386 - Factors in Golden Hour Affecting Survival without Morbidity and Mortality in Infants ≤ 1250g.

Publication Number: 386.5083

Bhuvaneshwari Jagadesan, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Heather Burgess, Regional One Health, Bartlett, TN, United States; Ajay J. Talati, University of Tennessee Health Science Center, Memphis, TN, United States

Background: Golden hour is the first 60 minutes of post-natal life of a neonate. Care provided during this period has lasting effects on the short term and long-term outcomes. A quality initiative was performed in our level 3 NICU, infants ≤ 29 weeks’ gestation (GA) or birth weight ≤ 1250 grams (Bwt) were included with special focus to prevent delays in admission, maintain normothermia, euglycemia which includes obtaining blood sugar, intravenous access and initiating intravenous fluids. Thereby minimizing the time required for extrauterine transition of the preterm infants. Multiple PDSA cycles were done to improve GH.

Objective: We looked at the long-term outcomes of these neonates. With special attention to chronic lung disease (CLD), necrotizing enterocolitis (NEC), severe interventricular hemorrhage (sIVH), severe retinopathy of prematurity (sROP), late onset sepsis (LOS) and death without any morbidity. We used the VON definitions to describe the outcomes. With an objective to identify associations of Golden hour metrics with these long term- outcomes.

Design/Methods: We included infants ≤ 1250g. Time required to admit, start intravenous access (IV), start intravenous fluid (IVF) were collected as part of our QI and PDSA cycle. In addition, we looked at the morbidities for these infants from Feb 2021 to December 2023

Results: 226 infants were included. Infants with and without morbidity or death were 138 and 88 respectively. Mean GA was lower in infants with morbidity 25 w (±2.8) compared to without morbidity 28w (±1.8). Mean Bwt was higher in the no morbidity group, 1000g (±232) compared to 717g (±211) in the group with any morbidity. Infants with late onset sepsis had higher mean blood sugar level on admission (P = 0.05). Infants with CLD, sROP and LOS had higher mean time to admission (P value= 0.01, 0.05, 0.01 respectively). We compared blood sugar levels with the number of morbidities (1 for 1 morbidity, 2 for 2 morbidities, 3 for 3 morbidities etc.). We used the Chi square test. Survival without morbidity and death was significantly lower in < 30mg/dl group compared to >75mg/dl group (p value = 0.02).

Conclusion(s): Infant stabilization within the first hour of life is dependent on multiple factors and teamwork. Infants with CLD, sROP and LOS had a higher mean time to get admitted. Infants with blood sugars < 30mg/dl had better morbidity free survival compared to those with > 75mg/dl. We can conclude infants tolerate low blood sugar better than high blood sugar levels.

Golden Hour Metrics of Infants with and without Morbidities and Death


Admission Blood Sugar and Number of Morbidities and Death


Anova test: (Left) Admission Blood Sugar Compared with Morbidities and Death. (Right) Time to Admission Compared with Morbidities and Death