Preventing ROP in the first golden hour after birth

Golden hour clinical care for the preterm infant describes what should be achieved within the child’s first hour of life. Provision of good quality clinical care during the golden hour has many benefits for the newborn including a reduction in the risk of ROP.

In the video on this step, we show you how a clinical team prepares for the birth of a preterm baby and provides care in the first hour of life. The video includes footage of a team at Homerton University Hospital, United Kingdom, demonstrating good care practice at delivery.

High-quality neonatal care reduces the risk of ROP

Neonatal care during the first hours and weeks of life determines a preterm baby’s chances of avoiding retinopathy of prematurity (ROP) and its complications. Oxygen management and low-cost interventions make all the difference.

The number of new cases (the incidence) of ROP varies considerably between different neonatal intensive care units (NICU), even those with similar levels of equipment and clinical staff. Whilst there may be several reasons behind this, one reason we can be certain about is different practices in newborn care. Routinely implementing standard interventions that are known to prevent ROP will improve outcomes and reduce the incidence of ROP.

Improving outcomes of neonatal care

In high-income countries, changes to the organisation of newborn care have improved survival rates for preterm babies and reduced the risk of adverse outcomes, including severe ROP. These changes include:

• Developing perinatal centres that provide care for high-risk pregnancies and the sickest preterm babies, and
• Developing dedicated transport systems when babies are being transported to, or between, neonatal units.

Providing high-quality neonatal care requires teamwork between different health professionals (doctors, nurses and allied health workers) and working closely with parents and health authorities.

All neonatal units should have agreed protocols for important aspects of newborn care. These protocols should be based on the best available evidence consisting of high-quality clinical trials and systematic reviews. Good data collection methods (local, demographic and clinical) are required to monitor trends in clinical activity, document outcomes, monitor trends and compare outcomes with similar neonatal units. Sharing information and best practices is easier if several units work together and establish formal clinical networks.

Consider what you know about care practices for newborn preterm babies in your setting and the protocols that are followed. Are there gaps that can be addressed and practices that should be improved? Share your thoughts and experiences in the Comments.