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Thermoregulation and golden hour practices in extremely preterm infants: an international survey

Jani P 1 , Mishra U 2 , Buchmayer J 3 , Walker K 4 , Gözen D 5 , Maheshwari R 2 Show all authors , D'Çruz D 2 , Lowe K 2 , Wright A 2 , Marceau J 2 , Culcer M 2 , Priyadarshi A 2 , Kirby A 6 , Moore JE 7 , Oei JL 8 , Shah V 9 , Vaidya U 10 , Khashana A 11 , Godambe S 12 , Cheah FC 13 , Zhou W 14 , Xiaojing H 15 , Satardien M 16

Affiliations 

  • 1 Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia. [email protected]
  • 2 Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
  • 3 Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
  • 4 The University of Sydney, Sydney, NSW, Australia
  • 5 Pediatric Nursing Department, Florence Nightingale Faculty of Nursing, İstanbul University - Cerrahpaşa, İstanbul, Turkey
  • 6 The National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
  • 7 Connecticut Children's, Division of Neonatal-Perinatal Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
  • 8 The Royal Hospital for Women, Randwick, NSW, Australia
  • 9 Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Mount Sinai Hospital, Toronto, ON, Canada
  • 10 Department of Pediatrics, King Edward Memorial Hospital, Pune, India
  • 11 Pediatrics, Suez Canal University, Ismailia, Egypt
  • 12 Divisional Director for Clinical Governance, Women Children and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
  • 13 Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Malaysia
  • 14 Department of Neonatology and Vice President, Children's Hospital of Fudan University, Shanghai, China
  • 15 Nursing Department, Children's Hospital of Fudan University, Shanghai, China
  • 16 Department of Paediatrics and Child Health, Tygerberg Hospital Cape Town, Cape Town, South Africa
Pediatr Res, 2023 May;93(6):1701-1709.
PMID: 36075989 DOI: 10.1038/s41390-022-02297-0

Abstract

BACKGROUND: Are thermoregulation and golden hour practices in extremely preterm (EP) infants comparable across the world? This study aims to describe these practices for EP infants based on the neonatal intensive care unit's (NICUs) geographic region, country's income status and the lowest gestational age (GA) of infants resuscitated.

METHODS: The Director of each NICU was requested to complete the e-questionnaire between February 2019 and August 2021.

RESULTS: We received 848 responses, from all geographic regions and resource settings. Variations in most thermoregulation and golden hour practices were observed. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission, and having local protocols were the most consistent practices (>75%). The odds for the following practices differed in NICUs resuscitating infants from 22 to 23 weeks GA compared to those resuscitating from 24 to 25 weeks: respiratory support during resuscitation and transport, use of polyethylene plastic wrap and servo-control mode, commencing ambient humidity >80% and presence of local protocols.

CONCLUSION: Evidence-based practices on thermoregulation and golden hour stabilisation differed based on the unit's region, country's income status and the lowest GA of infants resuscitated. Future efforts should address reducing variation in practice and aligning practices with international guidelines.

IMPACT: A wide variation in thermoregulation and golden hour practices exists depending on the income status, geographic region and lowest gestation age of infants resuscitated. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission and having local protocols were the most consistent practices. This study provides a comprehensive description of thermoregulation and golden hour practices to allow a global comparison in the delivery of best evidence-based practice. The findings of this survey highlight a need for reducing variation in practice and aligning practices with international guidelines for a comparable health care delivery.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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