Neonatology

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Neonatologist
HumanNewborn.JPG
Occupation
NamesDoctor, Medical Specialist
Occupation type
 Specialty
Activity sectors
 Pediatrics (medicine)
Description
Education required
Fields of
employment
 Hospitals, Clinics
Physician performing a physical exam on a newborn baby after a Caesarean section. Newborn checkup.jpg
Physician performing a physical exam on a newborn baby after a Caesarean section.

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 practised 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.

Contents

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. [1] 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. [1] [2] Around the mid-19th century, the care of newborns was in its infancy and was led mainly by obstetricians; [3] however, the early 1900s, pediatricians began to assume a more direct role in caring for neonates. [1] The term neonatology was coined by Dr. Alexander Schaffer in 1960. [4] 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. [5] By the mid-1850s, these "warming tubs" were in regular use at the Moscow Foundling Hospital for the support of premature infants. [5] 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. [5] 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. [6]

The 1950s brought a rapid escalation in neonatal services with the advent of mechanical ventilation of the newborn, allowing for survival at an increasingly smaller birth weight. [2]

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. [7]

The first dedicated neonatal intensive care unit (NICU) was established at Yale-Newhaven Hospital in Connecticut in 1965. [8] Prior to the development of the NICU, premature and critically ill infants were attended to in nurseries without specialized resuscitation equipment. [8]

In 1968, Dr. Jerold Lucey demonstrated that hyperbilirubinemia of prematurity (a form of neonatal jaundice) could be successfully treated through exposure to artificial blue light. [9] This led to widespread use of phototherapy, which has now become a mainstay of treatment of neonatal jaundice. [10]

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. [2]

Academic training

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. [11] 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. [12] 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. [13] The last two to three years of this would be devoted to training in neonatology as a subspecialty.

Neonatal nursing is subspecialty of nursing that specialize in neonatal care. [14]

Spectrum of care

A 30 minutes old infant in Iran. The nurse is providing necessary care after birth. 30 minutes infant.JPG
A 30 minutes old infant in Iran. The nurse is providing necessary care after birth.

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, are far from fully developed. Diseases of concern during the neonatal period include:

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. [15]

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. [16] In 2012, maternal or neonatal hospital stays constituted the largest proportion of hospitalizations among infants, adults aged 18–44, and those covered by Medicaid. [17]

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. [18] 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). [19]

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, [20] Newborn Care International, [21] and the Global Newborn Society [22] are some notable examples. The goal is to organize and standardize newborn care, and coordinate research efforts.

Related Research Articles

<span class="mw-page-title-main">Neonatal intensive care unit</span> Intensive care unit specializing in the care of ill or premature newborn infants

A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. The NICU is divided into several areas, including a critical care area for babies who require close monitoring and intervention, an intermediate care area for infants who are stable but still require specialized care, and a step down unit where babies who are ready to leave the hospital can receive additional care before being discharged.

<span class="mw-page-title-main">Newborn transport</span> Movement of infants for medical purposes

Newborn transport is used to move premature and other sick infants from one hospital to another, such as a medical facility that has a neonatal intensive care unit and other services. Neonatal transport services such as NETS use mobile intensive care incubators fitted with mechanical ventilators, infusion pumps and physiological monitors capable of being used in a mobile environment. These transport systems seek to emulate the environment of a neonatal intensive care and permit uninterrupted care to occur in a referring hospital and then during the journey by road or air ambulance. Power and medical gas supplies are carried within the system as well as making use of external supplies; as available. Infant transport systems commonly weigh over 100 kg and present a challenge to vehicle operators in terms of weight, manual handling, crashworthiness and power consumption.

<span class="mw-page-title-main">Morgan Stanley Children's Hospital</span> Hospital in New York, United States

Morgan Stanley Children's Hospital of NewYork-Presbyterian is a women's and children's hospital at 3959 Broadway, near West 165th Street, in the Washington Heights neighborhood of Manhattan, New York City. It is a part of NewYork-Presbyterian Hospital and the Columbia University Irving Medical Center. The hospital treats patients aged 0–21 from New York City and around the world. The hospital features a dedicated regional ACS designated pediatric Level 1 Trauma Center and is named after financial firm Morgan Stanley, which largely funded its construction through philanthropy.

