Family Health: Care in golden hour offers premature babies best chance

The first moments after a child is born make great memories. All the anticipation is finally over and you get to see your baby’s perfect hands and feet, hear her voice and watch as she gets a look at the world.

But for some babies, those first moments have a very different meaning. When infants are born prematurely, that peaceful time takes a back seat to the efforts of doctors and nurses intent on giving them the care they need.

This initial time after delivery of a premature baby is so important that experts have borrowed a term from cardiology to describe it: the neonatal golden hour. In cardiology, the golden hour refers to the time right after a heart attack or stroke, when care has the best chance of leading to recovery. For a premature baby, that hour is when doctors and other experts in a neonatal intensive care unit go to work.

Infants born too early have not had time to fully develop, and their body systems may be too immature to function properly. According to the American Academy of Pediatrics and other experts, this can cause a number of problems that need care quickly, such as:

  • Difficulty breathing. Lungs in a premature baby may lack a substance called surfactant that allows them to expand. This can lead to a respiratory distress syndrome.
  • Circulation problems. Premature babies may need intravenous fluids and medicines to treat low blood pressure.
  • Difficulty staying warm. Premature babies don’t have enough body fat to retain heat, and their body temperature can fall so low they get hypothermia. That can lead to breathing problems and low blood sugar.
  • Eye problems. Babies with retinas that are not fully developed can get a condition called retinopathy of prematurity. It usually resolves on its own, but serious cases may need treatment.
  • Infections. With their immature immune systems, premature babies are vulnerable to infections that can quickly become serious.

Women who are at risk for having a premature baby can often take steps to avoid it. Eating right, getting prenatal care, avoiding alcohol and staying away from tobacco can help. Some risks, though, can’t be avoided. Women who are under age 16 or older than age 40, or who have had a previous premature birth, are more likely to deliver prematurely. Pregnancy with twins or more, and some chronic conditions such as high blood pressure and diabetes, also increase the risk.

If you have any of these risks, or if your doctor has said your baby may be born prematurely, it’s a good idea to schedule your delivery in a center that is associated with an NICU. NICUs are classified into four levels, and Montana has a number of level 3 NICUs, including the one at Community Medical Center in Missoula.

Level 3 NICUs can care for premature infants born at less than 32 weeks gestation, and also for babies at any gestational age with a critical illness. They are less likely than lower-level ones to have to transport a sick infant to a level 4 NICU in a larger city. That means babies get a better continuum of care, and moms don’t wind up traveling to stay with their newborn.

With about half a million babies born prematurely each year in the U.S., it’s a good idea for any expectant mom to think ahead about where you and your baby will be during that golden hour.


Shawn Lake writes for Community Medical Center.