Array ( [0] => {{Short description|Medical care of newborns, especially the ill or premature}} [1] => {{For|the journal|Neonatology (journal)}} [2] => {{Distinguish|Neontology}} [3] => {{Infobox Occupation [4] => | name= Neonatologist [5] => | image=HumanNewborn.JPG [6] => | caption= [7] => | official_names= Doctor, Medical Specialist [8] => [9] => | type= [[Specialty (medicine)|Specialty]] [10] => | activity_sector= [[Pediatrics]] (medicine) [11] => | competencies= [12] => | formation= [13] => * [[Doctor of Medicine]] (MD) [14] => * [[Doctor of Osteopathic Medicine]] (DO) [15] => * [[Bachelor of Medicine, Bachelor of Surgery]] (MBBS/MBChB) [16] => | employment_field= [[Hospital]]s, [[Clinic]]s [17] => | related_occupation= [18] => }} [19] => [20] => [[File:Newborn checkup.jpg|thumb|right|Physician performing a physical exam on a newborn baby after a [[Caesarean section]].]] [21] => '''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 unit]]s (NICUs). The principal patients of neonatologists are [[newborn]] infants who are ill or require special medical care due to [[Preterm birth|prematurity]], [[low birth weight]], [[intrauterine growth restriction]], [[congenital malformation]]s ([[birth defect]]s), [[sepsis]], [[pulmonary hypoplasia]], or [[birth asphyxia]]. [22] => [23] => ==Historical developments== [24] => 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.{{Cite journal|last1=Lussky|first1=Richard C.|last2=Cifuentes|first2=Raul F.|last3=Siddappa|first3=Ashajyothi M.|date=April 2005|title=A history of neonatal medicine-past accomplishments, lessons learned, and future challenges. Part 1-the first century|journal=The Journal of Pediatric Pharmacology and Therapeutics |volume=10|issue=2|pages=76–89|doi=10.5863/1551-6776-10.2.76|issn=1551-6776|pmc=3468063|pmid=23118629}} 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.{{Cite journal|last=Avery|first=M. E.|date=June 1992|title=A 50-year overview of perinatal medicine|url=https://pubmed.ncbi.nlm.nih.gov/1396277/|journal=Early Human Development|volume=29|issue=1–3|pages=43–50|doi=10.1016/0378-3782(92)90056-m|issn=0378-3782|pmid=1396277|access-date=2021-09-20|archive-date=2021-09-20|archive-url=https://web.archive.org/web/20210920213251/https://pubmed.ncbi.nlm.nih.gov/1396277/|url-status=live}} Around the mid-19th century, the care of newborns was in its infancy and was led mainly by obstetricians;{{Cite journal|last=Philip|first=Alistair G. S.|date=October 2005|title=The Evolution of Neonatology|journal=Pediatric Research|language=en|volume=58|issue=4|pages=799–815|doi=10.1203/01.PDR.0000151693.46655.66|pmid=15718376|issn=1530-0447|doi-access=free}} 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.{{Cite journal|last=Vulliamy|first=David|date=1972-09-01|title=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|url=https://pediatrics.aappublications.org/content/50/3/508|journal=Pediatrics|language=en|volume=50|issue=3|pages=508–509|doi=10.1542/peds.50.3.508|issn=0031-4005|access-date=2021-09-20|archive-date=2021-09-20|archive-url=https://web.archive.org/web/20210920213003/https://pediatrics.aappublications.org/content/50/3/508|url-status=live}} The American Board of Pediatrics established an official sub-board certification for neonatology in 1975. [25] => [26] => In 1835, the Russian physician Georg von Ruehl developed a rudimentary incubator made from two nestled metal tubs enclosing a layer of warm water.{{Cite journal|last=Cone|first=Thomas E.|date=1981-07-01|title=The First Published Report of an Incubator for Use in the Care of the Premature Infant (1857)|url=http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/archpedi.1981.02130310062020|journal=Archives of Pediatrics & Adolescent Medicine|language=en|volume=135|issue=7|pages=658–660|doi=10.1001/archpedi.1981.02130310062020|pmid=7018217|issn=1072-4710}} 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.{{Cite journal|last=Bauer|first=A. Robert|title=A Combination Resuscitator and Incubator for New-Born Infants|date=1937-05-29|url=https://doi.org/10.1001/jama.1937.92780220002008a|journal=Journal of the American Medical Association|volume=108|issue=22|pages=1874|doi=10.1001/jama.1937.92780220002008a|issn=0002-9955}} [27] => [28] => 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. [29] => [30] => 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.