• Nurse Tori

What is the NICU Golden Hour?

Updated: Nov 2

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 intervention for 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 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. 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.

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 “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

BASELINE PATIENT ASSESSMENT 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 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.

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

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Tori Meskin BSN RNC-NIC has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a nurse, blogger, podcaster, NICU & Pediatric Critical Care RN, MSN student, a Barco Uniforms Ambassador, and Brave beginnings affiliate. Find her at www.tipsfromtori.com or info@tipsfromtori.com

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