Neonatology
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2008-06-22T19:35:37Z
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[[Image:Newborn checkup.jpg|thumb|right|Doctor doing a checkup 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 infant. It is a [[hospital]]-based specialty, and is usually practiced in [[neonatal intensive care unit]]s (NICUs). The principal patients of [[neonatologist]]s are [[newborn]] infants who are ill or requiring special medical care due to [[Pewk tjpqoirjykatghfkhgremature birth|prematurity]], low birth weight, [[intrauterine growth retardation]], [[congenital malformation]]s ([[birth defect]]s), [[sepsis]], or [[birth asphyxias]].
==History==
While high infant mortality rates were recognized by the British medical community at least as early as the 1860s,<ref>{{cite paper
| author = Baines, M.A.
| title = Excessive Infant-Mortality: How Can It Be Stayed?
| date = 1862
| url = http://www.neonatology.org/classics/baines.html#note1
| format =
| accessdate = 2007-02-18 }}</ref> modern neonatal intensive care is a relatively recent advance. In 1898 Dr. [[Joseph B. De Lee]] established the first premature infant incubator station in [[Chicago]], [[Illinois]]. The first American textbook on [[prematurity]] was published in 1922. In 1952 Dr. [[Virginia Apgar]] described the [[Apgar score|APGAR score]] 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]] and in 1975 the American Board of Pediatrics established sub-board certification for neonatology.<ref>{{cite journal
| author = American Academy of Pediatrics
| title = Committee Report: American Pediatrics: Milestones at the Millennium
| journal = Pediatrics
| year = 2001
| volume = 107
| pages = 1482–1491
| doi = 10.1542/peds.107.6.1482
| pmid = 11389283
}}</ref>
The 1960s brought a rapid escalation in neonatal services with the advent of [[mechanical ventilation]] of the newborn. This allowed for survival of smaller and smaller newborns. 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 survivors. In 2006 newborns as small as 450 grams and as early as 22 weeks gestation have a tiny chance of survival. In modern NICUs, infants weighing 1000 grams and at 27 weeks gestation have an approximately 90% chance of survival and the majority have normal neurological development.<ref>{{cite journal
| author = Lemmons, J.A., et al
| title = Very Low Birth Weight Outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 Through December 1996
| journal = Pediatrics
| year = 2001
| volume = 107(1)
| pages = 1–8
| doi =10.1542/peds.107.1.e1
| pmid = 11134465
}}</ref>
==Academic training==
{{globalize/USA}}
A ''neonatologist'' is a physician practicing neonatology, holding either an [[M.D.]] (Medical Doctor) or D.O. (Doctor of Osteopathy) degree. 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 certified]] 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.
==Spectrum of care==
Rather than focusing on a particular organ system, neonatologists focus on the care of newborns who require ICU hospitalization. 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, may follow infants for months or even years after hospital discharge to better assess the long term effects of health problems early in life. Some neonatologists perform clinical and basic science research to further our understanding of this special population of patients.
==References==
<references/>
[[Category:Pediatrics]]
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