492 - Compliance with the Golden Hour bundle in deliveries attended by a specialized neonatal transport team compared with staff at non-tertiary centers

Poster Number: 492
Publication Number: 492.232

Maher Shahroor, Sunnybrook Health Sciences Center, Milton, ON, Canada; Andrew Whyte-Lewis, The Hospital for Sick Children, Toronto, ON, Canada; Wendy Mak, The Hospital for Sick Children, Toronto, ON, Canada; Bridget R. Liriano, The Hospital for Sick Children, Ajax, ON, Canada; Bonny Jasani, The Hospital for Sick Children, Toronto, ON, Canada; Kyong-Soon Lee, The Hospital for Sick Children, Toronto, ON, Canada

Background: Preterm infants born at < 32 weeks gestational age (GA) have increased morbidity if they are born outside tertiary perinatal centers (outborn) and require optimal stabilization and resuscitation after birth consistent with the neonatal Golden Hour practices (NGHP) to improve outcomes. Regional neonatal transport teams (NTT) have extensive training that includes delivery room resuscitation and provide an important resource for resuscitation of outborn preterm deliveries

Objective: To evaluate physiologic outcomes of hypothermia and hypoglycemia; and compliance with NGHP by the NTT compared to the referral hospital team (RHT) during the stabilization of infants born at < 32
weeks GA

Design/Methods:
A retrospective case control study of infants born at < 32 weeks GA during 2016-2019, at non-tertiary perinatal centers where the NTT attended the delivery (cases) were matched to infants where the RHT team attended the delivery (controls) matched by GA, gender, mode of delivery, month of birth and twin versus singleton. Outcomes were key practices in each domain of NGHP bundle including resuscitation, interventions for temperature regulation and prevention of hypoglycemia, respiratory and cardiovascular support

Results: Over the 4-year period, NNT team received 437 requests to attend deliveries at < 32 weeks GA and
attended prior to delivery in 76 (17.4%). These cases were matched 1:1 with controls composed of deliveries attended by the RHT. Baseline characteristics of the two groups are summarized in Table 1. The rate of hypothermia (temperature ≤36.0) was 5.5% versus 19.7% in the NTT and RHT groups respectively (p=0.01); and rate of hypoglycemia was 13.7% compared with 17.1% in the NTT and RHT groups respectively (p=0.64). The NTT had better compliance with NGHP bundle practices compared with RHT (Table 2,3).
Potentially modifiable practices by RHT identified included decreasing the use of fluid boluses during resuscitation and postnatal period, use of more devices for thermoregulation, and increased skills acquisition for intravenous access and endotracheal intubationConclusion(s): High-risk preterm deliveries attended by NTT compared with RHT had increased compliance with NGHP and earlier implementation of the NGHP elements; and resulted in improved physiologic stability with lower rates of hypothermia. Areas to target for improved compliance to the NGHP by RHT were identified which can be used as the focus of outreach education to RHT
Table 1: Baseline characteristics
Table 2: Compliance with neonatal Golden Hour practices (part 1)