Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant. It is ahospital-based specialty, and is usually practiced in neonatal intensive care units (NICUs).
The principal patients of neonatologists are newborn infants who are ill or requiring special medical care due to prematurity, low birth weight,intrauterine growth retardation, congenital malformations (birth defects),sepsis, pulmonary hyperplasia or birth asphyxias.
In 1898 Dr. Joseph DeLee established the first premature infant incubator station in Chicago, Illinois. the first American newborn intensive care unit ( NICU ) was opened in New Haven, Connecticut and in 1975 the American Board of Pediatrics established sub-board certification for neonatology. The history of neonatology
Perinatal period : is defined as the period from the 28 wk of gestation through the 7 th day after birth ( additional definition include the 20 th wk of gestation to the 7 th days, and the 20 th wk of gestation to the 28 th day ). Neonatal period : is defined as less than 28 th day of life and may be further subdivided into :- Period 1 = birth to less than 24 hr, Period 2 = 24 hr to less than 7 days and Period 3 = from 7 days to less than 28 day of life. Perinatal mortality : refers to the fetal deaths occurring from the 20 th wk of gestation until the 7 th or ( 28 th day ) after birth and is expressed as number of death per 1000 live birth. Neonatal mortality rate : include all infants dying during the period beginning after birth and continuing up to the first 28 days of life also it is expressed as number of death per 1000 live births. Postnatal period : which begins after 28 days of life and extend to the end of the 1 st year of life. Infant mortality rate : include both the neonatal and the post-neonatal period and also expressed as number of death per 1000 live birth.
Evaluation of the newborn :- Features of the newborn examination that differ from those of children and adolescents include : A- General appearance : 1- careful observation is necessary to assess spontaneous activity, passive muscle tone, respirations, and abnormal signs, such as cyanosis, intercostal muscle retractions, or meconium staining. 2- Apgar score : are a simple, systematic assessments of intrapartum stress and neurologic depression at birth, conducted at 1 and 5 minutes after birth. A persistently very low Apgar score indicates the need for resuscitation, and scoring should be continued every 5 minutes until a final score of 7 or more is reached.
Apgar score 210Score >100/min<100/minAbsent H.R. Good, cryingSlow, irregularAbsentRespiration Active motionSome, flexionLimpMuscle tone Cough, sneeze,cry GrimaceNo responseReflex Irritability Completel pinkBody pink,blue extremeties Blue, pale Color
B- Skin examination : Texture differ with gestational age ; skin is softer and thinner in premature infant. 1- Lanugo hair : is the thin hair that covers the skin of preterm infants. It is minimally present in term infants. 2- Vernix caseosa : is a thick, white, creamy material found in term infants ; it covers large areas of the skin in preterm infants. It is usually absent in post-term infants. 3- Color : is pink a few hr after birth, but acrocyanosis : is cyanosis of the hand and feet, it is very frequent during the first hr and in some infants it can last throughout the first month of life, particularly when the infant is cold. Acrocyanosis and cutis marmorata ( mottling of the skin with venous prominence ) are frequent intermittent signs of the vasomotor instability. 4- Pallor : may be a sign of neonatal asphyxia, shock, sepsis or anemia.
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.