Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, and is usually practiced in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or require special medical care due to prematurity, low birth weight, intrauterine growth restriction, congenital malformations (birth defects), sepsis, pulmonary hypoplasia or birth asphyxia.
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While high infant mortality rates were recognized by the British medical community at least as early as the 1860s, modern neonatal intensive care is a relatively recent advance. In 1898 Dr. Joseph DeLee established the first premature infant incubator station in Chicago, Illinois. The first American textbook on prematurity was published in 1922. In 1931 Dr A Robert Bauer invented the first incubator to combine heat, and oxygen, as well as humidity while at Henry Ford Hospital.  In 1952 Dr. Virginia Apgar described the Apgar score scoring system as a means of evaluating a newborn's condition. It was not until 1965 that the first American newborn intensive care unit (NICU) was opened in New Haven, Connecticut. In 1975 the American Board of Pediatrics established sub-board certification for neonatology.
The 1950s brought a rapid escalation in neonatal services with the advent of mechanical ventilation of the newborn. This allowed for survival of smaller and smaller newborns. In the 1980s, the development of pulmonary surfactant replacement therapy further improved survival of extremely premature infants and decreased chronic lung disease, one of the complications of mechanical ventilation, among less severely premature infants. In 2006 newborns as small as 450 grams and as early as 22 weeks gestation have a chance of survival. In modern NICUs, infants weighing more than 1000 grams and born after 27 weeks gestation have an approximately 90% chance of survival and the majority have normal neurological development.
Just like any other physician, to become a neonatologist you must first obtain a bachelor’s degree in order to learn the foundational and psychological theories. The effort that goes into studying the sciences at this level will give a good insight to the strenuous schedules that come with residency, internships and fellowships. After passing the MCAT (Medical College Admissions Test) students will move on to medical school where they will further expand their knowledge of the human body. Next, a perspective neonatologist will complete a three-year residency/internship program focused on pediatrics followed by a three-year neonatology fellowship. Lastly, they must become board certified by the American Board of Pediatrics or the American Osteopathic Board of Pediatrics.
The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. (December 2010) (Learn how and when to remove this template message)
In the United States, a neonatologist is a physician (MD or DO) practicing neonatology. To become a neonatologist, the physician initially receives training as a pediatrician, then completes an additional training called a fellowship (for 3 years in the US) in neonatology. In the United States of America most, but not all neonatologists, are board certified in the specialty of Pediatrics by the American Board of Pediatrics or the American Osteopathic Board of Pediatrics and in the sub-specialty of Neonatal-Perinatal Medicine also by the American Board of Pediatrics or American Osteopathic Board of Pediatrics. Most countries now run similar programs for post-graduate training in Neonatology, as a subspecialisation of pediatrics.
In the United Kingdom, after graduation from medical school and completing the two-year foundation programme, a physician wishing to become a neonatologist would enroll in an eight-year paediatric specialty training programme. The last two to three years of this would be devoted to training in neonatology as a subspecialty.
Neonatal Nurse Practitioners (NNPs) are advanced practice nurses that specialize in neonatal care. They are considered mid-level providers and often share the workload of NICU care with resident physicians. They are able to treat, plan, prescribe, diagnose and perform procedures within their scope of practice, defined by governing law and the hospital where they work.
The work of a neonatologist begins before the fetus is even born. They provide consultation to the mother of an unborn fetus who has known congenital anomalies which require preparation for the birth and coordination of services. Neonatologists will also be present during high risk deliveries, providing supportive care to infants straight out of the womb, in addition to the daily management of critically ill infants. Other than intensive care medicine and conducting technical procedures, they are counselors, helping families cope with the uncertainties that come along with unstable newborns and other ethical dilemmas.
Depending on the specific neonatology practice, each neonatologist has a structured scheduling model put in place to meet clinical needs and to provide the best care possible for their patients. For example, a neonatologist could work during the day and be on-call at night while a neonatal nurse practitioner or pediatrician covers the night shift. In a research practice, the neonatologists are most likely assigned to certain weeks of research and other weeks of covering the NICU.
