BENGALURU: The first hour in the life of preterm infant (those born alive before 37 weeks of pregnancy) is the most important hour in life that represents a time period during which the babies faces challenges that carry risks of long-term injury, lifelong developmental delay, and even death.
During first hour of life, the aim is to prevent complications that may have lifelong effects on the infant, and to improve outcomes with an organized process that promotes teamwork in an appropriate NICU set up.
Teamwork Essential
Neonatal resuscitation is complex and takes place in an extremely dynamic and complex environment. In this type of environment, communication and team function can become important factors in success.
Neonatologist is faced with complex decisions based on multiple systems that require attention knowing that care in these first minutes of life can alter the lifelong medical issues. Obstacles to success, therefore, include poor individual communication skills and listening skills, an unwillingness to challenge traditional hierarchical barriers, and a narrow focus on one’s individual task without regard to the overall team goal.
Approaches to minimize that risk include the neonatal resuscitation program developed by various major countries which is also followed in India by trained clinicians.
Golden Hour Concept
Golden hour concept in neonatal-perinatal medicine offers the opportunity to develop better-functioning teams.The stabilization of preterm babies involves prompt stabilization of the airway and cardiopulmonary support with attention to multiple aspects of the baby’s condition (vital signs, saturation, and response to resuscitation), attention to the prevention of injury (oxygen toxicity), rapid initiation of vascular access, rapid initiation of therapeutic interventions (surfactant), and the prevention of injury progression (alveolar recruitment).
Clinical Management
Resuscitation, thermoregulation, rapid treatment of sepsis, timely parenteral nutrition administration euglycemia and a completed admission are essential within 60 minutes of delivery. While the infants require interventions for sustained life, these same interventions may cause irreversible damage and lead to lifelong morbidities.
Inappropriate resuscitation of the preterm infants may lead to increased morbidities including hypothermia, chronic lung disease, and retinopathy of prematurity and intraventricular hemorrhage.
Temperature
Since body temperature of the preterm infant can drop by 2-3º C in the first 30 minutes after delivery. Research shows low admission temperatures increases risk of mortality as well as infection.
Delivery room practices that can support normal temperature include appropriate room temperature, a preheated radiant warmer, wrapping or covering the infant with polyethylene to prevent heat loss and use of a chemical thermal mattress under the late preterm babies and.
Several studies showed a reduction in hypothermia and improved admission temperatures with the use of a polyethylene wrap immediately at delivery and without drying the infant.
Respiratory Issues
Delivery room resuscitation may have a significant impact on the development of chronic lung disease which has a high risk of mortality in the first year of life and persistent severe developmental delay.
Any day less on the ventilator is a day that the infant is not at risk for developing chronic lung disease or ventilator-associated pneumonia.
Retinopathy of Prematurity
Hyperoxia (when tissues or organs are exposed to an excess of oxygen) has been shown to play a significant role in the development of retinopathy of prematurity (ROP) in very and extreme preterm infants.
Intraventricular Hemorrhage
Premature infants are at increased risk for intraventricular hemorrhage (IVH) due to their poor ability to auto-regulate blood flow to the brain, fragile vasculature of their brain and the rich arterial supply supporting brain growth during week’s 24-32 gestation.
CEO and Director: Kangaroocare Women and children Hospital