We hypothesised that significant differences in thermoregulation and golden hour practices may be occurring. We designed this international survey to provide a comprehensive description of the variations in thermoregulation and golden hour practices for EP infants, categorised according to the NICUs' geographic location, country’s income status, and the lowest gestational age (GA) of infants resuscitated. 7, 8 Whether NICUs around the world are comparable in their ability to deliver evidence-based practice is unknown. 6 Regional variations exist for golden hour period practices. 5 Implementation of these practices aims to prevent the occurrence of hypothermia and hyperthermia, both of which are associated with adverse outcomes. International resuscitation guidelines recommend the maintenance of normothermia (body temperature between 36.5 and 37.5 ☌) from birth as a vital step in the stabilisation of preterm infants and list multiple strategies for thermoregulation. There is emerging evidence for better short-term outcomes from these practices, even in EP infants at borderline ages of viability. During this important period, evidence-based initial stabilisation practices including maintenance of normothermia are performed. 2 One of the most critical periods of life is the “golden hour”, this refers to the first hour of life following the birth of an EP infant. 1 Many neonatal intensive care units (NICUs) are now providing active care to infants as young as 22 weeks gestation. The survival of extremely preterm (EP) infants (those born <28 weeks of gestation) has improved steadily due to advances in neonatal care. 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. 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. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission and having local protocols were the most consistent practices. ImpactĪ wide variation in thermoregulation and golden hour practices exists depending on the income status, geographic region and lowest gestation age of infants resuscitated. Future efforts should address reducing variation in practice and aligning practices with international guidelines. ConclusionĮvidence-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. 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. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission, and having local protocols were the most consistent practices (>75%). Variations in most thermoregulation and golden hour practices were observed. We received 848 responses, from all geographic regions and resource settings. The Director of each NICU was requested to complete the e-questionnaire between February 2019 and August 2021. 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.
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