Neonatology (premature babies)

A neonatologist is a pediatrician with additional training in the care of sick and premature babies. Although a pediatrician can solve the majority of health problems in newborns, a neonatologist is trained specifically to handle the most complex and high-risk situations. In addition, neonatologists use equipment that is designed specifically for the tiniest patients.

If your newborn is premature or has a serious illness, injury, or birth defect, a neonatologist may assist at the time of delivery and in the subsequent care of your newborn. If a problem is identified before your baby is born, a neonatologist can also become involved in your baby’s care during your pregnancy.

Which babies need special care?

Most babies admitted to the Neonatal Intensive Care Unit (NICU) are premature – that is, born before 37 weeks of pregnancy. Important organs such as the heart, lungs, stomach, and skin may not be mature enough to function without special help. Other babies have low birth weight (less than 5.5 pounds), or have a medical condition that requires special care. Twins, triplets, and other multiples are often admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU.

What types of treatments do neonatologists provide?

According to the American Academy of Pediatrics , neonatologists generally provide the following care:

• Diagnose and treat newborns with conditions such as breathing disorders, infections, and birth defects
• Coordinate care and medically manage newborns born premature, critically ill, or in need of surgery
• Ensure that critically ill newborns receive the proper nutrition for healing and growth
• Stabilise and treat newborns with any life-threatening medical problems
• Provide care to the newborn at a cesarean or other delivery that involves medical problems in the mother or baby that may compromise the infant’s health and require medical intervention in the delivery room
• Consult with obstetricians, pediatricians, and family physicians about conditions affecting newborn infants

Where do neonatologists work?

Neonatologists work mainly in the special care nurseries or newborn intensive care units of hospitals. In some cases, after a newborn has been discharged from the unit, a neonatologist may provide short-term follow-up care on an outpatient basis. 

A premature or preterm baby is born before 37 weeks of pregnancy have been completed. Because premature babies are born before they are physically ready to leave the womb, they often have health problems. Their lungs, digestive system, immune system and skin might still be underdeveloped. Generally, the earlier a baby is born, the higher the risk of complications. Any complications of a premature newborn will be addressed in the neonatal intensive care unit (NICU).

The most common conditions that occur in premature babies includes yellowing of the skin and eyes (jaundice), low blood sugar, and lack of red blood cells to carry oxygen to the baby's tissues (anemia). More-serious concerns might include infection, episodes of interrupted breathing (apnea) and bleeding into the brain. Some premature babies have impaired hearing or vision. Others experience developmental delays, learning disabilities, motor deficits, or behavioural, psychological or chronic health problems.

Thankfully, medical technology has made it possible for premature babies to survive the first few days, weeks or months of life until they are strong enough to make it on their own. This means that most premature babies catch up and experience normal healthy development.

How you can participate in the Neonatal Intensive Care Unit

Although you might feel helpless, there are additional ways to provide care for your baby in the NICU. Both parents are generally encouraged by the NICU staff to interact with their baby. Here are some suggestions:

• Find out about your baby’s condition: When you have a preterm baby, it’s natural to feel concerned about your baby’s health and the possible long-term effects of prematurity. Uncertainty can be frightening so Mayo Clinic suggests reading material provided by the hospital, doing your own research about your child’s condition, and asking your pediatrician or neonatologist questions. The more you learn, the better prepared you'll be to handle the situation.
• Establish your milk supply: Breast milk contains proteins that help fight infection and promote growth. Although your baby might not yet be able to feed from your breast or a bottle, breast milk can be given in other ways or frozen for later use. Once you are able to start breastfeeding directly, your baby should nurse frequently to increase your milk supply.
• Spend time with your baby: Speak to your baby in loving tones and touch him or her as much as possible. Your baby can recognise your voice and be comforted by hearing you. It will also help you feel closer to him or her. When your baby is ready, cradle him or her in your arms. Hold your baby under your robe or shirt to allow skin-to-skin contact. When possible, change your baby’s diaper and participate in your baby’s first bath.

If you've just found out that your child has a birth defect, you're most likely experiencing many emotions. Understanding the nature and causes of birth defects can help reduce the confusion, fear and guilt often associated with them.

What are birth defects?

Birth defects are also called congenital anomalies or congenital abnormalities. They are abnormalities of structure, function, or body chemistry that are present in a baby at the time he or she is born. These will require medical or surgical care or could have some effect on a child's development. There are thousands of different types of birth defects, which can range from mild to severe. Some may even be life-threatening. In many cases, the cause of birth defects are not known, however research shows that they can be inherited or caused by environmental factors such as exposure to drugs, radiation, or illness. Doctors may detect a birth defect during prenatal testing.

What types of birth defects are there?

Birth defects can affect almost any part of the body and may influence how the body looks, works, or both. There are two main types of birth defects: structural and functional.

• Structural birth defects: These are related to a problem with body parts. Some physical problems include cleft palate, heart defects such as missing or misshaped valves, and abnormal limbs such as a club foot.
• Functional birth defects: These are related to a problem with how a body part or body system works. Functional birth defects often lead to developmental disabilities and can include things such as nervous system problems, metabolic disorders, sensory problems, and degenerative disorders.

What treatments are available for newborns with birth defects?

Treatments for birth defects vary by disorder. Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained healthcare professionals to provide specialised care for newborns.

If you want to find out more about pre-mature babies, check out the following associations:

• American Academy of Pediatrics
• American Pregnancy Association
• Baby Centre
• Canadian Paediatric Society
• Caring for Kids – Canadian Paediatric Society
• Centers for Disease Control and Prevention, Topic: ‘Birth Defects’ (Fact sheets)
• Council of Pediatrics Subspecialties
• Healthy Children – American Academy of Pediatrics
• March of Dimes
• National Center on Birth Defects and Developmental Disabilities
• Pediatrics and Neonatology (Journal)
• Swiss Society of Neonatology