Neonatology

Neonatology is a medical specialty dedicated to the health of newborns. It focuses on the care and management of ill or premature infants, particularly those who require intensive medical intervention or those born with certain congenital problems. Neonatology also entails understanding how these medical conditions can affect the overall development and long-term well-being of the infant.

 

Understanding Neonatologists

A Neonatologist works with hospitals, universities, children's medical-care institutions, and community centers, among other similar medical locations. They are specialists catering to newborn patients experiencing various diseases, infections, and complications. There are also cases where complicated pregnancies require specialized attention and specific treatments, catering to a particular illness, which may extend from breathlessness to heart and lung diseases.

 

Are Neonatologists Pediatricians?

Every baby first undergoes a comprehensive physical examination by the pediatrician after birth. Neonatologists are pediatricians who care for newborns who need advanced life support or advanced care. One of the specialization areas that require special training and experience under the pediatrics department is neonatology. Neonatologists are specialists in the field of pediatric health and diseases, but they specifically treat newborn children as part of their specialty. A neonatologist is a medical doctor who successfully completes a 4 year pediatric training and a 3-year neonatology training following a 6-year medical training.

All treatments provided by a Neonatologist are geared towards the treatment of a wide variety of neonatal diseases and conditions, including cancer, hereditary diseases, birth anomalies and various other diseases that require special care and delicate handling.

 

The Types Of Neonatal Conditions

There are numerous types of conditions that newborns experience, with varying degrees of seriousness, depending on the symptoms, detection stage, intensity, and even the diagnosis. Neurological conditions in newborns can often be difficult to diagnose and manage, but having a comprehensive understanding of them is essential in providing quality patient care. To easily understand different conditions treated in newborns through Neonatology, it is important to categorize them into specific categories.

Premature Birth

The pregnancy period is commonly 40 weeks, whereas premature birth occurs in less than 37 weeks. Preterm babies born before 37 weeks are more likely to have neurodevelopmental disorders, growth retardation, and disorders such as insulin resistance and obesity in adulthood.

Birth Injuries

These are simply injuries that take place during birth. Typical injuries include fractures, bruising, cuts, and sometimes even nerve damage due to birth trauma. These defects are more common in overweight, large and premature babies.

Breathing Difficulties

This is a common occurrence among premature babies, but can also occur in term babies. One of the terminologies describing respiratory distress in newborn babies is apnea. Respiratory apnea occurs if the infant stops breathing for 20 seconds or longer.

Jaundice

This is common among premature and breastfed babies. Breast milk jaundice, which is seen due to breast milk, is a type of physiological jaundice, but in some cases, jaundice may be prolonged. Physiological jaundice usually resolves within 1 to 2 weeks. Jaundice that lasts longer than 2 faults in term infants and longer than 3 weeks in preterm infants is prolonged jaundice. In this case, advanced laboratory tests, direct and indirect bilirubin determination and imaging tests can be applied. Babies with jaundice have a yellow discoloration on their skin and especially on the white part of the eyes (sclera). The reason for the yellow color is the bilirubin pigment that occurs due to the destruction of the red blood cell or liver problems.

Seizures

Neurological convulsions are one of the most common neurological problems in newborn babies that cause difficulties in treatment and diagnosis. Newborns are highly susceptible to convulsions and require immediate treatment. There may be long-term effects, sequelae may develop. The time of occurrence of the convulsion and the type of the seizure are important in determining the cause of the convulsion. While seizures due to intracranial hemorrhage are common in preterm infants, it is essential to rule out hypoglycemia in any infant who has seizures.

Birth Defects

Congenital defects in the womb due to developmental abnormalities or hereditary and environmental factors are not uncommon in the community. Common congenital defects can be summarized as follows.

