Neonatology and Perinatology

Perinatology is a subspecialty of obstetrics concerned with the care of the fetus and complicated, high-risk pregnancies. Perinatology is also known as maternal-fetal medicine. Since the perinatal period, depending on the definition, starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth, perinatology logically could be an obstetrical and pediatric subspecialty but, in practice, it is part of obstetrics. The comparable area of pediatrics is neonatology. A high-risk baby might be cared for by a perinatologist before birth and by a neonatologist after birth.

Track 3: Neonatal Intensive Care Unit(NICU)

A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit specializing in the care of ill or premature newborn infants. A NICU is typically directed by one or more neonatologists and staffed by nurses, nurse practitioners, pharmacists, physician assistants, resident physicians, respiratory therapists, and dietitians. Many other ancillary disciplines and specialists are available at larger units.

A Neonatal nurse practitioner are advanced practice nurses that care for premature babies and sick newborns in intensive care units, emergency rooms, delivery rooms and special clinics. Prematurity is a risk factor that follows early labour, a planned caesarean section or pre-eclampsia.

A congenital disorder, also known as a congenital disease, deformity, birth defect, or anomaly, is a condition existing at or before birth regardless of cause. Of these disorders, those characterized by structural deformities are termed "congenital anomalies" and involve defects in a developing fetus. Birth defects vary widely in cause and symptoms. Any substance that causes birth defects is known as a teratogen. Some disorders can be detected before birth through prenatal diagnosis (screening).

Birth defects may be the result of genetic or environmental factors. This includes errors of morphogenesis, infection, epigenetic modifications on a parental germline, or a chromosomal abnormality. The outcome of the disorder will depend on complex interactions between the pre-natal deficit and the post-natal environment. Animal studies indicate that the mother's (and likely the father's) diet, vitamin intake, and glucose levels prior to ovulation and conception have long-term effects on fetal growth and adolescent and adult disease. Animal studies have shown that paternal exposures prior to conception and during pregnancy result in increased risk of certain birth defects and cancers.

Neonatal nursing is a subspecialty of nursing that works with newborn infants born with a variety of problems ranging from prematurity, birth defects, infection, cardiac malformations, and surgical problems. The neonatal period is defined as the first month of life; however, these newborns are often sick for months. Neonatal nursing generally encompasses care for those infants who experience problems shortly after birth, but it also encompasses care for infants who experience long-term problems related to their prematurity or illness after birth. A few neonatal nurses may care for infants up to about 2 years of age. Most neonatal nurses care for infants from the time of birth until they are discharged from the hospital.

Congenital heart disease (CHD) is the most common congenital disorder in new-borns. Critical CHD, defined as requiring surgery or catheter-based intervention in the first year of life, occurs in approximately 25% of those with CHD. Although many new-borns with critical CHD are symptomatic and identified soon after birth, others are not diagnosed until after discharge from the birth hospitalization. In infants with critical cardiac lesions, the risk of morbidity and mortality increases when there is a delay in diagnosis and timely referral to a tertiary center with expertise in treating these patients.

Nutrition plays  an important role especially in the first couple of weeks after the child birth. Breast Feeding has important ingredients that build the baby’s immune system.  Neonatal nutrition is important for the growth and development of the newborn babies. In general, babies should be atleast 4 pounds before they are ready to come out of the incubator.

 Neonatal CNS Disorders

The central nervous system of a growing foetus starts with a simple structure called the ‘neural groove’ that folds in to form the ‘neural tube’. This then develops into the spinal cord and brain. By day 28 after conception, the neural tube should be closed and fused. If it doesn’t close, the result is a neural tube defect.

In many cases, these defects can be diagnosed during pregnancy with ultrasound scans and, rarely, with other tests such as amniocentesis (analysing a sample of amniotic fluid).

 Neonatal kidney problems

Acute renal failure (ARF) is a very common problem in the neonatal intensive care unit. The new-born kidney has a very low glomerular filtration rate (GFR) that is maintained by a delicate balance between vasoconstrictor and vasodilatory forces. Although sufficient for growth and development under normal conditions, the low GFR of the new-born kidney limits postnatal renal functional adaptation to endogenous and exogenous stresses. This limited response predisposes the new-born to the development of ARF and is even more pronounced in the low birth weight infant (ie, <2,500 g due to preterm birth or intrauterine growth restriction). Given this predisposition, early identification of ARF in the neonate is essential to preserving renal function.

New-borns have an immature immune system that renders them at high risk for infection while simultaneously reducing responses to most vaccines, thereby posing challenges in protecting this vulnerable population. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Many vaccines require multiple doses for maximum effectiveness, either to produce sufficient initial immune response or to boost response that fades over time. For example, tetanus vaccine boosters are often recommended every 10 years. Vaccine schedules are developed by governmental agencies or physicians groups to achieve maximum effectiveness using required and recommended vaccines for a locality while minimizing the number of health care system interactions.