Neonatology
Encyclopedia
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
that consists of the medical care of newborn infants, especially the ill or premature newborn infant. It is a hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
-based specialty, and is usually practiced in neonatal intensive care unit
Neonatal intensive care unit
A Neonatal Intensive Care Unit —also called a Special Care Nursery, newborn intensive care unit, intensive care nursery , and special care baby unit —is an intensive care unit specializing in the care of ill or premature newborn infants.The problem of premature and congenitally ill infants is not a...
s (NICUs). The principal patients of neonatologists are newborn infants who are ill or requiring special medical care due to prematurity
Premature birth
In humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...
, low birth weight
Low birth weight
Low birth weight is defined as a birth weight of a liveborn infant of less than 2,500 g. regardless of gestational age-Causes:LBW is either the result of preterm birth or of the infant being small for gestational age , or a combination of...
, intrauterine growth retardation, congenital malformations (birth defects), sepsis
Sepsis
Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
, or birth asphyxias.
History
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 B. De Lee established the first premature infant incubator station in ChicagoChicago
Chicago is the largest city in the US state of Illinois. With nearly 2.7 million residents, it is the most populous city in the Midwestern United States and the third most populous in the US, after New York City and Los Angeles...
, Illinois
Illinois
Illinois is the fifth-most populous state of the United States of America, and is often noted for being a microcosm of the entire country. With Chicago in the northeast, small industrial cities and great agricultural productivity in central and northern Illinois, and natural resources like coal,...
. The first American textbook on prematurity was published in 1922. In 1952 Dr. Virginia Apgar
Virginia Apgar
Virginia Apgar was an American pediatric anesthesiologist. She was a leader in the fields of anesthesiology and teratology, and effectively founded the field of neonatology...
described the Apgar score
Apgar score
The Apgar score was devised in 1952 by the eponymous Dr. Virginia Apgar as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after birth...
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
Connecticut
Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...
and 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
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
of the newborn. This allowed for survival of smaller and smaller newborns. In the 1980s, the development of pulmonary surfactant
Pulmonary surfactant
Pulmonary surfactant is a surface-active lipoprotein complex formed by type II alveolar cells. The proteins and lipids that surfactant comprises have both a hydrophilic region and a hydrophobic region...
replacement therapy further improved survival of extremely premature infants and decreased chronic lung disease, one of the complications of mechanical ventilation
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
, 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.
Academic training
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. Most, but not all neonatologists are board certifiedBoard certified
Board certification may refer to:* Board certification, for physicians in an area of medical specialization.* Nursing board certification, for nurses who obtain additional specialty training....
in the specialty of Pediatrics by the American Board of Pediatrics, and in the sub-specialty of Neonatal-Perinatal Medicine also by the American Board of Pediatrics. Most countries now run similar programs for fellowship training in Neonatology.
Neonatal Nurse Practioners (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.