Neonatologist

Neonatology is a science that studies newborn children: their growth, development, pathological conditions. A doctor whose duty is to apply the theoretical knowledge of this branch of medical science in practice is called a neonatologist.

For the first time, neonatology as an independent type of medical practice was singled out at the beginning of the 20th century, and until that time it belonged to the field of pediatrics and obstetrics. In the fifties, Dr. Virginia Apgar proposed a scale, later named after her, to assess the condition of a newborn and decide on the need to apply resuscitation measures to him. Later, the Silverman scale was developed, according to which it is possible to analyze the state of breathing and the presence of disorders of the respiratory system in a baby. And after the first apparatus for artificial ventilation of the lungs of premature babies was designed in the sixties, neonatology began to develop rapidly, respectively, the demand for relevant specialists – neonatologists, increased.

The terms “neonatology” and “neonatologist” themselves were first proposed in 1960 in the medical publication “Diseases of the Newborn”.

Patients of a neonatologist and his field of activity

Medicine recognizes as newborns children under the age of 28 days, that is, within the first 4 weeks after birth.

The patients of the neonatologist are both newborn babies and children up to a year old. However, in most cases, after the first month of life, the pediatrician already leads the baby.

Premature babies (born between 28 and 38 weeks of gestation), full-term (who were born within the normal period – after 38 and before 40 weeks), post-term (born after 40 weeks) – all babies immediately after birth get their first appointment exactly to a neonatologist. It is important to note another criterion for determining the health of a baby – maturity, that is, how all of its systems and organs are able to function normally in new conditions for them. Immature can be both children born on time, and those who were born late or, conversely, earlier than expected.

The responsibility of a neonatologist is very significant – it is this specialist who must notice and identify any possible deviations in development, possible violations of the functioning of organs, disorders of mental reactions and reflexes. His competence includes the initial examination of all systems of the child’s body, so a neonatologist is also called a micropediatrician.

To assess the health of an infant, the doctor uses the Apgar and Silverman scales. The first one contains 5 criteria:

• breath;
• muscle tone;
• coloration of the skin;
• the frequency of contractions of the heart muscle;
• reflex excitability.

Based on the results of assessing the condition of the child, the doctor decides on the need for resuscitation or other special measures for the newborn.

The Silberman scale is used to assess the degree of respiratory distress in preterm infants. At the same time, 5 criteria are also analyzed:

• position of the lower jaw;
• retraction of the sternum;
• breath;
• chest movements;
• retraction of the intercostal space.

This means that the specialist must have the knowledge of a resuscitator, neurologist, surgeon and diagnostician, because the detection of health disorders in the early stages of a baby’s development greatly facilitates their treatment and the future life of a small person.

In addition, the neonatologist’s area of ​​interest also includes the expectant mother, so this doctor must also have the knowledge of an obstetrician, as well as understand the diseases of pregnant women. After all, the health of the newborn, first of all, is affected by the well-being and health of the mother. It is the neonatologist who helps the pregnant woman prepare for the birth process, he puts the newborn on the mother’s breast for the first time, and in the first days of his birth he advises the mother on all issues that arise in the life of the child.

In addition to diagnosing, the competence of a specialist includes the observation and treatment of infants. It should be noted that most of the methods of therapeutic exposure used for adults or children from 1 month old are not suitable for newborns. The decision to prescribe a therapy regimen for a newborn is made by a neotologist, pediatrician and obstetrician, sometimes with the participation of department heads or the entire medical institution.

What a neonatologist should check: organs, systems and reactions of a newborn

In maternity hospitals, perinatal centers and centers for the rehabilitation of premature babies, a specialist of this profile is simply irreplaceable. It is normal practice to have not only an obstetrician-gynecologist and surgeon present at the birth, but also a neonatologist. Immediately after the baby is born, the doctor checks his condition according to a certain scheme. First, he feels the stomach in order to determine whether the spleen and liver are normal, what sizes they have. The doctor also checks whether the original feces have passed from the baby, and what is its structure. Thus, it is possible to determine the presence or absence of intestinal pathologies, as well as some infections. Normal stool is odorless, viscous, sticky, and tar-like with an olive or dark green hue.

Next, the doctor examines the neck and head of the child – it is very important at this stage to identify if there are any violations caused during childbirth, for example, curvature or displacement. The clavicle, sternum are palpated, after which the bones of the skull, the size of the fontanelles and the presence of birth tumors are checked.

Using a phonendoscope, the doctor listens to the heartbeat, checks for noise and extraneous sounds during breathing.

Inspection of the genital organs occurs in order to check:

• in boys, whether the testicles have descended into the scrotum;
• in girls – whether small ones are covered with large labia.

An obligatory process of studying a newborn is the study of muscle tone and the health of the hip joints. In the normal state of the newborn, his muscles are tense: the arms are bent at the elbows, the hands are gathered into fists, the neck is pressed to the body, the legs are bent at the knees and hips. It is obligatory to check whether the legs are well apart in the hip joints, and how symmetrical the skin folds are in these places. Such a study makes it possible to determine the presence of joint dysplasia in infancy, which is especially important, since the most effective treatment of the pathology is possible only up to 2-3 years. In adulthood, it is almost impossible to cure dysplasia, and this violation can cause a lot of inconvenience to a person, in severe cases, cause disability.

