95: Golden Hour Management Practices for Infants <32 Wks Gestational Age in Canada

Abstract

Care practices during neonatal transition can significantly impact both short- and long-term neonatal outcomes. The Evidence-based Practice for Improving Quality (EPIQ) II study was initiated in 2009 with the goal of improving neonatal outcomes (results in CMAJ 2014, 186:E485–94). As part of the study, the EPIQ Golden Hour Committee focused on transitional care (TC) practices in the first hour after birth, including use of the 2010 NRP recommendations for immediate management of preterm infants. Determine the current management practices during the Golden Hour for infants of <32 weeks GA in Canadian NICUs. A survey was emailed to all EPIQ II site investigators and/or co-ordinators in August 2014 with two monthly reminders. The survey included questions on unit characteristics, antenatal management, composition of the TC team, and management in the first hour after birth. The responses to the questions were categorized into four GA groups: 230/7–236/7 wks, 240/7–256/7 wks, 260/7–276/7 wks, and 280/7–316/7 wks. Of the 23 EPIQ II NICUs that were perinatal centers, 13 (56%) completed the survey. Eight sites had >15 level III NICU beds. Antenatal counseling was provided >75% of the time by 92% and 77% of units for GA <28 and 28 to 316/7 wks, respectively. A neonatal fellow or neonatologist/paediatrican was mostly responsible for counseling. 92% did not have a structured template for counseling although one-half used decision aids. The TC team consisted of three or more individuals for stabilization of infants of <28 wks GA and neonatologists were present in 92% of the units, this varied according to the time of the day. 77% of units practiced DCC, 100% used thermal wrap to maintain temperature, the initial FiO2 ranged from 21–40%, and 100% followed the NRP recommended oxygen saturation guide. In spontaneously breathing infants, CPAP was the initial mode of ventilatory support. Prophylactic surfactant was administered by 31% of units for <26 wk GA infants. Infants of <24 wks GA were most likely to be intubated and ventilated. Umbilical venous and arterial catheters were used by 92% for infants of 24 wks GA. Most units did not measure sound levels or offer skin-to-skin contact in the delivery room. Most Canadian NICUs practice NRP recommendations for preterm infants. DCC, thermal wrap, non-invasive ventilation, and FiO2 of <40% are used during the first hour after birth.