Neonatology

The 2019 novel coronavirus (2019-nCoV) is a new virus linked to the same family of viruses as Severe Acute Respiratory Syndrome (SARS) and some types of common cold. 

The virus is transmitted through direct contact, respiratory droplets like coughing and sneezing, and touching surfaces contaminated with the virus. It is not yet known how long the virus survives on surfaces, but simple disinfectants can kill it. Symptoms can include fever, cough and shortness of breath.

In more severe cases, infection can cause pneumonia or breathing difficulties. More rarely, the disease can be fatal.

Resource: https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know

Babies born before the 37th week of gestation are considered premature. All premature babies experience complications; being born too early can cause short-term and long-term health problems for preemies. In general, the earlier a baby is born, the higher the risk of complications. Birth weight also plays an important role, too. The most common causes of neonatal deaths are preterm birth complications, new born infections and birth asphyxia. Any complication that a premature new-born experience will be treated in the neonatal intensive care unit (NICU)/Intensive care Nursery (ICN).

The Neonatal Intensive Care Unit (NICU) )/Intensive Care Nursery (ICN) is where your new-born will stay for days, weeks, or possibly longer, depending on the baby’s degree of prematurity. Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birth weight (less than 5.5 pounds), or have a medical condition that requires special care. The unit is staffed by specially trained physicians and nurses and also includes paediatric residents and neonatal fellows (physicians who are specializing in treating sick new-born’s). Neonatal Medicine is one of the best neonatal cares for the sickest babies as they require specialized care in the region's newest and most up-to-date neonatal intensive care unit (NICU).

Infant Behaviour & Development is nothing but the babies born at risk for developmental delays or behavioural problems due to prematurity or born with other medical complications that resulted in hospitalization in one of our Neonatal Intensive Care Units. It includes the development of sleep, crying, reflexes, vision, hearing, and breathing in new-born’s.

Neonatal Psychology & Psychiatry is the study of behavior and the mind. Infants can suffer serious mental health disorders, yet they are unlikely to receive treatment that could prevent lasting developmental problems. While mental health issues can be difficult to diagnose in babies who can’t talk about their thoughts and feelings, infants are capable of feeling anxiety, stress and even depression. In this field, a professional practitioner or researcher is called a psychologist.

Neonatal Infectious Diseases are the infections of the neonate (new-born) during the neonatal period or first four weeks after birth. Infections may be contracted by Tran’s placental transfer in utero, in the birth canal during delivery (perinatal), or by other means after birth. Some neonatal infections are apparent soon after delivery, while others may develop postpartum within the first week or month. Some infections acquired in the neonatal period do not become apparent until much later such as HIV, hepatitis B and malaria and there is a higher risk of infection with preterm or low birth weight neonates.

Neonatal pulmonology is a medical sub-specialty that deals with diagnosis and treatment of diseases involving respiratory tract. Neonatal/Paediatric pulmonologists are specially trained in pulmonary neonatal diseases and conditions of the broken rib or collapsed lung, particularly pneumonia, asthma, tuberculosis, complicated chest infections, etc. The most common cause of persistent pulmonary hypertension of the new-born is meconium aspiration syndrome. Most infants who have meconium aspiration syndrome (60%) are born by caesarean delivery, indicating that they aspirate meconium before birth. Some aspiration may occur during the second stage of labour. Children who present with stridor and respiratory distress with epiglottitis, the presentation of this disease in neonates may be different. Hence it is important to study the diagnosis, immunization and preventive measure of these diseases.

Neonatal surgery is the sub-specialty of pediatrics surgery which is dealing with all the surgical operationsin newborn infants, especially the ill or premature newborn. It is responsible for the treatment of many disorders through surgical operations in newborn infants and playing vital role in saving lives at birth stage by newborn and fetal surgery. Neonatal surgeons are the ones who perform surgeries including chest, abdominal and urological defects.  It includes the treatment of infants in the first 28 days of birth.

Neonatal Nursing is a subspecialty of nursing that works for newborn infants up to 28 days after birth. Babies are born with a variety of problems ranging from prematurity, birth defects, infection, cardiac malformations, and surgical problems, according to the National Association of Neonatal Nurses (NANN).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. Neonatal nurses treat sick newborns until they are discharged from the hospital, even if that takes several months.

Neonatal Hepatology is a branch of medicine dealing with the study, prevention, diagnosis and management of diseases that affect the liver, gallbladder, biliary tree and pancreas. Viral infection and inborn metabolic disorders are the two main causes of Acute Liver Failure in infants.

Neonatal Gastroenterology developed as a sub-specialty of paediatrics and gastroenterology. It is concerned with treating the gastrointestinal tract, liver and pancreas from infancy until age eighteen. The principal diseases it is concerned with are acute diarrhoea, persistent vomiting, gastritis, and problems with the development of the gastric tract. Gastrointestinal disorders in neonates range from minor to life threatening, and short- to long-term or chronic. Neonatal Jaundice is one of the most common conditions needing medical attention in babies. Gastrointestinal food allergies are not rare in infants and children. Gastrointestinal (GI) endoscopic procedure a fetal and neonatal endoscopy has become an essential modality for evaluation and treatment of GI diseases. Complex gastrointestinal surgery is one of the common methods to treat GI disorder in neonates. Pediatric gastroenterologists care for Infants with problems of the gastrointestinal tract.

Neonatal Nutrition is essential, especially to promote growth and sustain the physiologic requirements at the various stages of a child's development in the first couple weeks of life. Breast Feeding and complementary feeding has important ingredients that are not found in any infant formula, to build the baby’s immune system.  In general, babies should be at least 4 pounds before they are ready to come out of the incubator. Neonatal/paediatric nutritional needs vary considerably with age, level of activity, and environmental conditions and they are directly related to the rate of growth.

