Parents also need to be informed that inspite to the best efforts, both things namely the exact prognosis or outcome for a specific infant either antenatally or immediately after delivery and prediction of long-term neurologic outcome remains limited. In the counselling the parents should be told about most accurate prognostic morbidity and mortality data available for their infant based on hospital-specific database or regional or national data. Antenatal counselling especially before a preterm delivery has many benefits for parents like reducing parental anxiety, increasing knowledge, facilitating informed decision-making and making rapport with the neonatal clinicians. The three components of effective counseling are assessment of risks, communication of those risks, and ongoing support. The decision to provide comfort care will also depend upon the variables such as perceived accuracy of gestational age assignment, the presence or absence of chorioamnionitis, and the level of care available for location of delivery. The parents can be offered comfort care for the newborn born at gestational below 25 weeks, but this decision needs to be made after consideration of region specific guidelines. The goal of antenatal counseling is to inform parents and assist them in decision-making over either providing resuscitation or giving only comfort care to the neonate. Estimated gestational age of delivery has shown strong association with neurodevelopmental outcome and it serves as the basis for antenatal counselling, although it has some fallacies that limits its role for using as single parameter like the rate of fetal development during the early third trimester and the inaccuracy of gestational age dating. Infants born at an extremely low gestational age have a high mortality rate and are at risk of having neurodevelopmental disabilities ranging from subtle to severe in grade. įull size table Antenatal counseling and team briefing The details of all the interventions with current evidence can be read from other published reviews of the author. In this review article, we have covered the various components of golden hour approach in preterm and term neonatal care (Fig. In the golden hour, standard approach is followed derived from the best available evidence with aim of practicing gentle but timely and effective interventions with non-invasive procedures if required. The prime objective of golden hour is to use evidence based interventions and treatment for better neonatal outcome, importantly for extremely low gestational age neonates (ELGAN). There are many interventions that needs to be practiced in golden hour for neonatal care so that neonatal complications are minimized. The neonatal management in the first hour of life have an important effect on both immediate and long-term outcomes of all neonates. was the first person to implement this concept in the neonatal care. Adams Cowley gave the concept of “Golden Hour” in emergency medicine and showed that with the use of golden hour approach there was decrease in patient mortality with better transport and patient outcome. The golden hour term has been adopted from adult trauma where it is used for the initial first hour of trauma management. The concept of “Golden Hour” has been introduced recently in field of neonatology, highlighting the importance of neonatal care in the first 60 minutes of postnatal life. In this review article, we will discuss various components of neonatal care that are included in “Golden hour” of preterm and term neonatal care. The studies that evaluated the concept of golden hour in preterm neonates showed marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborn to neonatal intensive care unit, respiratory and cardiovascular support and initial course in nursery. Although the current evidence supports the concept of golden hour in preterm and still there is no evidence seeking the benefit of golden hour approach in term neonates, but neonatologist around the globe feel the importance of golden hour concept equally in both preterm and term neonates. The “Golden hour” concept includes practicing all the evidence based intervention for term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcome. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. “Golden Hour” of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates.
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