Published onIn Utero Insights
The “golden hour” is a critical time period for infants born with congenital anomalies. The golden hour represents the time immediately after birth when a series of complex physiologic changes occur. Optimal golden hour care is associated with improved outcomes for other high-risk populations, like preterm infants.
Newborns with congenital anomalies confront significant challenges during the transition to the extrauterine environment, leading to the need for delivery room resuscitation. However, existing resuscitation algorithms do not address infants with congenital anomalies. Thus, care is currently expert based and not data driven, transitional physiology is undefined, and best practices are often unknown. This is a major limitation to care.
For more than 25 years, our Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT) has been one of the largest centers worldwide dedicated to babies with congenital anomalies. With the 2008 opening of our Garbose Family Special Delivery Unit (SDU) — the world’s first birthplace for babies with anomalies within a freestanding children’s hospital — the CFDT introduced a new paradigm of specialized delivery. Our neonatal and obstetric teams were united in one location, eliminating the need to transport fragile infants with anomalies and keeping families together.
We care for the largest delivery volume of these infants nationally. Immediate stabilization and resuscitation of high-risk infants after birth is performed by a dedicated core team of neonatologists and neonatal providers. This makes us uniquely positioned to generate the necessary data to define and improve optimal, diagnosis-specific “golden hour” management for this specialized population.
SDU Newborn Stabilization & Resuscitation Team
Since the SDU’s opening, our neonatology team has expanded our neonatal resuscitation research program to focus on infants with congenital anomalies and has made significant progress in optimizing delivery room management of these babies. We recently received a significant investment from CHOP to further expand our research and clinical program for neonatal resuscitation in the SDU. With this support, we are poised to revolutionize neonatal resuscitation science for these babies globally.
In 2019, we conducted the first neonatal delivery room clinical trial in the SDU and demonstrated that a novel approach of initiating resuscitation prior to umbilical cord clamping for infants with congenital diaphragmatic hernia is safe, feasible, and well accepted by mothers. Importantly, this study established essential organization and infrastructure to support neonatal resuscitation research at CHOP.
One breakthrough of our program will be the innovation of how we deliver critical knowledge to providers performing resuscitation. By refining our prototype digital tool to be an interactive platform that integrates real-time patient physiologic data, we will drive resuscitation team performance and improve outcomes of babies born with congenital anomalies.
Our team will also focus on improving the family experience during resuscitation. That first moment after birth is a very high stress time for parents. Many times, the baby is immediately removed from the mother and resuscitated in a different room. We think there are numerous opportunities to better support mothers and their partners throughout this process and elevate the experience for parents during neonatal resuscitation.
Through this work, we aim to improve outcomes for our most vulnerable patients by providing resuscitation that is evidence based, that integrates a host of physiologic data in real-time to help the team perform the best interventions possible, and that is informed by our experience with the previous 5,000+ deliveries in our SDU. This represents a major clinical breakthrough that would advance the field of neonatal resuscitation science.
Contributed by: Elizabeth E. Foglia, MD, MA, MSCE