1. First hour care in at risk neonates Why is it important ?
Dr. Rajiv Chaudhary
Consultant Neonatologist
Acute Neonatal Transfer Service for East of England

2. Giving high risk neonates best possible start

3. Objectives Philosophy of first hour care and its successes.
Role in neonatal care
Standardisation of care through organised & structured teamwork

4. Golden hour care in trauma
Dr R A Cowley ( )
University of Maryland Shock Trauma Center
Concept of time

5. Trauma networks and centers
Aero-Medical rescues
Advanced pre hospital support
Setting up systems: Developing services, training staff, guidelines, pathways, monitoring the results.

6. Myocardial Infarction
Heat Stroke
Myocardial Infarction
Pulmonary Embolism
Stroke
Paediatric Transport
This concept has been embraced by various specialities with good effect.

7. Streamlining of prehospital stroke management: the golden hour
Klauss Fassbender et al., Lancet Neurol 2013;12:

8. Evidence Based protocols / Procedures
Communications/Collaborations
Improvement in quality of care

9. Initiation of treatment
Prevention of harm
Stabilisation
Initiation of treatment

10. Do you think I need first hour care ?

11. High Intensity and Dynamic Situation
Multitude of tasks
Performance impacts outcome
Transitional state, , mostly goes well, 10 percent need admission, this could be due to prematurity, infection, birth trauma, HIE, congenital malformations. Multitude of tasks, different perssonell, different skills, need of equipment, communications, all have to work to perfection to get best possible result, give example of mask, unable to intubate as skilled personnel not present, Unable to support then can have life long effect, potential to impact it positively or negatively, human factors, events happening in sequence and parallel, can all go wrong. Give examples where things can go wrong and where things have gone well.

12. Communication Preparation Treatment Notification Family ANTS Manpower
Material
Treatment
DR management (NLS Based)
Stabilisation

13. Thermoregulation
Respiratory
Circulation
General
Stabilisation

14. Vermont Oxford Network
GHP implementation resulted in improvements compared with past internal performance in time to surfactant administration, time to administration of dextrose and amino acids, body temperature at admission, odds of developing chronic lung disease, and odds of developing retinopathy of prematurity. A standardized interdisciplinary approach to the care of ELBW infants in the first hour of life can lead to more efficient care delivery and contribute to improved outcomes
Outcomes of a Neonatal Golden Hour Implementation Project. Ashmeade TL1, Haubner L2, Collins S2, Miladinovic B2, Fugate K3.
Am J Med Qual Sep 5. pii: [Epub ahead of print]

15. Network first hour care audit
Cold on admission
Delay in starting IV Fluids
Delay in starting antibiotics
Slow to start caffeine

16. First Hour Care Team structure Communications Proficiency Evidence
Teamwork
Collaboration
Communication - SBAR
Evidence based protocols & procedures
Roles & responsibilities
Checklists & process maps
Standardise

17. Questions?