Neonatology

A newborn baby adapts within minutes from life in the womb to breathing air, keeping warm and feeding. Most babies manage this without help, but some need support, particularly those born before 37 weeks, those with a low birth weight, and those affected by infection, a lack of oxygen around birth or a condition present before birth. Neonatology is the branch of paediatrics devoted to these babies. Neonatal units are graded by level: special care for babies who need monitoring, tube feeding or light support, high dependency care for babies who need more help with breathing, and full intensive care for the smallest and sickest babies, including those on ventilators. The neonatal team includes neonatologists, specialist nurses, dietitians and therapists, and it works with obstetricians before the birth and with paediatric surgeons, cardiologists and other specialists afterwards. Parents are encouraged to stay closely involved in daily care.

Prematurity is the most common reason for neonatal care. Babies born early may have immature lungs, causing respiratory distress syndrome, as well as difficulty keeping warm, feeding and fighting infection. Very premature babies can also develop bleeding in the brain, a serious bowel condition called necrotising enterocolitis, chronic lung disease and retinopathy of prematurity, an eye condition that needs regular screening. Babies born at term may need care for jaundice, low blood sugar, infection or breathing problems. Hypoxic-ischaemic encephalopathy, a brain injury caused by a lack of oxygen around birth, is treated with cooling within hours of birth. Babies with conditions found before birth, such as heart defects, diaphragmatic hernia or bowel blockages, are stabilised by the neonatal team before and after surgery. Areas of special focus include neonatal neurology, neonatal nutrition and the developmental follow-up of babies who needed intensive care.

Breathing support ranges from extra oxygen through small nasal tubes, to CPAP, which keeps the lungs gently open with air pressure, to mechanical ventilation for babies who cannot breathe well enough on their own. Surfactant, a substance that immature lungs lack, can be given directly into the airway. Nutrition starts with feeding through a vein when needed and moves to breast milk or formula through a tube, then to breast or bottle feeding. Jaundice is treated with phototherapy, a special blue light, and severe cases may need an exchange transfusion. Infections are treated with antibiotics. Therapeutic hypothermia cools the baby's body to about 33 to 34 degrees Celsius for 72 hours to reduce brain injury after oxygen deprivation, and it must start within about 6 hours of birth. Retinopathy that needs treatment is managed with laser or eye injections. When surgery is needed, the neonatal team plans the timing with the paediatric surgeons.

Monitoring in a neonatal unit is continuous: heart rate, breathing, oxygen levels and temperature are tracked at the cot side. Blood tests check sugar, infection markers, bilirubin and blood gases, using tiny samples. Cranial ultrasound, done at the bedside through the soft spot on the baby's head, looks for bleeding or other changes in the brain, and MRI is used when more detail is needed, for example after cooling therapy. A simplified brain wave recording, called amplitude-integrated EEG, watches for seizures in babies at risk. Echocardiography checks the heart. Premature babies receive regular eye examinations to screen for retinopathy, and every baby should have hearing and blood spot screening for metabolic and genetic conditions. Incubators, ventilators and phototherapy units are adapted to very small babies, and infection control is strict, so parents are shown how to wash their hands and handle their baby with care.

Families rarely travel for neonatal care after a birth, and an unwell newborn should be treated where they are, with any transfer decided and arranged by the local medical team. Travel makes sense in two situations. The first is a planned birth: if a pregnancy scan shows a condition that will need surgery or intensive care, or the pregnancy is high-risk, the mother can travel in good time to give birth where a suitable neonatal unit and surgical team are on hand. Airlines restrict flying late in pregnancy, so plan the journey with your obstetrician. The second is a second opinion, in which the team reviews a baby's records and scans remotely. If your baby needs intensive care, expect a stay of weeks to months, and plan for accommodation, the baby's passport and birth documents, and the journey home.