Newborns are not just small adults. They have unique medical needs that differ from even young children and toddlers. Neonatologists are physicians with special training that qualifies them to care for newborns and premature babies. These tiny patients present interesting challenges that a neonatologist is uniquely skilled to handle. They are familiar with treating common and not-so-common illnesses, disorders, and congenital abnormalities the use of special equipment designed for the smallest patients.
It's not easy to become a neonatologist. Neonatologists must complete four years of medical school followed by three years as a general pediatric resident. After that, they require three years of training in a neonatal or newborn intensive care unit. In all, neonatologists complete 10 years of schooling and hands-on education before that can seek certification from the Neonatal-Perinatal Medicine sub-board of the American Board of Pediatrics.
A neonatologist manages the day-to-day care of patients in the NICU or the neonatal intensive care unit. Often, their work begins before the birth, consulting on the medical teams of pregnant women whose babies have congenital abnormalities. They answer any questions the mother and family may have and put together a plan for delivery and the interventions required after birth. Neonatologists also attend high-risk deliveries so they can intervene immediately if necessary.
Most neonatologists work in the NICU but these special units are often available only in large academic or private hospitals. Some neonatologists are also involved in follow-up care, monitoring the progress of high-risk infants who recently left a NICU, and determining if sick babies require admission to the unit. A primary role of these special doctors is to provide support to parents while addressing the challenging uncertainties of treatment.
Neonatologists manage day-to-day care in the NICU or high-risk nurseries. This involves coordinating care with surgeons and other members of the care team, attending high-risk births and intervening when necessary, and diagnosing and treating infections, defects, and disorders. They also ensure proper growth and nutrition for patients in the NICU and monitor lab results, respiratory status, and vital signs.
There are common heart problems include ductus arteriosus (PDA) and septal defects. Cardiac defects are often discovered during pregnancy. In those cases, a neonatologist will likely be present at delivery to assume care when the baby is born. Some defects, including tetralogy of Fallot or transposition of the great arteries, require care from a neonatologist that specializes in the heart.
A neonatologist's schedule depends on where they work and their role in the care team. They cover day and night shifts in the NICU, and while an attending neonatologist may not be in the hospital overnight, they are typically on call at home while fellows and neonatal nurse practitioners are in-house. When completing training in the NICU, those doctors hoping to be neonatologists may alternate between providing in-house care and weeks of research or other enrichment projects.
A lot of neonatologists work in direct patient care, but there are other opportunities in the field, too. Many specialists make significant contributions to laboratory work, epidemiology, research, teaching, and administration to improve treatment and care guidelines. That said, all neonatologists spend time at the bedside caring for patients at some point in their careers. They can then take what they learn and contribute to the field in other ways.
It takes a special person to become a neonatologist. It's an extremely rewarding field but taking care of the tiniest and sickest babies is difficult work. To be successful, neonatologists must know about developmental biology, maturation outside the womb, and how to treat and care for a fragile newborn and their family.
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