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Expert Opinion--Neonatal: Is Evidence-Based Practice Routine in the Golden Hour?
Jacqueline M. McGrath PhD, RN, FNAP, FAAN; Associate Professor

Journal of Perinatal and Neonatal Nursing
June 2012 
Volume 26  Number 2
Pages 109 - 111
  PDF Version Available!

Initial treatment in the delivery room and continuing with admission to the neonatal intensive care unit (NICU) have been termed the "golden hour" because the potential to positively or negatively influence short- and long-term outcomes is so great in this critical period.1-3 Recent research findings have laid the foundation for integration of several newer evidence-based practices into the golden hour. Yet, I wonder how many of these practices are making it into routine caregiving in the delivery room nearest you. For example, are oxygen blenders standard in your delivery room so that 100% oxygen is not delivered routinely to all infants showing any degree of distress as has been done in the past? Is blow-by oxygen via a face mask reserved only for those babies who demonstrate real distress? Is a pulse oximeter routinely used to monitor oxygen saturation? And, are there set parameters for oxygenation saturation during the transition to extrauterine life that mirror normal progression of oxygen saturation in transition? Is the air temperature of the delivery room humidified and warm when a very low-birth-weight (VLBW) infant is expected to deliver?4,5 Prewarming the bed to an appropriate temperature before the baby is delivered has been the standard of care for many years, but given the permeability of the skin of VLBW infants, this intervention may not be enough to protect this population.4 In addition, is the warmer routinely stocked with polyethylene wrap or plastic body bags and are they used quickly and consistently to maintain body temperature and decrease the risks of hypothermia? Even more important, once the wrap is in place around the infant, is the containment with the polyethylene continuous for at least the first 24 to 48 hours of life?4,5 Are stockinet or cotton hats used for VLBW infants in the delivery room? For this population, these materials for covering the head are just not sufficient. Last but not the least, what is the appropriate blood pressure

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