Neonatology
Specialty | |
Activity sectors | Pediatrics (medicine) |
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Description | |
Education required |
|
Fields of employment | Hospitals, Clinics |
Neonatology is a subspecialty of
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.
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
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) |
In the
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
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:
- Anemia of prematurity
- Apnea of prematurity
- Atrial septal defect
- Atrioventricular septal defect
- Benign neonatal hemangiomatosis
- Brachial plexus injury
- Bronchopulmonary dysplasia
- Cerebral palsy
- CHARGE syndrome
- Cleft palate
- Coarctation of the aorta
- Congenital adrenal hyperplasia
- 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 infections
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
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.
References
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- S2CID 41296774.
- ^ a b "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.
- from the original on 2021-09-20. Retrieved 2021-09-20.
- PMID 15231951.
- ^ "What is a Neonatologist?". HealthyChildren.org. Archived from the original on 2021-09-26. Retrieved 2021-09-13.
- ^ "Specialties & Subspecialties". American Osteopathic Association. Archived from the original on 13 August 2015. Retrieved 23 September 2012.
- ^ "Training and development (paediatrics)". Health Careers. 2015-04-21. Archived from the original on 2021-09-13. Retrieved 2021-09-13.
- ^ "What is Neonatal Nursing". NANN. Archived from the original on 2021-09-20. Retrieved 2021-09-20.
- ^ "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.
- from the original on 2014-08-03. Retrieved 2014-08-01.
- ^ 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.
- from the original on 2018-09-24. Retrieved 2015-04-06.
- from the original on 2014-11-29. Retrieved 2014-11-26.
- ^ "International Neonatal Consortium". Archived from the original on 2022-01-23. Retrieved 2022-01-23.
- ^ "Newborn Care International". Archived from the original on 2022-01-23. Retrieved 2022-01-23.
- ^ "Global Newborn Society". Archived from the original on 2022-01-20. Retrieved 2022-01-23.