<span class="mw-page-title-main">Neonatal nursing</span>

Neonatal nursing is a sub-specialty of nursing care for newborn infants up to 28 days after birth. The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin". Neonatal nursing requires a high degree of skill, dedication and emotional strength as they care for newborn infants with a range of problems. These problems vary between prematurity, birth defects, infection, cardiac malformations and surgical issues. Neonatal nurses are a vital part of the neonatal care team and are required to know basic newborn resuscitation, be able to control the newborn's temperature and know how to initiate cardiopulmonary and pulse oximetry monitoring. Most neonatal nurses care for infants from the time of birth until they are discharged from the hospital.

<span class="mw-page-title-main">Rainbow Babies & Children's Hospital</span> Hospital in Ohio, United States

Rainbow Babies & Children's Hospital is a pediatric acute care children's teaching hospital located in Cleveland, Ohio. It is affiliated with Case Western Reserve University School of Medicine and has a neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), and level 1 pediatric trauma center.

<span class="mw-page-title-main">Karthik Nagesh</span>

Dr. Karthik Nagesh is a neonatologist in India. He has been practicing neonatal intensive care since 1992 at the Manipal Hospital in Bangalore. He is well known in India for his pioneering work in intensive care for sick neonates especially, Surfactant Therapy and ventilation for sick babies with respiratory distress. He is currently the Chairman of the Manipal Advanced Children's Center and Chairman and HOD of Neonatology and Neonatal ICUs at the Manipal Hospitals Group as well as an adjunct professor of paediatrics, KMC at Manipal University.

<span class="mw-page-title-main">Joan Hodgman</span> American physician

Joan Hodgman was a pioneer of neonatology. Her leadership and influence helped develop neonatology as a specialty. She practiced at LAC+USC Medical Center for more than 60 years, holding various positions, including Director of the Divisions of Neonatology. She worked to develop the intensive care unit with guidelines on neonatal care. She later received the AAP Virginia Apgar Award in 1999, the highest award offered in neonatology. She is well known by all practicing neonatologists; Dr. Opas, chief of pediatrics at USC referred to her as one of neonatology's "great sages."

Louis Gluck (1924–1997) was an American neonatologist who made many important contributions to the care of newborns, and who is considered "the father of neonatology."

<span class="mw-page-title-main">Pulmonary interstitial emphysema</span> Collection of air outside of the normal air space of the pulmonary alveoli

Pulmonary interstitial emphysema (PIE) is a collection of air outside of the normal air space of the pulmonary alveoli, found instead inside the connective tissue of the peribronchovascular sheaths, interlobular septa, and visceral pleura. This collection of air develops as a result of alveolar and terminal bronchiolar rupture. Pulmonary interstitial emphysema is more frequent in premature infants who require mechanical ventilation for severe lung disease. Infants with pulmonary interstitial emphysema are typically recommended for admission to a neonatal intensive care unit.

The Bloxsom air lock was an incubator used in the treatment of respiratory distress among newly born infants in the 1950s. The device attempted to mimic the rhythm of uterine contractions, which were thought to have a role in stimulating fetal breathing. The device was developed by Dr. Allan Bloxsom, a pediatrician at St. Joseph Hospital and Baylor College of Medicine in Houston, Texas. At its peak, the device was utilized in more than 700 hospitals.

<span class="mw-page-title-main">Neonatal nurse practitioner</span> Type of certified nurse practitioner

A neonatal nurse practitioner (NNP) is an advanced practice registered nurse (APRN) with at least 2 years experience as a bedside registered nurse in a Level III NICU, who is prepared to practice across the continuum, providing primary, acute, chronic, and critical care to neonates, infants, and toddlers through age 2. Primarily working in neonatal intensive care unit (NICU) settings, NNPs select and perform clinically indicated advanced diagnostic and therapeutic invasive procedures. In the United States, a board certified neonatal nurse practitioner (NNP-BC) is an APRN who has acquired Graduate education at the master's or doctoral level and has a board certification in neonatology. The National Association of Neonatal Nurse Practitioners (NANNP) is the national association that represents neonatal nurse practitioners in the United States. Certification is governed by the National Certification Corporation for Obstetrics, Gynecologic and Neonatal Nursing Specialties (NCC).