{{Cite journal|last=Calmes|first=Selma H.|date=May 2015|title=Dr. Virginia Apgar and the Apgar Score: How the Apgar Score Came to Be|url=https://dx.doi.org/10.1213/ANE.0000000000000659|journal=Anesthesia & Analgesia|language=en-US|volume=120|issue=5|pages=1060–1064|doi=10.1213/ANE.0000000000000659|pmid=25899273|s2cid=41296774|issn=0003-2999|doi-access=free}} [31] => [32] => The first dedicated [[neonatal intensive care unit]] (NICU) was established at Yale-Newhaven Hospital in Connecticut in 1965.{{Cite journal|date=October 1992|orig-year=October 7, 1985|title=Neonatal Intensive Care: A History of Excellence|url=http://www.neonatology.org/classics/nic.nih1985.pdf|journal=National Institutes of Health|access-date=September 20, 2021|archive-date=October 25, 2021|archive-url=https://web.archive.org/web/20211025141405/http://www.neonatology.org/classics/nic.nih1985.pdf|url-status=live}} Prior to the development of the NICU, premature and critically ill infants were attended to in nurseries without specialized resuscitation equipment. [33] => [34] => 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.{{Cite journal|last1=Lucey|first1=Jerold|last2=Ferreiro|first2=Mario|last3=Hewitt|first3=Jean|title=Prevention of hyperbilirubinemia of prematurity by phototherapy|date=1968-06-01|url=https://pediatrics.aappublications.org/content/41/6/1047|journal=Pediatrics|language=en|volume=41|issue=6|pages=1047–1054|doi=10.1542/peds.41.6.1047|issn=0031-4005|pmid=5652916|s2cid=41816888|access-date=2021-09-20|archive-date=2021-09-20|archive-url=https://web.archive.org/web/20210920212307/https://pediatrics.aappublications.org/content/41/6/1047|url-status=live}} This led to widespread use of phototherapy, which has now become a mainstay of treatment of neonatal jaundice.{{Cite journal|last=American Academy of Pediatrics Subcommittee on Hyperbilirubinemia|date=July 2004|title=Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation|journal=Pediatrics|volume=114|issue=1|pages=297–316|doi=10.1542/peds.114.1.297|issn=1098-4275|pmid=15231951|doi-access=free}} [35] => [36] => In the 1980s, the development of pulmonary surfactant replacement therapy further improved survival of extremely premature infants and decreased [[bronchopulmonary dysplasia|chronic lung disease]], one of the complications of mechanical ventilation, among less severely premature infants. [37] => [38] => ==Academic training== [39] => {{Globalize|article|USA|2name=the United States|date=December 2010}} [40] => In the [[United States]], a ''neonatologist'' is a physician ([[Doctor of Medicine|MD]] or [[Doctor of Osteopathic Medicine|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.{{Cite web|title=What is a Neonatologist?|url=https://www.healthychildren.org/English/family-life/health-management/pediatric-specialists/Pages/What-is-a-Neonatologist.aspx|access-date=2021-09-13|website=HealthyChildren.org|archive-date=2021-09-26|archive-url=https://web.archive.org/web/20210926155747/https://healthychildren.org/English/family-life/health-management/pediatric-specialists/Pages/What-is-a-Neonatologist.aspx|url-status=live}} 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.{{cite web|title=Specialties & Subspecialties|url=http://www.osteopathic.org/inside-aoa/development/aoa-board-certification/Pages/specialty-subspecialty-certification.aspx|publisher=American Osteopathic Association|access-date=23 September 2012|archive-url=https://web.archive.org/web/20150813083503/http://www.osteopathic.org/inside-aoa/development/aoa-board-certification/Pages/specialty-subspecialty-certification.aspx|archive-date=13 August 2015|url-status=dead}} Most countries now run similar programs for post-graduate training in Neonatology, as a subspecialisation of pediatrics. [41] => [42] => 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.{{Cite web|date=2015-04-21|title=Training and development (paediatrics)|url=https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/paediatrics/paediatrics/training-and-development|access-date=2021-09-13|website=Health Careers|language=en|archive-date=2021-09-13|archive-url=https://web.archive.org/web/20210913175821/https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/paediatrics/paediatrics/training-and-development|url-status=live}} The last two to three years of this would be devoted to training in neonatology as a subspecialty. [43] => [44] => Neonatal nursing is subspecialty of nursing that specialize in neonatal care.