Neonatology

Neonatology deals with treating new-born children. New-borns can have complex diseases which can be treated only by someone with unique skills and medical expertise. Babies who are born prematurely and those with underdeveloped organs require the care of a neonatologist the most.

Apart from providing care and treatment to babies, the neonatology department also provides services like counselling for parents before, during and after the birth of their child. This training helps parents feel more prepared to carry out their new-born’s responsibilities easily. Neonatologists are vital since any health issue that is unchecked or ignored in new-borns can haunt them in the future as adults by having adverse growth defects.

Types of Neonatology Services

Neonatology can be considered a sub-division of paediatrics. However, they only specialise in providing care and treatment to infants. A neonatologist offers several types of treatments based on the patient's requirements. Some of them are as follows:

• Providing care during a C-section or any other medically complex delivery where The baby would require medical intervention right after the birth of the baby due to the ill health of the mother or the infant in the womb.
• Ensuring that the proper nutrition is given to babies for growth
• Treating new-born babies with life-threatening diseases and infections
• Diagnose and treat conditions like breathing disorders, infections or any kind of congenital disabilities in new-borns.
• Consult and coordinate with family physicians, obstetricians and paediatricians regarding issues affecting the new-born’s health.

Neonatology Symptoms

Both the foetus in your womb and the new-born baby may showcase a few symptoms hinting at the requirement of the specialities of neonatologists. While inside the womb, the mother may notice the following symptoms, which determine the need for a neonatologist during the delivery:

• The mother is unable to feel the baby move much
• Not enough weight gained 
• Fluid leaks from the vagina
• The uterus is too small and hasn't dilated in accordance with the trimester.
• History of complications in prior pregnancies

After birth, a neonatologist would be required if the new-born has the following symptoms:

• Rapid breathing
• Minimal to no breathing due to blockage in the airway
• Low BP
• Pale grey or blueish skin colour
• Swelling in the eyes, abdomen or legs
• Problems in feeding
• The baby isn't crying after it's born

Apart from this, abnormalities in physical appearance can also be a symptom requiring the attention of a neonatologist. Sometimes babies are born with an extra pair of limbs or other body parts, which will need the specialities of neonatologists to be appropriately treated.

When To See A Neonatologist?

You may need to see a neonatologist if:

• The baby has had a premature birth
• The baby is injured during the birthing process
• The baby is born with a severe illness
• You are having a high-risk pregnancy.
• The baby is born with congenital disabilities like a weak immune system, underdeveloped organs, etc.
• The baby has an irregular heart rate and breathing pattern
• If you're having conjoined twins
• In the case of sepsis which can be life-threatening
• If the mother has bacterial infections like chorioamnionitis
• In cases of hypoglycaemia

You may see a neonatologist to treat certain birth defects when the baby is still in the utero of the mother. They are as follows:

● Lower urinary tract obstruction

Here, the urine is unable to exit the foetus’s body, causing permanent kidney damage. This obstruction can be relieved, thus protecting the kidney from any further damage.

● Irregular heartbeat

There are a series of medications that doctors can prescribe to the mother. These medications go through the placenta and treat the foetus.

● Congenital diaphragmatic hernia

This is a condition where a hole in the chest allows abdominal fluid to enter it. This restricts the lung development of the baby. Lung development could be improved through a surgery called fetoscopic endotracheal occlusion. This surgery can be performed after birth and has good survival in most cases.

Diseases Treated by Neonatologists

Neonatologists treat several diseases and infections occurring in infants and foetuses. Some of them are as follows:

• Anaemia: It refers to the lack of sufficient blood cells in the baby. It usually occurs in premature babies. Neonatologists treat this condition by giving the babies few iron supplements. In rare cases, Doctors may also conduct a blood transfusion.
• Difficulty in feeding: Babies sometimes may face difficulty in being fed by a breast or bottle. In such cases, they are fed by placing a small tube or catheter in the baby's vein at the baby's foot, hand, belly button or scalp.
• Heart-related issues: Neonatologists treat heart-related problems like heart failure, heart valve abnormalities, heart murmur, etc., found in babies.
• Pneumonia: This lung infection is quite common in premature babies. Symptoms may include breathing issues, changed heart rate and increased apnoea episodes.
• Apnoea: Apnoea refers to stoppage in the breath. Premature don't always breathe well. A baby might follow irregular breathing patterns by taking short and long breaths. If the pause between these breaths lasts longer than 15 seconds, the baby may require medical intervention.
• Sepsis is an infection in the bloodstream caused by a virus or bacteria. It is usually treated by administering antibiotics.

Babies in the NICU will be monitored around the clock by medical specialists. They are usually placed in a warmer and provided with a bed and equipment like ventilators and tubes on their nose to help them breathe. They may also be attached to an IV to facilitate the consumption of medications. Sometimes babies are also connected to a feeding tube. The type of equipment will depend on the support your baby needs. The time spent by the baby in the NICU will depend on the success rate of response by the baby towards the medications administered to them.

Diagnosis of Neonatology

Neonatologists may conduct the following tests to diagnose diseases and infections in babies:

● Ultrasound

They are performed to check for the fluid build-up and to bleed in the brain. They are also conducted to detect problems in the liver, kidney and gastronomical tracts.

● Echocardiogram

It's basically an ultrasound of the baby's heart. It is performed to detect heart-related problems occurring in infants.

● Eye exam

Your neonatologist might ask an eye doctor to examine your baby's eye to detect problems relating to the retina.

● Heart rate monitor

The doctor uses a breathing and heart rate monitor to detect any irregularities in the baby's heartbeat and breathing patterns. Doctors will take blood pressure readings constantly too.

● Blood tests

Blood tests may be conducted to analyse the levels of glucose, calcium, etc. In the baby's body. They are also performed to diagnose diseases like anaemia.

Based on the diagnosis, your doctor might suggest medications or surgery treat the condition. A neonatologist usually consults with paediatricians and other related doctors when the need arises to give the best possible care for your baby.

Watching your baby go through the pain alone in the NICU can be overwhelming, but delaying a visit to the neonatologist can be dangerous for the baby. Your baby will be allowed to go home once he/she can breathe without support, is gaining weight naturally and slowly, can be breast or bottle-fed, maintains a steady temperature and is free of any infection.

Last Update

Reviewed by Dr. Manish Malik, Associate Director and Head of Neonatal Services, Paediatrics (Ped), Neonatology on 14-Oct-2022.

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