Julius Hess was an American physician who is often considered the father of American neonatology. In 1922, he published the first textbook focused on the care of prematurity and birth defects in infants. That same year, Hess and nurse Evelyn Lundeen created the first premature infant station in the United States, recognizing the importance of nursing care and temperature management in the care of preterm babies. Hess also made early contributions to the transport of such infants to specialty centers.

Neelam Kler is an Indian neonatologist, known for her pioneering work on neonatal intensive care and ventilation. She is credited with developing neonatal care to better the survival rate of extremely tiny preterm babies to 90 percent. The Government of India honoured her with the third-highest civilian award, Padmabhushan, in 2014, for her services to the fields of medicine and neonatology.

William Aaron Silverman was an American physician who made important contributions to neonatology. He held academic positions at Columbia University College of Physicians and Surgeons and served as the medical director of the neonatal intensive care unit at Columbia-Presbyterian Medical Center. Silverman urged physicians to address considerations like quality of care in formulating medical treatment plans, especially in the management of premature infants.

<span class="mw-page-title-main">Children's Hospital at Erlanger</span> Hospital in Tennessee, United States

Children's Hospital at Erlanger is a 118-bed, tertiary care children's hospital located in Chattanooga, Tennessee. The hospital serves as the pediatric center of excellence for Erlanger Health System, the tenth largest public health system in the United States. Children's Hospital at Erlanger treats infants, children, teens, and young adults aged 0-21. It is located adjacent to Erlanger Baroness Hospital, just east of downtown Chattanooga.

<span class="mw-page-title-main">Gerhard Jorch</span> German pediatrician (born 1951)

Gerhard Jorch is a German pediatrician. He is Professor for general pediatrics and neonatology at the Otto-von-Guericke University of Magdeburg and director of the University children's hospital.

Jen-Tien Wung is a Taiwanese-American pediatrician, author and professor of pediatrics at Columbia University's New York Presbyterian Hospital who developed Bubble CPAP for the treatment of premature babies.

Akhil Maheshwari is a neonatologist.

Jerold Francis Lucey was an American pediatrician and journal editor. He specialised in the field of neonatology, and introduced several therapies to mainstream use in the United States, including phototherapy for neonatal jaundice, transcutaneous oxygen monitoring, and pulmonary surfactant use.

<span class="mw-page-title-main">Henry Halliday (paediatrician)</span> British neonatologist (1945–2022)

Henry Lewis Halliday was a British-Irish peaditrician and neonatologist. In 2021, Halliday was awarded the James Spence Medal for research into neonatology, for coordinating two of the largest neonatal multicentre trials for prevention and treatment of a number of neonatal respiratory illnesses and for a breakthrough in the development of a new lung surfactant that brought relief to very small babies suffering from infant respiratory distress syndrome (RDS).

