Neonatology is a subspecialty of

pediatrics Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, Adolescence, adolescents, and young adults. In the United Kingdom, pediatrics covers many o ...

that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a

hospital A hospital is a healthcare institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...

-based specialty and is usually practised in neonatal intensive care units (NICUs). The principal patients of neonatologists are

newborn In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to Juvenile (orga ...

infants who are ill or require special medical care due to prematurity, low birth weight, intrauterine growth restriction, congenital malformations ( birth defects),

sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...

, pulmonary hypoplasia, or birth asphyxia.

Historical developments

Though high infant mortality rates were recognized by the medical community at least as early as the 1860s, advances in modern neonatal intensive care have led to a significant decline in infant mortality in the modern era. This has been achieved through a combination of technological advances, enhanced understanding of newborn physiology, improved sanitation practices, and development of specialized units for neonatal intensive care. Around the mid-19th century, the care of newborns was in its infancy and was led mainly by obstetricians; however, the early 1900s, pediatricians began to assume a more direct role in caring for neonates. The term ''neonatology'' was coined by Dr. Alexander Schaffer in 1960. The American Board of Pediatrics established an official sub-board certification for neonatology in 1975. In 1835, the Russian physician Georg von Ruehl developed a rudimentary incubator made from two nestled metal tubs enclosing a layer of warm water. By the mid-1850s, these "warming tubs" were in regular use at the Moscow Foundling Hospital for the support of premature infants. 1857, Jean-Louis-Paul Denuce was the first to publish a description of his own similar incubator design, and was the first physician to describe its utility in the support of premature infants in medical literature. By 1931, Dr. A Robert Bauer added more sophisticated upgrades to the incubator which allowed for humidity control and oxygen delivery in addition to heating capabilities, further contributing to improved survival in newborns. The 1950s brought a rapid escalation in neonatal services with the advent of

mechanical ventilation Mechanical ventilation or assisted ventilation is the Medicine, medical term for using a ventilator, ventilator machine to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, wit ...

of the newborn, allowing for survival at an increasingly smaller birth weight. In 1952, the anesthesiologist Dr. Virginia Apgar developed the Apgar score, used for standardized assessment of infants immediately upon delivery, to guide further steps in resuscitation if necessary. The first dedicated neonatal intensive care unit (NICU) was established at Yale-Newhaven Hospital in Connecticut in 1965. Prior to the development of the NICU, premature and critically ill infants were attended to in nurseries without specialized resuscitation equipment. In 1968, Dr.

Jerold Lucey Jerold Francis Lucey (March 26, 1926 – December 10, 2017) was an American pediatrician and journal editor. He specialized in the field of neonatology, and introduced several therapies to mainstream use in the United States, including phototherap ...

demonstrated that hyperbilirubinemia of prematurity (a form of neonatal jaundice) could be successfully treated through exposure to artificial blue light. This led to widespread use of phototherapy, which has now become a mainstay of treatment of neonatal jaundice. 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.

Academic training

In the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

, 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 three 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 The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...

, after graduation from

medical school A medical school is a tertiary educational institution, professional school, or forms a part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, ...

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 nursing is a subspecialty of nursing that specializes in neonatal care.

Spectrum of care

Rather than focusing on a particular organ system, neonatologists focus on the care of newborns who require hospitalization in the neonatal intensive care unit (NICU). 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 who perform clinical and basic science research, may follow infants for months or even years after hospital discharge to better assess the long-term outcomes. The infant is undergoing many adaptations to extrauterine life, and its physiological systems, such as the

immune system The immune system is a network of biological systems that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to bacteria, as well as Tumor immunology, cancer cells, Parasitic worm, parasitic ...

, are far from fully developed. Diseases of concern during the neonatal period include: * Anemia of prematurity * Apnea of prematurity * Atrial septal defect * Atrioventricular septal defect * Benign neonatal hemangiomatosis * Brachial plexus injury * Bronchopulmonary dysplasia *

Cerebral palsy Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, spasticity, stiff muscles, Paresis, weak muscles, and tremors. There may b ...

* CHARGE syndrome * Cleft palate * Coarctation of the aorta *

Congenital adrenal hyperplasia Congenital adrenal hyperplasia (CAH) is a group of Genetic disorder#Autosomal recessive, autosomal recessive disorders characterized by impaired cortisol synthesis. It results from the deficiency of one of the five enzymes required for the Biosy ...

* Congenital diaphragmatic hernia * Congenital heart disease * Diffuse neonatal hemangiomatosis * DiGeorge syndrome * Encephalocele * Gastroschisis * Hemolytic disease of the newborn * Hirschsprung disease * Hypoplastic left heart syndrome * Hypoxic ischemic encephalopathy * Inborn errors of metabolism * Intraventricular hemorrhage * Lissencephaly * Meconium aspiration syndrome * Necrotizing enterocolitis * Neonatal abstinence syndrome * Neonatal cancer * Neonatal jaundice * Neonatal respiratory distress syndrome * Neonatal lupus erythematosus * Neonatal conjunctivitis * Neonatal pneumonia * Neonatal tetanus * Neonatal sepsis * Neonatal bowel obstruction * Neonatal stroke * Neonatal diabetes mellitus * Neonatal alloimmune thrombocytopenia * Neonatal herpes simplex * Neonatal hemochromatosis * Neonatal meningitis * Neonatal hepatitis * Neonatal hypoglycemia * Neonatal cholestasis * Neonatal seizure * Omphalocele * Patent ductus arteriosus * Perinatal asphyxia * Periventricular leukomalacia * Persistent pulmonary hypertension of the newborn * Persistent truncus arteriosus * Pulmonary hypoplasia * Retinopathy of prematurity * Spina bifida * Spinal muscular atrophy * Supraventricular tachycardia * Tetralogy of Fallot * Total (or partial) anomalous pulmonary venous connection * Tracheoesophageal fistula * Transient tachypnea of the newborn * Transposition of the great vessels * Tricuspid atresia * Trisomy 13/18/21 * VACTERL/VATER association * Ventricular septal defect *

Vertically transmitted infection A vertically transmitted infection is an infection caused by pathogenic bacteria or viruses that use mother-to-child transmission, that is, transmission directly from the mother to an embryo, fetus, or baby during pregnancy or childbirth. It ...

Compensation

Neonatologists earn significantly more than general pediatricians. In 2018, a typical pediatrician salary in the United States ranged from $221,000 to $264,000, whereas the average salary for a neonatologist was about $299,000 to $355,000.

Hospital costs

Premature birth is one of the most common reasons for hospitalization. The average hospital costs from 2003 to 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). Encouragingly, an increasing number of programs focused on collaboration of newborn care are now being established all over the world. The International Neonatal Consortium, Newborn Care International, and the Global Newborn Society are some notable examples. The goal is to organize and standardize newborn care, and coordinate research efforts.

References