{{Cite web|title=What is Neonatal Nursing|url=http://nann.org/about/what-is-neonatal-nursing|access-date=2021-09-20|website=NANN|language=en|archive-date=2021-09-20|archive-url=https://web.archive.org/web/20210920212610/http://nann.org/about/what-is-neonatal-nursing|url-status=live}} [45] => [46] => ==Spectrum of care== [47] => [[File:30 minutes infant.JPG|thumb|300px|A 30 minutes old infant in Iran. The nurse is providing necessary care after birth.]] [48] => Rather than focusing on a particular organ system, neonatologists focus on the care of newborns who require hospitalization in the [[Neonatal intensive care unit|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. [49] => [50] => The infant is undergoing many [[Adaptation to extrauterine life|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: [51] => * [[Anemia of prematurity]] [52] => * [[Apnea of prematurity]] [53] => * [[Atrial septal defect]] [54] => * [[Atrioventricular septal defect]] [55] => * [[Benign neonatal hemangiomatosis]] [56] => * [[Brachial plexus injury]] [57] => * [[Bronchopulmonary dysplasia]] [58] => * [[Cerebral palsy]] [59] => * [[CHARGE syndrome]] [60] => * [[Cleft lip and cleft palate|Cleft palate]] [61] => * [[Coarctation of the aorta]] [62] => * [[Congenital adrenal hyperplasia]] [63] => * [[Congenital diaphragmatic hernia]] [64] => * [[Congenital heart defect|Congenital heart disease]] [65] => * [[Diffuse neonatal hemangiomatosis]] [66] => * [[DiGeorge syndrome]] [67] => * [[Encephalocele]] [68] => * [[Gastroschisis]] [69] => * [[Hemolytic disease of the newborn]] [70] => * [[Hirschsprung disease]] [71] => * [[Hypoplastic left heart syndrome]] [72] => * [[Hypoxic ischemic encephalopathy]] [73] => * [[Inborn errors of metabolism]] [74] => * [[Intraventricular hemorrhage]] [75] => * [[Lissencephaly]] [76] => * [[Meconium aspiration syndrome]] [77] => * [[Necrotizing enterocolitis]] [78] => * [[Neonatal abstinence syndrome]] [79] => * [[Childhood cancer|Neonatal cancer]] [80] => * [[Neonatal jaundice]] [81] => * [[Infant respiratory distress syndrome|Neonatal respiratory distress syndrome]] [82] => * [[Neonatal lupus erythematosus]] [83] => * [[Neonatal conjunctivitis]] [84] => * [[Pneumonia|Neonatal pneumonia]] [85] => * [[Neonatal tetanus]] [86] => * [[Neonatal sepsis]] [87] => * [[Neonatal bowel obstruction]] [88] => * [[Neonatal stroke]] [89] => * [[Neonatal diabetes mellitus]] [90] => * [[Neonatal alloimmune thrombocytopenia]] [91] => * [[Neonatal herpes simplex]] [92] => * [[Neonatal hemochromatosis]] [93] => * [[Neonatal meningitis]] [94] => * [[Neonatal hepatitis]] [95] => * [[Neonatal hypoglycemia]] [96] => * [[Neonatal cholestasis]] [97] => * [[Neonatal seizure]] [98] => * [[Omphalocele]] [99] => * [[Patent ductus arteriosus]] [100] => * [[Perinatal asphyxia]] [101] => * [[Periventricular leukomalacia]] [102] => * [[Persistent pulmonary hypertension of the newborn]] [103] => * [[Persistent truncus arteriosus]] [104] => * [[Pulmonary hypoplasia]] [105] => * [[Retinopathy of prematurity]] [106] => * [[Spina bifida]] [107] => * [[Spinal muscular atrophy]] [108] => * [[Supraventricular tachycardia]] [109] => * [[Tetralogy of Fallot]] [110] => * Total (or partial) [[anomalous pulmonary venous connection]] [111] => * [[Tracheoesophageal fistula]] [112] => * [[Transient tachypnea of the newborn]] [113] => * [[Transposition of the great vessels]] [114] => * [[Tricuspid atresia]] [115] => * [[Trisomy]] 13/18/21 [116] => * [[VACTERL association|VACTERL/VATER association]] [117] => * [[Ventricular septal defect]] [118] => * [[Vertically transmitted infection]]s [119] => [120] => == Compensation == [121] => [122] => 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.{{cite web |url=https://www.merritthawkins.com/uploadedFiles/merritthawkins_2018_compensation_brochure.pdf |title=2018 Compilation of Physician Compensation Surveys |author= |date=2018 |website=Merritt Hawkins |publisher=AMN Healthcare |access-date=October 23, 2020 |archive-date=October 24, 2020 |archive-url=https://web.archive.org/web/20201024190515/https://www.merritthawkins.com/uploadedFiles/merritthawkins_2018_compensation_brochure.pdf |url-status=live }} [123] => [124] => ==Hospital costs== [125] => [[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.