Neonatology - Golden Hour, Umbilical Artery Catheterisation

Neonatology focuses on the care of newborn infants, especially those who are born prematurely or with complex medical conditions. Staying up to date with the latest updates in neonatology is important for those preparing for the NEET PG exam.

In the NEET PG exam, there are often questions related to neonatology, including the management of common neonatal conditions, the latest guidelines for neonatal resuscitation, and advances in neonatal intensive care. Therefore, having a good understanding of the latest updates in neonatology is crucial for success in the NEET PG exam.

In this blog we’ll cover this important pediatric topic with a focus on golden hour, umbilical artery catheterisation. Keep reading.

ANTENATAL CORTICOSTEROIDS

• Not recommended in late preterm neonates (34 weeks to 36^6/7 weeks)
• In peri viable gestation (22 to 24 weeks) decision to be individuated based on capability of NICU & parent’s wishes. 

Golden Hour

• 1^st hour of life is called the golden hour .
• Interventions should include: 

1. Thermal protection
2. Establishment of FRC of lungs in least invasive manner
3. Avoiding hyperoxia by titrating O2 administration

ANTENATAL MgSO₄ FOR NEUROPROTECTION

• Indicated for pregnant women 31 weeks of gestation with imminent preterm birth 
• Effects
• Neuroprotection by 

• Anti-inflammatory effects 
• Vasodilation
• Decreased free radical injury 
• Inhibiting ca²⁺ influx into cells

“Coming in of Milk”

• Feeling of breast fullness & milk leakage from nipples, as perceived by mother. 
• 59-67 hours after delivery 
• Earlier in multiparous
• If it occurs later than 72 hours: called as Delayed onset of lactation 

Perinatal Asphyxia

• Most common cause of stillbirth 
• Severity can be assessed by

• Sarnat & Sarnat staging 
• Levine’s classification
• Thompson score

• Max (worst) score → 22
• Score ≥ 15 is suggestive of abnormal outcome at 12 months of age with PPV of >92%

PDA in Preterm Neonates

• Both Indomethacin & Ibuprofen are equally efficacious (70-80%) in preterm 32 weeks 
• Ibuprofen is preferred in view of better safety profile 
• Oral PCM has been shown to be equally efficacious as Ibuprofen 

Hypotension in 1^ST 24 Hours of Life        

• Mean BP < 30 mm Hg
• Mean BP < Gestational age in weeks (mm Hg)

Hyperoxia Test

• Helps to determine whether heart disease is a likely cause in an infant with cyanosis 
• Give 100% O₂ for 10 min

↓

PaO₂ < 50 mm Hg → Highly sensitive of Cyanotic CHD

PaO₂ 50-150 mm Hg → needs further evaluation

PaO₂ > 150 mm Hg or rise in PaO₂ by > 80-120 mm Hg above base line → Cyanotic CHD is unlikely 

Critical CHD

• Cardiac lesions requiring surgical or catheter-based interventions during infancy 
• 25% of all CHD

Pediatrics Related Articles:

Feed Intolerance in Neonates

• Symptoms: Vomiting, Lethargy, apnea
• Signs

• Abdomen distension / tenderness 
• Increased gastric residual (>2ml/kg)
• Reduced / absent bowel sounds 
• Bradycardia or cyanosis 

NEC

• L-Arginine: a substrate NO may help in prevention of NEC but no definite recommendation as more evidence required

Invasive Candidiasis in Neonates          

• Incidence α 1birth weight
• Most common → C Albicans

Intractable Seizures in Neonates Are Seen in             

• Pyridoxine deficiency
• Molybdenum cofactor deficiency 
• Non ketotic hyperglycinemia (NKH)
• Folinic acid responsive seizures

Umbilical Artery Catheterisation (UAC)

• Most common complication of UAC → Blanching of 1 leg

Treatment of blanching

Rewarm the opposite leg with warm towel

↓

Reflex vasodilation

↓

Colour of opposite limb improves (If doesn’t improve in 5 min, then remove UAC)

Learn all about the latest updates in neonatology from experts. Download the PrepLadder app and get access to in-depth video lectures covering the topic in detail along with entire Pediatrics syllabus for NEET PG exam.