatal meeting, late cord clamping, hypothermia protection, respiratory support, cardiovascular support, nutritional support, infection prevention practices, and the frequency of morbidity and mortality of the patients were recorded. The effect of golden hour practices on morbidity and mortality was evaluated.

Result: Gestational age of 105 patients included in the study was between 20+2 and 35+3 week; birth weights were between 350-1490 grams. We determined that antenatal meeting, protection from hypothermia, respiratory and cardiovascular support, nutritional support and infection prevention were applied among the golden hour practices. Delayed cord clamping could not be applied. Necrotizing enterocolitis incidence is increased with red cell transfusion and no inotropic support initiation in the first 48 hours in multivariet logistic regression analysis while intraventricular hemorrhage is increased with red cell transfusion, bronchopulmonary dysplasia and patent ductus arteriorus with low birth week and lastly mortality rate with intubation in delivery room, administration of an inotropic agent within the first 48 hours and slow infusion rate.

Conclusion: As a result of this study, we need to improve the delayed cord clamping or milking protocol, we should choose noninvasive ventilation methods instead of empirical intubation and invasive ventilation, and if delayed cord clamping or milking is not performed, the initial fluid amount should be started over 3.3 cc/kg/hour, taking into account the hypovolemia and hypotension possibilities of the patient and we concluded that we should plan the treatment of hemodynamic insufficiency by evaluating the mean arterial pressure in the first hour.