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What is the NICU Golden Hour?

What is the “Golden Hour”?!

What do NICU Nurses do in the Golden Hour?

THE GOLDEN HOUR "Golden Hour" of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour.

The “Golden hour” concept includes practicing all the evidence-based interventions for the term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcomes.

Preterm infants are a vulnerable patient population, especially during the first hours of life. Hypothermia, hypoglycemia, and early-onset sepsis are common problems related to prematurity. Implementation of a Golden Hour protocol has been shown to improve outcomes for preterm infants.

The first 60 minutes of a premature infant’s life is considered the “Golden Hour”. Care and treatment provided during the first hour of life can mean the difference between life and death or long-term health problems. In recognition that some of its processes were not meeting best practices (e.g. administering antibiotics within one hour), hospitals around the country use lean methodologies and process improvement techniques to standardize practice for all premature infants admitted to the Neonatal Program.

Although the current evidence supports the concept of the golden hour in preterm and still there is no evidence seeking the benefit of the golden hour approaches in term neonates, neonatologists around the globe feel the importance of the golden hour concept equally in both preterm and term neonates. The initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborns to the neonatal intensive care unit, respiratory and cardiovascular support, and an initial course in the nursery.

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).

In this review article, we will discuss various components of neonatal care that are included in the “Golden hour” of preterm and term neonatal care.

Conditions We Treat in the NICU


Brain Bleeds

Bronchopulmonary Dysplasia (BPD)

Cerebral Palsy (CP)

Complex Birth Defects

Congenital Diaphragmatic Hernia

Down Syndrome

Extreme Prematurity

Feeding Disorders



Hyaline Membrane Disease

Jaundice (Hyperbilirubinemia)

Meconium Aspiration


Metabolic Diseases

Necrotizing Enterocolitis (NEC)

Neonatal Abstinence Syndrome

Patent Ductus Arteriosus (PDA)

Perinatal AsphyxiaPrematurity

Pulmonary Hypertension

Respiratory Distress Syndrome:

Newborn Retinopathy of Prematurity

Seizures and Epilepsy in Children


Spina Bifida


Transient Tachypnea

Twin to Twin Transfusion


What makes the NICU so unique is our patients are brand new. And often unpredictable. In addition, we must learn about this brand new baby quickly! FORTUNATELY for these babies, special newborn care is available, THE NICU.


1. Prepare the bed (isolette or warmer) 2. Turn on warmer 3. Attach temperature probe 4. Place electrodes & pulse ox probes 5. Take temperature 6. Measurements (Head circumference, length, weight) 7. Suction available (oral & nasal) 8. Oxygen as needed (neopuff or mask) 9. Intubation (breathing tube) if necessary 10. Blood pressures

11. Vital Signs (Heart Rate, Respiratory, Temperature) 12. Head to Toe Assessment 13. Skin assessment 14. Sacral Dimple Check 15. Nare /Throat Patency nose 16. Collect Labs (CBC, Type & Cross, MRSA, Blood Cultures) 17. IV access (UVC/UAC or peripheral IV) 18. MD or NP / RN assess Ballard Neonatal Reflexes 19. Start antibiotics if needed 20. Blood Glucose 21. Review Newborn Delivery Room History 22. Review Maternal Mother History 23. Orient Mother & Father to Unit as available

24. Eyes & Thighs! (Erythromycin and Vitamin K) 25. Obtain Orders 26. CHART!!

The Golden Hour Protocol reviews a baby’s health status at one hour after admission in five critical areas: respiration, cardiovascular function, neurological response, fluid and glucose levels, and body temperature.

The results from each of these five areas determine the infant’s health status: red (acute) zone requiring immediate interventions, yellow zone requiring close monitoring, or green zone where the infant is responding well to stabilization.

Small Baby Recommendations ~ Post Admission 1st 72 hrs of life:

  • Keep head midline

  • Head of bed elevated 30 degrees *

  • Two person cares (one person provides containment throughout)

  • Do not raise legs with diaper changes

  • No weights or abdominal girths

  • Minimize handling, suctioning & movement in space

  • With UAC lab draws, 40 second pull/40 second push per 1ml (set timer) **

  • No peripheral BP’s if UAC line present

  • No prone positioning or skin-to-skin holding (encourage “hand hugs”)

  • Do not forget Colostrum swabbing

  • Administer a loading dose of caffeine in 1st 24 hours, maintenance dosing beginning the following day (if applicable to gestation)

Complex decisions are based on Diagnoses, Age, & Weight!

NICU Nurse Essential Resources

American Academy of Pediatrics

Academy of Neonatal Nursing

Childhood & Adult Immunization CDC Guidelines

March of Dimes! Resources for parents & providers

Access 1,300+ Drugs with Easy-to-Understand Lactation Risk Categories

National Association of Neonatal Nurses

National Certification Corporation - NICU National certifications for experienced nurses

NICU University & Peds University

Vermont Oxford Network - 1,300 hospitals collaborating around the world!

Tori's Tips on NICU NURSE BLOG:

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Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, Sponsored Capella University MSN student, a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at or

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