{{cite journal | author = Weiss AJ | author2 = Barrett ML | author3 = Steiner CA | title = Trends and Projections in Inpatient Hospital Costs and Utilization, 2003–2013 | journal = HCUP Statistical Brief #175 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = July 2014 | pmid = 25165806 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb175-Hospital-Cost-Utilization-Projections-2013.jsp | access-date = 2014-08-01 | archive-date = 2014-08-03 | archive-url = https://web.archive.org/web/20140803212302/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb175-Hospital-Cost-Utilization-Projections-2013.jsp | url-status = live }} In 2012, maternal or neonatal hospital stays constituted the largest proportion of hospitalizations among infants, adults aged 18–44, and those covered by Medicaid.{{cite web | author = Wiess, AJ | author2 = Elixhauser A | name-list-style = amp | title = Overview of Hospital Utilization, 2012 | work = HCUP Statistical Brief #180 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = October 2014 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb179-Emergency-Department-Trends.jsp | access-date = 2014-10-20 | archive-date = 2014-12-24 | archive-url = https://web.archive.org/web/20141224224220/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb179-Emergency-Department-Trends.jsp | url-status = live }} [126] => [127] => 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.{{cite journal | vauthors = Witt WP, Wiess AJ, Elixhauser A | title = Overview of Hospital Stays for Children in the United States, 2012 | journal = HCUP Statistical Brief #186 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = December 2014 | pmid = 25695124 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb187-Hospital-Stays-Children-2012.jsp | access-date = 2015-04-06 | archive-date = 2018-09-24 | archive-url = https://web.archive.org/web/20180924070927/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb187-Hospital-Stays-Children-2012.jsp | url-status = live }} 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).{{cite journal| author = Moore B| author2 = Levit K| author3 = Elixhauser A| name-list-style = amp| title = Costs for Hospital Stays in the United States, 2012| journal = HCUP Statistical Brief #181| publisher = Agency for Healthcare Research and Quality| location = Rockville, MD| date = October 2014| pmid = 25521003| url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb181-Hospital-Costs-United-States-2012.jsp| access-date = 2014-11-26| archive-date = 2014-11-29| archive-url = https://web.archive.org/web/20141129104404/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb181-Hospital-Costs-United-States-2012.jsp| url-status = live}} [128] => [129] => 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,{{cite web|title= International Neonatal Consortium|url= https://c-path.org/programs/inc/|access-date= 2022-01-23|archive-date= 2022-01-23|archive-url= https://web.archive.org/web/20220123213248/https://c-path.org/programs/inc/|url-status= live}} Newborn Care International,{{cite web |title= Newborn Care International |url= https://newborncareinternational.org/ |access-date= 2022-01-23 |archive-date= 2022-01-23 |archive-url= https://web.archive.org/web/20220123213246/https://newborncareinternational.org/ |url-status= live }} and the Global Newborn Society {{cite web|title= Global Newborn Society|url= https://www.globalnewbornsociety.org/|access-date= 2022-01-23|archive-date= 2022-01-20|archive-url= https://web.archive.org/web/20220120200628/https://www.globalnewbornsociety.org/|url-status= live}} are some notable examples. The goal is to organize and standardize newborn care, and coordinate research efforts. [130] => [131] => ==References== [132] => {{Reflist|33em}} [133] => [134] => {{Medicine}} [135] => {{Authority control}} [136] => [137] => [[Category:Neonatology]] [] => )
good wiki

Neonatology

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).

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