Neonatology is the study of the newborn infant. Neonatologists diagnose and treat newborns who are born prematurely, of low birth weight, with congenital malformations or following a birth injury. Approximately 12% of U.S. babies are born prematurely, or before 37 weeks gestation. Nearly 500,000 deaths each year are attributed to complications of prematurity. Today, our smallest new citizens have a much better chance of survival due to advancements in research and a better understanding of newborn needs.
Learn more about what neonatology research has provided to medical practice and how this may affect you as a new parent.
The APGAR Scoring System
It wasn’t until the 1950’s that a system for monitoring the clinical condition of a newborn was developed. APGAR scoring is now widely used as a reliable means for measuring newborn health.
APGAR refers to the units of measure taken at 1 minute, 5 minutes and 10 minutes after birth. Appearance, pulse, grimace, activity and respiration are observed and a score between 0 and 10 is given. Normal babies hover in the 7 to 10 range, while babies scoring under 7 require special care. If a baby, for instance, appears blue in color and has weak respiration, this may be a sign of airway obstruction caused by mucus or birth injury. A baby with pink color, lots of movement and strong respiration is considered well and healthy.
APGAR scores give the nurse and physician a quick estimate of how well the baby is doing during those crucial first minutes. If signs of distress are evident, the physician is able to intervene immediately to lessen the possibility of brain damage.
My son was born post-term, almost 10 days overdue, and survived a grueling 18 hour labour. What a relief to finally get to meet him after 3 hours of pushing. My doctor placed him on my chest, he took his first breath and then proceeded to turn blue. He wasn’t breathing and had a first APGAR score of 3. I have never seen doctor’s move so quickly. A neonatal specialist came bounding into our room while nurses provided CPR and started trying to intubate my son almost immediately. His APGAR score at 5 minutes went up to 7 as he eventually coughed up the mucus that had clogged his trachea.
Neonatal Intensive Care
If a newborn has low APGAR score’s and requires more intensive care, he/she is often admitted to a Neonatal Intensive Care Unit (NICU) and cared for by a neonatologist or pediatrician. NICU’s provide a specialized environment for newborns and include equipment like feeding tubes, respiratory machines, and monitoring devices. This equipment provides vital support to a fragile new life.
Isolation from infection or disease is also extremely important for premature and low birth weight babies who can suffer severe health consequences from exposure to a simple cold. Babies in the NICU are monitored 24 hours a day by highly trained nurses.
In the 1960’s, a low birth weight neonate (weighing under 5 lbs) would have had a 40% chance of survival. By the 1980’s, after the widespread use of incubators and neonatal intensive care units, 80% survived those critical first weeks.
Newborn Care
Early newborn care involved an over reliance on hope. In fact, many premature infants were sent home to be cared for out of whatever materials were available. Medical advancements brought a swing of the pendulum to increasing reliance on machinery. Today, society has demanded a more humanized approach to care and a return to parent involvement.
Nurses and neonatologists understand the importance of human contact in those first hours and weeks after birth. Contact creates a better outcome for the baby and helps parents feel in control of their baby’s care.
My son spent his first night in neonatal intensive care, and at 8 pounds, was the largest baby there that night. A small monitoring device was attached to his foot as they monitored him for any signs of lasting damage from his anxious first moments. Nurses took me into the unit and let me watch him sleep and eventually hold him. In a special private room, I was able to feed him and take a few moments to take in what had happened. The nurses let me know he was a fiesty little guy and loved his milk! And I was completely amazed at how devoted those nurses were to the babies, including three other premies in incubators. My son was discharged from the NICU the following afternoon after showing signs of being resilient and healthy. He spent the rest of the hospital stay in my room.
As I learned, having an ill baby is an extremely anxious time for new parents. Now, parents are invited to see, feel and be present with their babies even in intensive care units. Mother’s can feed, bathe and cuddle their new babies and even breastfeed if the baby is far enough along in their development. Father’s can also be a part of the process as never before.
And now with neonatology as a pediatric subspecialty, parents can ask questions and get answers from someone specially trained to care for their baby. Parents are encouraged to be part of the decision-making process.
Prevention: The Future of Neonatology
It isn’t good enough to simply treat critically ill infants. We must attempt to understand and prevent illness in early life. Neonatal research has found factors such as maternal health, exposure to environmental toxins (like cigarette smoke) and genetics as contributing to low birth weight and prematurity. Educating the public on the importance of prenatal care is paramount.
Reaching out to at-risk pregnant women is also important. Poverty, addiction and abuse can all lead to social isolation for some soon-to-be-mothers. Early intervention and care is critical to the healthy development of the baby and in preventing medical problems later on.
With advancements in technology, most congenital malformations are now discovered in utero. The neonatologist, therefore, is prepared at birth for the specific needs of the baby. A surgeon often becomes involved in cases of malformation. Malformation is rare and can include heart defects, cleft lip, spina bifida and defects of the limbs.
For more on neonatology, visit www.neonatology.org which includes an alphabetical listing of newborn medical conditions and information for families.
www.neonatology.com
