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Neonatology - Golden Hour, Umbilical Artery Catheterisation

Apr 12, 2023

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.


  • Not recommended in late preterm neonates (34 weeks to 366/7 weeks)
  • In peri viable gestation (22 to 24 weeks) decision to be individuated based on capability of NICU & parent’s wishes. 

Golden Hour

  • 1st 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

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  • 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 1ST 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:

What are the 9 Abnormalities of Development?Behavioral Disorders in ChildrenNutrition And Malnutrition
Everything about Important Motor MilestonesAssessment of Growth and Growth Charts by WHONeonatal Sepsis: Risk Factors, Clinical Features, Diagnosis & Treatment
Important Hematological Disorders In ChildrenNeonatal Jaundice Breast Milk Jaundice, PhototherapyRheumatic Fever and Rheumatic Heart Disease
Breast Milk And Breast Feeding - NEET PG PediatricsNEET PG - High-Yield Topics For PediatricsCarbohydrate and Amino Acid Metabolism DISORDERS - NEET PG Pediatrics

Feed Intolerance in Neonates

  • Symptoms: Vomiting, Lethargy, apnea
  • Signs
  • Abdomen distension / tenderness 
  • Increased gastric residual (>2ml/kg)
  • Reduced / absent bowel sounds 
  • Bradycardia or cyanosis 


  • 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)

SkinSticky friable, Transparent  Gelatinous, red, translucent Smooth, pink; visible veinsSuperficial peeling and or rash; few veinsCracking, pale areas; rare veins Parchment deep cracking; no vessels Leathery, cracked wrinkled 
LanugoNoneSparseAbundant Thinning Bald areasMostly baldMaturity Rating
Plantar surface Heal – toe 40-50 mm; -1<40 mm:-2> 50 mm no crease Faint red marks Anterior transverse crease only Creases anterior 2/3Creases over entire soleScoreWeeks 
BreastImperceptibleBarely perceptible Flat areola, no budStippled areola 1-2 mm budRaised areola 3-4 mm budFull areola 5-10 mm bud526
Eye / EarLids fused loosely -1Tightly -2Lids open Pinna flat Stays foldedSlightly curved pinna, soft, slow recoilWell curved pinna; soft but ready recoilFormed and firm instant recoilThick cartilage; ear stiff2534
genitals (male)Scrotum flat, smoothScrotum empty, faint rugaeTestes in upper canal, rare rugae Testes descending, few rugae Testes down, good rugaeTestes pendulous, deep rugae 4542
Genitale (female)Clitoris prominent, labia flatClitoris prominent, small labia minoraClitoris prominent, enlarging minoraMajora and minora equally prominentMajora large, minora smallMajora cover cli

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.

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