Neonatology is the medical speciality of taking care of newborn, sick and premature babies. It is a subspecialisation of Paediatrics.
A Neonatal Intensive Care Unit (NICU) is a special area of the hospital that is devoted to the care of critically ill babies. Typically a NICU is completely separated from the nursery for healthy newborns, (the nursery is always located near the rooms for the mothers). The staff for the NICU and the staff for the newborn nursery are completely separate as well.
In most hospitals, babies are only admitted to the NICU directly from the delivery room, the newborn nursery, or from another hospital’s NICU or nursery. For reasons of infection control, if a baby has become sick at home and come back to the hospital, the baby will probably be admitted to a paediatric ward or paediatric intensive care unit rather than the NICU. Of course, exceptions can be made if the baby has a problem that definitely requires the constant attention of a neonatologist.
Babies usually stay in the NICU until they are ready to go home, even if that takes several months. This is different to an adult or paediatric intensive care unit, where the patient will leave the unit as soon as they are stable and do not need help with their breathing and constant monitoring. For this reason, NICUs are often divided by walls or partitions into several distinct regions: a true “intensive care” area where the nurses and doctors spend most of their time at the babies’ bedsides, an “intermediate care” area for babies that are still on IVs (intra-venous medication) or extra oxygen, and a quieter area for the “growers.”
In most neonatal intensive care units, about half of the babies that are admitted to the unit are usually full-term babies (born after 37 weeks) and the other half are premature babies - babies that were born too early (before 37 weeks gestation).
Premature babies are not really “sick” but the various systems and organs of their body are not yet fully developed, which can lead to a host of problems that require expert interventions and constant monitoring.
- the lungs are not fully developed, so premature babies may need extra oxygen or assistance with their breathing from a ventilator (“respirator”).
- the surface area of a premature infant’s body is large compared to its volume and there is very little body fat, so premature babies get cold easily and must be kept in an incubator or radiant warmer.
- the liver is not fully developed, so premature babies have a tendency to become much more jaundiced than a full-term baby. If the jaundice is too severe, it can cause brain damage
- the immune system is not fully developed, so premature babies are very susceptible to infections
- the stomach and intestines are not fully developed, so many premature babies’ digestive systems cannot handle breast milk or formula adequately, and must get part or all of their nutrition through an IV for a while
- the brain is not fully developed, so many premature babies are not able to breathe regularly and reliably on their own without assistance, or can’t coordinate sucking, swallowing and breathing without choking
The problems of the full-term babies that come to the neonatal intensive care unit are typically very different to those of the premature babies, and in some ways are much more complicated and less predictable. Here are a few examples:
- perinatal asphyxia - a lack of oxygen during the birth process leading to multiple problems such as seizures, kidney failure, heart failure
- congenital defects or “birth defects” - abnormalities of development, such as congenital heart defects, brain malformations or gastrointestinal malformations
- pneumonia, meningitis, or generalised infections in the blood (“sepsis”) - either acquired before birth or shortly afterwards
- hereditary or genetic disorders of various kinds - some involve broken or abnormal numbers of chromosomes, others are caused by small mutations in the DNA resulting in abnormal proteins or development
- hyperbilirubinemia - if a full-term baby has certain types of blood disorders, has an infection, or if the mother’s immune system makes antibodies against the baby’s blood type, jaundice can be very severe and this requires expert attention
- injuries during the birth process or during the newborn period.
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