Also, the doctor should check the child’s simplest reflexes, the absence of which may indicate serious developmental disorders. The infant is able to show many reflex reactions, the main ones, which, in the case of the initial examination of the newborn, are paid attention to are grasping, searching, proboscis, crawling reflex and Babinsky reflex (foot tickling reaction).

In addition, the neonatologist prescribes, and sometimes he himself conducts the first tests of the baby – a blood test to determine the group and Rh factor, and neonatal screening.

Diseases and pathologies treated by a neonatologist

Many parents are interested in the question “what does a neonatologist treat”. The doctor’s competence includes the most common problems and diseases of newborns. Among them:

• digestive disorders (nausea, vomiting, diarrhea, constipation);
• skin rashes and diaper rash;
• bronchitis;
• jaundice;
• thrush;
• eye inflammation;
• congenital disorders of the metabolic process and thyroid function;
• insufficient length of the frenulum of the tongue;
• umbilical bleeding, umbilical hernia;
• albuminuria (physiological disturbances in the functioning of the kidneys).

In addition, the neonatologist monitors the baby’s weight fluctuations during the first month of life, its temperature and appetite. Particular attention is paid to premature babies and measures for their rehabilitation.

When to See a Neonatologist

All the time while the baby and mother are in the hospital or perinatal center, the doctor observes and guides them until the moment of discharge. Already after the child gets home, parents, in addition to the usual measures for measuring temperature and weight, should carefully monitor his condition.

For the first time after the appearance of no light, for about 3-5 days, the weight of the child decreases slightly. This is due to the fact that the baby is in a completely different environment than he was before birth. Accordingly, all of its systems need to get used to working in a new way. The body’s own energy is spent on heating, maintaining breathing and the processes of digesting food.

Usually, after the child has stopped losing weight, he begins to gradually gain weight. At this time, the neonatologist can transfer the care of the baby’s health to the pediatrician, although there are cases when it is the neonatologist who continues to observe children under one year old.

Syndromes that should be a reason to visit a doctor are:

1. Violation of muscle tone, with difficult flexion and extension of the joints.
2. Frequent vomiting of food.
3. Bleeding from the navel or suspected umbilical hernia. In the first hours of a baby’s life, bleeding from the navel indicates that the umbilical cord was bandaged badly.
4. Nausea, vomiting, stool disorders.
5. Diaper rash.

Diaper rash can appear in the armpits, in the groin, behind the ears, in the lower abdomen, in the folds of the skin. Doctors distinguish between three degrees of diaper rash in infants:

1. First. Mild form, in which there is a slight reddening of the skin.
2. Second. In this case, there is a strong redness and a visible violation of the integrity of the skin (ulcers, wounds).
3. Third. Many wounds and sores are formed.

Doctor’s advice on child care

In addition to the fact that a specialist is ready to help if there are suspicions about a baby’s health problems, parents can get help and advice from a doctor on the preparation of a diet, breastfeeding, first feeding, feeding, sleep and rest. A doctor, also called a micropediatrician, helps the baby and mother adjust to their new lifestyle. He will answer questions about how to properly bathe a child, how to dress and how long you need to walk.

The doctor usually conducts an appointment at the perinatal center, however, in some cases, the examination can be carried out at home.

Differences between a neonatologist and a pediatrician

Neonatology as a medical science is part of pediatrics. For example, in Russia, in most cases, neonatologists are trained to specialize in pediatrics. However, there are some differences between these two professions.

Thus, the activity of a neonatologist can become relevant already in the later stages of pregnancy. Further, after the birth of the child, his competence includes an initial examination to determine the state of health of the child, as well as, if necessary, the appointment of resuscitation measures for infants.

Neonatologists usually monitor the health of children up to 4 weeks of life, sometimes until the moment when the baby begins to gain weight. In rare cases, a neonatologist leads a child up to a year, after which the responsibility for his health passes to the pediatrician. In fact, both are children’s doctors, but a pediatrician, unlike a neonatologist, is engaged in the diagnosis and treatment of children over a certain age.

Therapies

As you know, therapies that are relevant for adults are most often not suitable for newborns. If certain diseases or pathologies are detected in a child, a neonatologist, first of all, can prescribe various tests to clarify the diagnosis, for example, a complete blood count, a bilirubin test, an allergic panel, a coprogram, immunoglobulin E, bacteria from the nose and pharynx, and others. In addition, the doctor may prescribe a referral for an ultrasound of the hip joints or echocardiography.

The neonatologist is involved in the development of a treatment regimen for the baby: he can prescribe medication with special drugs that are allowed to be taken from the first days of life. Also, together with the surgeon and anesthesiologist, the specialist can decide on the need for surgical intervention in certain cases, for example, for resuscitation of a newborn.

In such cases, the operation is performed by a surgeon, but a neonatologist is always present in the operating room. Also, injections, massage, connection to a ventilator can be prescribed to save the baby’s life.

A neonatologist is a doctor of general specialization, who must have sufficient qualifications to determine the state of his health from the first moments of a child’s life, and, if necessary, prescribe adequate therapeutic measures. That is why expectant mothers, in addition to finding an obstetrician-gynecologist and an anesthesiologist for childbirth, should take care of choosing a neonatologist, and be sure to ask if he will be present at the birth.