References

  1. 1 2 3 Lussky, Richard C.; Cifuentes, Raul F.; Siddappa, Ashajyothi M. (April 2005). "A history of neonatal medicine-past accomplishments, lessons learned, and future challenges. Part 1-the first century". The Journal of Pediatric Pharmacology and Therapeutics. 10 (2): 76–89. doi:10.5863/1551-6776-10.2.76. ISSN   1551-6776. PMC   3468063 . PMID   23118629.
  2. 1 2 3 Avery, M. E. (June 1992). "A 50-year overview of perinatal medicine". Early Human Development. 29 (1–3): 43–50. doi:10.1016/0378-3782(92)90056-m. ISSN   0378-3782. PMID   1396277. Archived from the original on 2021-09-20. Retrieved 2021-09-20.
  3. ↑ Philip, Alistair G. S. (October 2005). "The Evolution of Neonatology". Pediatric Research. 58 (4): 799–815. doi: 10.1203/01.PDR.0000151693.46655.66 . ISSN   1530-0447. PMID   15718376.
  4. ↑ Vulliamy, David (1972-09-01). "Diseases of the Newborn, ed. 3, by Alexander J. Schaffer, M.D., and Mary Ellen Avery, M.D. Philadelphia/London/Toronto: W. B. Saunders, 1971, 919 pp., $22.00". Pediatrics. 50 (3): 508–509. doi:10.1542/peds.50.3.508. ISSN   0031-4005. Archived from the original on 2021-09-20. Retrieved 2021-09-20.
  5. 1 2 3 Cone, Thomas E. (1981-07-01). "The First Published Report of an Incubator for Use in the Care of the Premature Infant (1857)". Archives of Pediatrics & Adolescent Medicine. 135 (7): 658–660. doi:10.1001/archpedi.1981.02130310062020. ISSN   1072-4710. PMID   7018217.
  6. ↑ Bauer, A. Robert (1937-05-29). "A Combination Resuscitator and Incubator for New-Born Infants". Journal of the American Medical Association. 108 (22): 1874. doi:10.1001/jama.1937.92780220002008a. ISSN   0002-9955.
  7. ↑ Calmes, Selma H. (May 2015). "Dr. Virginia Apgar and the Apgar Score: How the Apgar Score Came to Be". Anesthesia & Analgesia. 120 (5): 1060–1064. doi: 10.1213/ANE.0000000000000659 . ISSN   0003-2999. PMID   25899273. S2CID   41296774.
  8. 1 2 "Neonatal Intensive Care: A History of Excellence" (PDF). National Institutes of Health. October 1992 [October 7, 1985]. Archived (PDF) from the original on October 25, 2021. Retrieved September 20, 2021.
  9. ↑ Lucey, Jerold; Ferreiro, Mario; Hewitt, Jean (1968-06-01). "Prevention of hyperbilirubinemia of prematurity by phototherapy". Pediatrics. 41 (6): 1047–1054. doi:10.1542/peds.41.6.1047. ISSN   0031-4005. PMID   5652916. S2CID   41816888. Archived from the original on 2021-09-20. Retrieved 2021-09-20.
  10. ↑ American Academy of Pediatrics Subcommittee on Hyperbilirubinemia (July 2004). "Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation". Pediatrics. 114 (1): 297–316. doi: 10.1542/peds.114.1.297 . ISSN   1098-4275. PMID   15231951.
  11. ↑ "What is a Neonatologist?". HealthyChildren.org. Archived from the original on 2021-09-26. Retrieved 2021-09-13.
  12. ↑ "Specialties & Subspecialties". American Osteopathic Association. Archived from the original on 13 August 2015. Retrieved 23 September 2012.
  13. ↑ "Training and development (paediatrics)". Health Careers. 2015-04-21. Archived from the original on 2021-09-13. Retrieved 2021-09-13.
  14. ↑ "What is Neonatal Nursing". NANN. Archived from the original on 2021-09-20. Retrieved 2021-09-20.
  15. ↑ "2018 Compilation of Physician Compensation Surveys" (PDF). Merritt Hawkins. AMN Healthcare. 2018. Archived (PDF) from the original on October 24, 2020. Retrieved October 23, 2020.
  16. ↑ Weiss AJ; Barrett ML; Steiner CA (July 2014). "Trends and Projections in Inpatient Hospital Costs and Utilization, 2003–2013". HCUP Statistical Brief #175. Rockville, MD: Agency for Healthcare Research and Quality. PMID   25165806. Archived from the original on 2014-08-03. Retrieved 2014-08-01.
  17. ↑ Wiess, AJ & Elixhauser A (October 2014). "Overview of Hospital Utilization, 2012". HCUP Statistical Brief #180. Rockville, MD: Agency for Healthcare Research and Quality. Archived from the original on 2014-12-24. Retrieved 2014-10-20.
  18. ↑ Witt WP, Wiess AJ, Elixhauser A (December 2014). "Overview of Hospital Stays for Children in the United States, 2012". HCUP Statistical Brief #186. Rockville, MD: Agency for Healthcare Research and Quality. PMID   25695124. Archived from the original on 2018-09-24. Retrieved 2015-04-06.
  19. ↑ Moore B; Levit K & Elixhauser A (October 2014). "Costs for Hospital Stays in the United States, 2012". HCUP Statistical Brief #181. Rockville, MD: Agency for Healthcare Research and Quality. PMID   25521003. Archived from the original on 2014-11-29. Retrieved 2014-11-26.
  20. ↑ "International Neonatal Consortium". Archived from the original on 2022-01-23. Retrieved 2022-01-23.
  21. ↑ "Newborn Care International". Archived from the original on 2022-01-23. Retrieved 2022-01-23.
  22. ↑ "Global Newborn Society". Archived from the original on 2022-01-20. Retrieved 2022-01-23.
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