Women’s Hospital (WH) has successfully implemented a lifesaving quality improvement project for babies born prematurely.
The project entitled ‘The Golden Hour Delivery Room Management’ adopts international evidenced-based practice to provide the best possible care to extreme preterm babies to ensure their optimal outcome (to improve the survival rate, quality of life and to reduce morbidity).These include infants with a gestational age of less than 29 weeks or a birth weight of less than 1,000 grams.
Dr Hilal Al Rifai, Women’s Hospital Medical Director and Director of its Neonatal/Perinatal Services and the Qatar Newborn Screening Program, said:
The Golden Hour is considered to be the first 60 minutes of a very premature baby’s life where a highly-specialised multidisciplinary team carries out team-oriented and task-driven protocols. These may include resuscitation, followed by gentle ventilation, thermo-regulation, early intravenous parenteral nutrition and early administration of antibiotics to treat potential infections, a known trigger in preterm birth.’
Dr. Al Rifai added:
To a premature baby, the first 60 minutes of life are a golden opportunity that gives the medical team a chance to keep the baby in a stable condition. This enhances the baby’s chance of survival and short and long term health outcomes.’
According to the American Academy of Pediatrics, infants that are born too early tend to have immature body systems which may not function properly. This can cause a number of problems that need prompt medical care such as difficulty in breathing and staying warm, circulation problems, eye problems, and infections.
Dr Al Rifai said:
The Golden Hour approach incorporates an organised process that promotes teamwork to produce the best possible outcomes for the newborns at risk.’
He further explained that the goal of this project was to implement international best practice aimed at providing highly-specialized care to the tiniest babies.
Dr Al Rifai said:
We believe we have been successful in achieving this goal as we have recorded a significant reduction in mortality and morbidity rates. The delivery room staff is fully equipped and committed to ensure the safe management of high-risk preterm babies.’
Under this initiative, WH has incorporated the use of safer alternatives in the management of premature infants such as the introduction of non-invasive ventilation using Continuous Positive Airway Pressure (CPAP). This treatment involves positioning a mask by the nostril/nose while air is blown at a constant pressure to keep the baby’s airways open. This is followed by the selective use of surfactant, a fatty substance that is deficient in the air sacs of the lungs of premature babies, which will help to prevent the lungs from collapsing and also minimize the work of breathing by the infant. These methods have replaced the conventional invasive management techniques.
After the initial stabilisation in the delivery room, babies are transferred with extreme care by highly-skilled and experienced staff to the newly-built Tiny Baby Unit (TBU), a section designed specifically for the care of high-risk babies.
The golden hour protocol has improved quality of life for several high-risk newborns including baby Robin who was recently treated for Tracheoesophageal fistula (TEF). This is a condition where part of the esophagus (tube that connects the throat to the stomach) and the windpipe is missing due to a congenital deformity combined with an irregular connection. The condition was diagnosed within the first hour of life – the golden hour for the baby.
Dr Amani Saeed Ibrahim, Specialist at the Neonatal Intensive Care Unit (NICU), WH, said:
TEF can be life-threatening if not treated right away. It can cause the child to breathe saliva and fluids from the upper part of the esophagus into the lungs. This can cause choking and pneumonia, and normal feeding by mouth would not be possible. Instead of reaching the baby’s stomach, the milk would flow to the lungs resulting in life-threatening consequences.’
The prompt diagnosis gave way to early surgical intervention for the baby who was at 28 weeks of gestation and less than 1kg in weight. After a six-hour surgery, the WH NICU team worked together to provide extraordinary care, using the highest risk management standards, in the days that followed.
Dr Ibrahim said:
The baby is recovering now and is under the care of highly-skilled staff at the NICU. The baby’s mother has also been among the first ones to use the newly-created mother and baby rooms at the expanded NICU where she is supported by staff and is building her confidence to care for her baby. We are delighted with the success of the surgery as baby Robin will soon be able to leave the hospital and go home with his family.’
The Golden Hour project was awarded the Managing Director’s Award at HMC’s annual Stars of Excellence Award ceremony held last month. Under the initiative, WH has successfully managed to reduce the number of mechanically ventilated babies and thereby has achieved an increase in survival rates on par with international standards.