• Cerebral Palsy: The brain controls the body's motor movements. The ailment of the portion of the brain that controls the body's muscle movement and posture is cerebral palsy. In newborns, especially, they may be born with the disease or sometimes contract it within the first two years of their life.
• Brain and Spinal Cord Anomaly: This is an anomaly where the child's brain or spinal cord develops unusually. The body defects of these types are tended to through surgery. Typically, surgery of this type demands the intervention of numerous specialists like neurologists and geneticists.
• Cleft Lip and Palate: Cleft lip and cleft palate are referred to as openings or clefts in the upper lip, palate, or both. Cleft lip and cleft palate occur when the developing facial structures are not fully closed or closed incorrectly. Cleft lip and cleft palate are among the most common birth defects. While isolated cleft palate and lip are mostly seen, it can also be seen with many hereditary diseases or syndromes. While the appearance of babies with this congenital defect can be distressing, most babies can regain normal function with a series of surgeries and have a more normal appearance with minimal scarring.
• Chest and Abdominal Anomalies: Diaphragmatic hernia, exomphalos, and gastroschisis are among the common abdominal birth defects. In diaphragmatic hernia, the organs in the abdomen can go into the chest cavity, while in the exomphalos, the organs can come out from the navel. In gastroschisis, organs may be protruding from the abdominal wall. These birth defects can be detected with pregnancy screening tests and routine ultrasounds. Depending on the severity of the disease and the characteristics of the patient, the treatment may be follow-up or surgery. Chest wall malformations can be mild or severe and are usually present at birth. Common types are pectus carinatum and pectus excavatum. In pectus carinatum, the ribs are bulging outwards and popularly known as pigeon chest. In pectus excavatum, the chest wall is collapsed inward and is also known as the shoemaker's chest.
• Urinary Tract Anomalies: Congenital anomalies of the kidney and urinary tract are birth defects that adversely affect the shape and function of the kidneys and urinary tract. Renal agenesis, renal hypoplasia, polycystic kidney disease, vesicoureteral reflux and ureteropelvic junction (UPJ) obstruction are among the most common congenital anomalies.

Genetic and Chromosomal Disorders

Genes are passed down from parents to children and are tasked with coding the body's functions. If the genes are exposed to various factors or the cause is unknown, it is called a genetic mutation. Mutations can also occur spontaneously. Changes in genes can cause health problems such as cystic fibrosis, sickle cell disease, heart defects and congenital abnormalities. Genetic disorders can also result from chromosome structures that carry genes. Like genes, undesirable changes can occur in chromosomes. Chromosomal defects can be caused by excess or missing chromosomes. One of the most common chromosomal disorders is Down syndrome. In Down syndrome, there are three copies of chromosome 21 instead of two. Among genetic disorders, diseases screened for before birth include cystic fibrosis (CF), spinal muscular atrophy (SMA), and hemoglobinopathies. CF is a disease that affects the respiratory and digestive systems. Children with cystic fibrosis very often have respiratory tract infections and intestinal problems. SMA is a genetic disease that causes muscle damage and weakness. Although some types of SMA have a milder course, it is a fatal disease. Hemoglobinopathies cause damage and loss of function in red blood cells in the body. Thalassemias and sickle cell disease are two common types of hemoglobinopathy. Hemoglobin is an oxygen-carrying protein found in red blood cells. In thalassemia, the amount of healthy red blood cells and hemoglobin decreases. In sickle cell disease, red blood cells take the "C" shape. C-shaped red blood cells have a short lifespan and are not functional. They also get stuck as they circulate in small blood vessels, preventing blood flow.

 

What Is the NICU Unit?

The newborns requiring additional care, nourishment and overall protection are placed in the neonatal intensive care unit (NICU). They are backed by leading equipment and skilled medical staff.

 

The Types Of Neonatological Treatment

Neonatologists leverage numerous treatments to cater to illnesses in newborns. The baby's health, in certain complications, prompts further visits to the NICU Unit. It is important to understand the NICU unit various neonatological treatments available, such as:                                                                                                               

• Ventilator: This is utilized to assist those newborn children who struggle with breathing. The ventilator extracts carbon dioxide and other harmful elements and provides oxygen for breathing.
• CPAP (Continuous Positive Airway Pressure): This method delivers respiratory support to newborns with upper airway obstruction or respiratory failure.                                                              
• ECMO (Extracorporeal Membrane Oxygenation): An artificial lung oxygenates and mechanically pumps the blood to the rest of the body, until complete recovery, the machine supports vital organs through steady blood flow and oxygenation thereby allowing the heart and lungs to rest.
• Warming Treatment for Premature Babies: It is administered most commonly as a part of incubation to ensure a steady body temperature for the newborn child.
• Cooling Therapy for Newborns: This relatively unique treatment form can help cure brain damage. This is a treatment that can be perceived as concerning, as the child is placed on a waterproof blanket, with temperatures lowered, to create a state of hypothermia. Following this, the temperature is allowed to rise, to normalcy, curing the patient.
• Light Therapy to Treat Jaundice: In this treatment, babies are typically exposed to phototherapy for 48 hours. Phototherapy is exposure to bright light but within a controlled environment.

Surgical treatment is an important aspect of neonatology, which can be both an incredible life-saving tool and an extremely difficult decision-making process in conditions such as cleft palate and lip, vesicoureteral reflux, chest wall anomalies, and limb defects.

 

USHAŞ: Your Partner in Health

As an institution affiliated to the Ministry of Health of the Republic of Türkiye, USHAŞ, as part of its initiatives to assist medical tourism, operates under the name of HealthTürkiye service in many health fields, including Neonatology, with its expert staff and health institutions with advanced technology. It aims to bring together private and public studies on health tourism and to guide guests from abroad to receive health services.