With the career of Neonatologists being a hospital-based subspecialty, they usually work in a NICU within a birthing hospital or a free-standing Children’s Hospital, but the type of care they give to newborns can vary. The specific roles of a Neonatologists depend on the level of acuity of the definitive NICU. The most basic neonatal care is provided by the Level 1 NICU, which gives routine care to well-off newborns. Level II gives intermediate care for stable, non-mechanically or short term ventilated infants. Lastly, a Level III NICU is where surgical subspecialties are performed, mechanical ventilation and ECMO services are provided. Neonatologist typically practice in a group setting, which could include not only certified Neonatologists but residents and fellows in training. Neonatology is not only exclusive to working in a NICU, these doctors could engage in research based work which includes translational, clinical, epidemiological, and/or health services. Neonatologists might even work in educating medical students, fellows, residents, nurses, and physician assistants.
Spectrum of careEdit
Rather than focusing on a particular organ system, neonatologists focus on the care of newborns who require Intensive Care Unit (ICU) hospitalization. They may also act as general pediatricians, providing well newborn evaluation and care in the hospital where they are based. Some neonatologists, particularly those in academic settings, may follow infants for months or even years after hospital discharge to better assess the long-term effects of health problems early in life. Some neonatologists perform clinical and basic science research to further our understanding of this special population of patients.
The infant is undergoing many adaptations to extrauterine life, and its physiological systems, such as the immune system, are far from fully developed. Diseases of concern during the neonatal period include:
- Neonatal jaundice (hyperbilirubinemia)
- Infant respiratory distress syndrome (surfactant deficiency syndrome)
- Neonatal lupus erythematosus
- Neonatal conjunctivitis
- Neonatal tetanus
- Vertically transmitted diseases
- Neonatal sepsis
- Neonatal bowel obstruction
- Benign neonatal seizures
- Neonatal acne
- Neonatal stroke
- Neonatal diabetes mellitus
- Neonatal alloimmune thrombocytopenia
- Neonatal herpes simplex
- Neonatal hemochromatosis
- Neonatal meningitis
- Neonatal hepatitis
- Neonatal hypoglycemia
- Neonatal adrenoleukodystrophy
- Neonatal isoerythrolysis
- Diffuse neonatal hemangiomatosis
- Benign neonatal hemangiomatosis
- Neonatal cholestasis
- Transient neonatal pustular melanosis
- Perinatal asphyxia
- Neonatal ichthyosis–sclerosing cholangitis syndrome
- Neonatal toxic shock-like exanthematous disease
Neonatologists significantly out-earn general pediatricians. The average pediatrician salary ranges from $161,000 to $229,000, whereas the average salary for a neonatologist is about $225,000 to $310,000 according to special issue of “Modern Healthcare” which conducted a salary survey on the medical world’s leading salaries.
Birth is one of the most common reasons for hospitalization. The average hospital costs from 2003-2011 for the maternal and neonatal surgical services were the lowest hospital costs in the U.S. In 2012, maternal or neonatal hospital stays constituted the largest proportion of hospitalizations among infants, adults aged 18–44, and those covered by Medicaid.
Between 2000 and 2012, the number of neonatal stays (births) in the United States fluctuated around 4.0 million stays, reaching a high of 4.3 million in 2006. Maternal and Neonatal stays constituted 27 percent of hospital stays in the United States in 2012. However, the mean hospital costs remained the lowest of the three types of hospital stay (medical, surgical, or maternal and neonatal). The mean hospital cost for a maternal/neonatal stay was $4,300 in 2012 (as opposed to $8,500 for medical stays and $21,200 for surgical stays in 2012).
Neonatal Intensive Care UnitEdit
The Neonatal Intensive Care Unit or NICU for short is an area of the hospital completely devoted to caring for critically ill newborns and is usually completely separated from the nursery of healthy babies. The NICU includes a staff of trained health care professionals that provide specialized care for newborns. Most babies in this area are premature, have a medical condition that requires round-the-clock care, or have under average birth weights. Babies will stay in the NICU until they are healthy or strong enough to go, no matter how long it takes.
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A Paper Contributed to the National Social Science Association, (London Meeting;) to Which Was Added a Short Paper, Reprinted from The Lancet
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Neonatal medicine is still a young field, and it's come a long way since it became an accepted medical discipline in the 1960s.
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