Neonatology

Neonatology is a subspecialty of pediatrics, dealing with the medical care of newborn infants, especially ill or premature infants. A newborn is a recently-born infant, usually considered a newborn for the first few hours of life. An infant is considered neonate in the first 28 days of life, and this period is considered critical to a healthy start in life. It is during this time that fundamental health and feeding practices are established. It is also during this time that the child is at highest risk for death. Neonatology is a hospital-based specialty, and is usually practiced in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or requiring special medical care, due to prematurity, low birth weight, intrauterine growth retardation, congenital malformations (birth defects), sepsis, or birth asphyxia. Abroad, health facilities are expected to provide care to two groups of [Page 1215]newborn infants; those who are delivered there and are mostly healthy, and those who are brought to the health facility from the community because of illness. Using simple but scientifically sound principles of care, as well as equipment and supplies, it is possible to treat most neonates at first-level facilities. Of the 7.1 million infants who die each year, approximately two-thirds die in the first 28 days after birth—the neonatal period.

Of these deaths, two-thirds take place in the first week after birth. Ninety-eight percent of all neonatal deaths occur in developing countries. Little is known about the actual impact and costs of maternal and newborn ill-health and death at the individual, familial, and societal level and their effect on poverty. The global status of maternal and newborn health provides one of the most striking examples of disparity between rich and poor countries. Improving newborn survival will dramatically reduce infant mortality worldwide.

Although there were some efforts to care for sick infants in the early 1900s, there was a rapid escalation in the services in the 1960s with the advent of mechanical ventilation of the newborn. This allowed for survival of smaller and smaller newborns. Today newborns as small as 450 g (1 lb) and as early as 22 weeks gestation have a small chance of survival. Infants weighing 1,000 g and at 27 weeks gestation have an approximately 90 percent chance of survival and the majority have normal neurological development.

One of the aims of the Infant and Neonatal Health (HNI) team within the World Health Organization (WHO) Department of Child and Adolescent Health and Development (CAH) is to reduce infant mortality and to ensure that newborns and infants have the opportunity for a healthy start in life. Studies clearly indicate that countries with high maternal, perinatal, and neonatal mortality have inadequate and poor-quality health services and this can be associated with reduced utilization of healthcare services. As such, increased emphasis is being placed on the need for standards of care, as well as mechanisms that address the barriers to provision and use of quality care.

Evidence also suggests that explicit, evidence-based guidelines improve the process and outcomes of healthcare when appropriately implemented. Success in reducing neonatal mortality requires many components: caring families, availability of adequate healthcare, ability to recognize when a sick child needs professional care, good nutrition, and support from communities. It is also important that every pregnant woman has adequate prenatal care. This includes having at least four prenatal visits with an appropriate healthcare provider, and receiving the recommended doses of the tetanus toxoid vaccination. The mother also needs support from her family and community in seeking care at the time of delivery and during the postpartum and lactation period.

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