Standardized Management of the First Hour of Premature Infants: A Meta-Analysis.

Abstract

Context: The postnatal management of preterm infants at birth may influence their clinical course in the short, medium, and long term. The concept of the "Golden Hour" (GH) has emerged in neonatology, aiming to standardize this management.

Objective: We conducted a meta-analysis to assess GH's impact on early clinical outcomes and on the comorbidities of prematurity.

Data sources: Pubmed, Embase, Scopus, and Cochrane Library were searched without any restriction.

Study selection: We included randomized, prospective, and retrospective studies comparing periods with and without the application of a GH protocol for preterm birth.

Data extraction: Two independent reviewers screened titles and abstracts and assessed full texts for eligibility.

Results: Twelve prospective and 6 retrospective studies were included, for a total of 5104 patients. There was a significant reduction in hypothermia both on admission and at 1 hour (odds ratio [OR], 0.40 [95% CI, 0.27-0.60] and OR 0.39 [95% CI, 0.18-0.85]), with increased temperature (mean difference [MD], +0.57 °C [95% CI, 0.07-1.07]). Mean blood glucose and hypoglycemia rates on admission were not statistically affected. However, time to intravenous infusion was reduced (MD, -27.51 minutes [95% CI, -49.40 to -5.56]). There was a significantly lower rate of severe intraventricular hemorrhage (OR, 0.65 [95% CI, 0.47-0.89]) and a trend toward decreased bronchopulmonary dysplasia (OR, 0.69 [95% CI, 0.47-1.02]). Time to administration of surfactant was statistically reduced (MD, -23.6 minutes [95% CI, -42.2 to -5]). Mortality and other comorbidities of prematurity were not different.

Limitations: Four studies were judged to be of poor quality, and certainty for evidence was graded as low or very low.

Conclusions: The application of a GH at birth reduced the rate of hypothermia and the time required for intravenous infusion without statistically significant impact on glycemic control.