A "Peek-a-Boo" into

Neonatology    

Created By:  Erin Collins

CIS 100

When I Grow Up...

Currently, I am a International Studies Pre-Med major with a Spanish minor.  Upon graduation from Spelman College, I plan to attend a four-year medical school.  Ultimately, I would like to enter the field of pediatrics with a specific concentration in neonatal care.  I have always had a passion for working with and caring for children because I believe that all human beings deserve a chance at life!

What is neonatology?

Neonatology is the medical specialty field that focuses solely on the care of premature babies, sick babies, and newborn babies.  All babies are cared for by neonatologists after when they first arrive in the world.

What is a Neonatal Intensive Care Unit?

A Neonatal Intensive Care Unit (NICU) is actually a entirely separate area of the hospital that is devoted to the care of critically ill babies.  Most often, the NICU is located in another area of the hospital, nowhere near the Pediatric intensive Care Unit (PICU) for healthy newborns.  In most instances, doctors admit babies to the NICU immediately after birth so as to not risk further infection to themselves or to other healthy babies nearby.  Critically ill babies stay in the NICU until they are well enough to go home.  Within the Neonatal Care Unit, there are 3 partitions that separate the unit into 3 kinds of rooms: the "intensive care unit" where the doctors and nurses spend most of their time at the babies' besides, an "intermediate care unit" for those babies that still need an IV or oxygen, and the "grower" section where babies are approaching a a healthy state in order to go home.

How Do Babies Become Sick?    

In the NICU, about half of the babies admitted are born full-term (37 weeks) and the other half are premature (born before 37 weeks).  Full-term infants can be born with various diseases of the internal organ system or be at high risk for developing a fatal disease.  Infants who are born to HIV positive mothers are often admitted to the NICU as a precautionary action; doctors will closely monitor the baby to ensure that they immune system and all organs are working efficiently.  Some of the most common reasons full-term babies are admitted to the NICU are:

• Perinatal asphyxia- a lack of oxygen during the birth process leading to multiple problems such as seizures, kidney failure, heart failure, and so on.
• Congenital defects or "birth defects"- abnormalities of development, such as congenital heart defects, brain malformations, or gastrointestinal malformations.
• Pneumonia, meningitis, or generalized 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 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, the jaundice can be very severe and this requires expert attention.
• Injuries during the birth process or during the newborn period.

Premature babies are not always critically ill when they are born; however, due to being born too early, their bodies have not yet fully developed, making them much more susceptible to infectious diseases.  Generally, premature babies spend more time in the NICU than full-term infants.  Developmental issues and infectious diseases that keep "preemie" babies in the NICU are:

• The lungs are not fully developed, so premature babies may need extra oxygen and/or may need 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 don't breath regularly and reliably on their own without assistance, or can't suck, swallow, and breath in a coordinated fashion without choking.

Staff in the Neonatal Intensive Care Unit

Many people have the misconception that neonatologists care for all sick babies in a hospital by themselves.  Actually, most hospitals have a team of neonatal doctors and nurses that are responsible for the care of the babies and their parents 24 hours, 7 days a week:

• Neonatal nurse practitioners
• Neonatal staff nurses
• Neonatal respiratory therapists
• Neonatal physical therapists
• Neonatal occupational therapists
• Neonatal social workers
• Neonatal nutritionists

From Imagination to Actualization

The educational path that must be taken in order to become a neonatologist is a long but prosperous one.  Many people become disheartened when they learn how  much schooling is involved with become a "baby doctor;" but they must realize that caring for critically ill infants is not an "everyday job" for uneducated, undedicated people.  Someone interested in becoming a neonatal doctor must complete the following educational course:

• 4 years of high school
• 4 years of undergraduate college
• 4 years of medical school
• 3 years of pediatric residency or internship
• 3 years of neonatology fellowship

All of these years of education are not necessarily spent sitting in a lecture-style classroom; there is a lot of hands-on experience and field work.

Five Medical School Choices

Note: (*) indicates my personal Top 3 choices

1. Duke University School of Medicine*- Durham, North       Carolina

                    Misson Statement:  "The Duke University School of Medicine is a community of scholars devoted to understanding the causes, prevention and treatment of human disease. We are a group of women and men committed to the highest of academic goals: the generation, conservation and dissemination of knowledge.

                    Interviewee:  Brenda Armstrong, M.D.

    2.    Johns Hopkins University School of Medicine*-               Baltimore, Maryland

                    Mission Statement:  "The mission of Johns Hopkins Medicine is to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, Johns Hopkins Medicine educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness.

                    Interviewee:  Dr. Simpson

    3.    Rush Medical College*- Chicago, IL

                    Interviewee:  Robert Kimura, M.D.

    4.    Meharry School of Medicine- Nashville, TN

                    Mission Statement:  "Meharry Medical College exists to improve the health and health care of minority and underserved communities by offering excellent education and training programs in the health sciences; placing special emphasis on providing opportunities to people of color and individuals from disadvantaged backgrounds, regardless of race or ethnicity; delivering high quality health services; and conducting research that fosters the elimination of health disparities."

                    Interviewee:  Sharon McMillan, M.D.

    5.    Columbia University College of Physicians and         Surgeons- New York, New York

                    Interviewee:  Michael Dillard, M.D.

Research Reflection

While conducting my interviews with the various admissions counselors at my top 5 medical school choices, I learned that medical school is an intense education process but as long as the student is passionate about their area of study, he/she can accomplish anything.  When I inquired about the average GPA for incoming 1st year medical students, I learned that they are not as high as I initially thought.  The admissions counselors were also kind enough to talk about the school's location and what the city has to offer to students.  Because I was born and raised in a large city, Atlanta, I prefer to attend a school in or relatively near a large metropolis.  The information I learned was more than appreciated and very helpful!

GO TO...

Rush Medical College

Duke University Medical School

Johns Hopkins University School of Medicine

Technology in Neonatology

Any Final Words?

Have more questions or just wanna talk?

Contact me:  ecollin2@spelman.edu

Sources: 

• http://www.neonatology.org/career/default.html

• http://www.rushu.rush.edu/medcol/adminstaff.html

• http://www.mmc.edu/

• http://admissions.mmc.edu/page.asp?SID=22&Page=1448

• http://t1.berlinprod.com/accounts/columbia/columbiasite8/home.html

• http://cpmcnet.columbia.edu/dept/ps/p_students/index.html

• http://medschool.duke.edu/

• http://dukemed.duke.edu/People/index.cfm?method=FacultyDetail&facultyNumber=1
• http://dukemed.duke.edu/StudentLife/index.cfm?method=StatsOnTheStudentBody
• http://www.hopkinsmedicine.org/
• http://www.hopkinsmedicine.org/admissions/apps.html
• http://www.hopkinsmedicine.org/about/05-06/awards/