Neonatal - Neonatologist

The term neonatal by definition refers to a baby's life from birth up until four weeks old. The neonatal period is slightly different than the perinatal period in that it starts before a baby is born. The perinatal period can start any time between the 20th to 28th week of pregnancy, depending on the definition, and ends at one to four weeks after birth.

The Importance of the Neonatal Period

Early infant mortality isn't as common as it once was in the western world. This is thanks to our modern healthcare system and first world medicine we all enjoy. But statistically, more than 10 million children die all over the world every year. Most of these children are under the age of five. Many of them are new babies under a month old. Statistics from the World Health Organization (WHO) says that neonatal deaths make up 40 percent of the deaths of children under five years old worldwide. Causes vary from diarrhea, preterm delivery, neonatal sepsis (a type of bacterial infection), asphyxia at birth, pneumonia or malaria.

Improvements in Neonatal Care

Neonatal care in first world countries is top rate. Many doctors have chosen to take on a subspecialty study of pediatrics called neonatology. These doctors are called neonatologists and they specialize in taking care of very young babies who are sick because of birth asphyxia, birth defects, prematurity, low birth weight, sepsis or intrauterine growth retardation. (Intrauterine growth retardation is the term used to describe stunted growth of a fetus or when a baby stops growing of undetermined reasons in utero.)

Modern neonatologists are a more modern type of doctor with the specialty not taking off until the creation of mechanical ventilation for a newborn in the 1950s. This was also the time that Dr. Virginian Apgar first described the Apgar scoring system in 1952 as a way to evaluate a newborn's condition. In 1965 the first American newborn intensive care unit (NICU) was open in Connecticut. In 1975 the American Board of Pediatrics established a neonatology sub-board certification.

In North America, a doctor who wishes to become a neonatologist must first complete training to be a pediatrician. Additional training of three years in the form of a fellowship is then required. Not all neonatologists are board certified.

The Neonatal Nurse Practitioner

The neonatal nurse also takes on additional training to be able to provide the specialized care needed in the NICU. All are registered nurses (RNs), meaning the nurse has graduated with a degree in nursing and has passed a national licensing exam. Some countries require their neonatal nurses to also have midwifery qualifications. New nurses rarely work in neonatal care and most hospitals require that their neonatal nurse practitioners have experience working in medical/surgical nursing or adult health nursing.

Some countries provide additional post secondary education in neonatal care such as a Master of Science in Nursing or doctorate degrees. Some neonatal nurses choose to further their education while already working in the NICU.

Levels of Neonatal Nurses

A neonatal nurse might work in one or several levels in a neonatal nursery. Level I neonatal nurses aren't common in North America but are classified as nurses who work in nurseries for healthy babies. There was a time when babies were commonly taken into a separate nursery after birth, but it's more typical for a baby to share a room with his mother until both mother and baby are discharged.

A Level II nursery is a nursery that provides care for premature or ill newborns. These babies typically require some special therapy or might have a few health concerns that mean they need more treatment before being discharged. The nurses and doctors in Level II neonatal nurseries are trained to provide special therapy as needed.

Level III nurses work in the Neonatal Intensive Care Unit (NICU). Babies in the NICU require the best technology and nurses trained to use this technology in order to survive. Infants in NICU require a lot of care and monitoring and NICU staff is made up of mostly skilled nurses. Typically nurses make up 90 percent or more of NICU staff.

Nurses in neonatal care are highly skilled like all staff so any parent who has a child in NICU can relax somewhat knowing his or her child is in good hands.


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