Neonatal Allergy/Immunology is an important subject to be learnt in order to promote understanding and advance the treatment of respiratory, allergic, and immunologic diseases in neonates. It emphasizes the epidemiologic research on the most common chronic illnesses of neonates—asthma and allergies as well as many less common and rare diseases. Allergic reactions in born babies include red eyes, atopic dermatitis (eczema), itchiness, runny nose, urticarial (hives), an asthma attack and sinusitis. The viruses, such as influenza virus (flu), adenovirus, respiratory syncytial virus (RSV) and human metapneumovirus, are common causes of pneumonia in New-born babies. A Neonatology allergist/immunologist finds and treats these allergies and immune system problems.

Neonatal Rheumatology: An inflammatory disease affects the joints, muscle weakness, a skin rash on the eyelids and knuckles, Juvenile lupus and connective tissues. Some like osteoarthritis, are the result of wear and tear. Others, such as rheumatoid arthritis, are immune system problems. Common Rheumatic disorders are Lyme disease, Systemic lupus Erythematosus, Behcet's disease, Polymyalgia Rheumatica, Rheumatic fever. Lupus erythematosus is a name given to a collection of autoimmune diseases in which the human immune system becomes hyperactive and attacks normal, healthy tissues.

Neonatal Cardiology is the fetal diagnosis and treatment given for pregnant women at risk of or known to be carrying babies with heart problems. Neonatal heart conditions mainly includes heart defects associated with other types of disease, such as diaphragmatic hernia, heart muscle disease (cardiomyopathy) or infection (myocarditis), Heart problems due to lung masses, etc. Congenital heart disease (CHD) is the most common, congenital disorder in newborns. A neonatal cardiologist is a pediatrician who has received extensive training in diagnosing and treating babies cardiac problems.

Neonatal Endocrinology is a medical subspecialty dealing with disorders of the endocrine glands, such as growth disorders, sexual differentiation in neonates, diabetes and other disorders. The other type of diabetes that is often misdiagnosed as type 1 or type 2 diabetes, called  monogenic diabetes which is seen in newborn babies. Endocrine disorders in neonates are caused by too many or too few hormones circulating throughout the body. If a newborn baby has problem with growth, diabetes, hormone-producing glands that help maintain growth and development, puberty, energy level and mood. Neonatal/ Pediatric endocrinologists are usually the primary physicians involved in the medical care of infants with intersex disorders.

Neonatal diabetes mellitus (NDM) is defined as a disease that affects an infant and their body's ability to produce or use insulin. It is a monogenic (controlled by a single gene) form of diabetes that occurs in the first 6 months of life. Infants with NDM do not produce enough insulin, leading to an increase in blood glucose. Maturity onset diabetes of the young (MODY) MODY is a rare form of diabetes which is different from both Type 1 and Type 2 diabetes, and runs strongly in families. MODY is caused by a mutation (or change) in a single gene. NDM is a rare condition accounting for up to 1 in 400,000 infants in the United States. Permanent neonatal diabetes mellitus is a type of diabetes that first appears within the first 6 months of life and persists throughout the lifespan.

Newborn genetic screening is the practice of testing every newborn for certain harmful or treatable genetic disorders in newborn infants.  Babies with these conditions appear normal at birth. It is only with time that the conditions affects the baby’s brain or physical development or causes other medical problems. By then the damage may be permanent.  Early diagnosis and treatment can result in normal growth and development and can reduce morbidity and mortality.

Newborn babies to be tested for rare diseases. A rare birth defect is a health condition that is present at birth. Birth defects may change the shape or function of one or more parts of the body as there are thousands of different birth defects. The most common are heart defects, cleft lip and palate, Down syndrome and spina bifida.

Orphan Drug Act (ODA) provided incentives to stimulate treatment product development for infants with rare disease.

Neonatal oncology is a sub specialty of pediatrics oncology that deals with the prevention, diagnosis, and treatment of cancer in babies. Newborn cancer is rare and comprises a heterogeneous group of neoplasms with substantial histological diversity. Almost all types of pediatrics cancer can occur in fetuses andneonates. The causes of neonatal cancer are unclear, but genetic factors probably have a key role. Teratoma and neuroblastoma are the most common histological types of neonatal cancer, with soft-tissue sarcoma, leukemia, renal tumors, and brain tumors also among the more frequent types. Neonatal cancer raises diagnostic, therapeutic, and ethical issues, and management requires a multidisciplinary approach. Medical professionals who practice oncology are called Cancer specialists or oncologists.

Neonatal Hematology is the study of blood and blood-forming organs, as well as their diseases in born babies. Surgeons frequently encounter hematologic issues with respect to wound healing, inflammation and hemostasis. Because of the complexity and broad scope of hematology, this review is limited to an overview of hematopoiesis and hemostasis in the neonates. Diseases of blood cells including disorders of white cells, red cells, and platelets. A medical practitioner who specializes in this field of pediatric hematology is calledNeonatal/pediatric hematologist. It is important that one should be familiar with the educational and preventive measures in order to prevent children being affected with blood disorders.

Neonatal Ophthalmology is a branch of medicine and surgery which deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a specialist in Paediatric/Neonatology ophthalmology. Multiple ophthalmic disorders can present in neonates. Such disorders can be isolated or be associated with other systemic anomalies. Timely referral, diagnosis, and management are critical to allow optimal visual development. The critical period of visual development is in the first 6 months after birth. Infants who meet screening criteria for retinopathy of prematurity (ROP) should be screened to help prevent serious visual sequelae, including blindness. Pediatricians and neonatologists should identify ocular abnormalities and refer patients for detailed ophthalmic evaluation when deemed necessary.

Neonatal Neurology refers to a service that can delivery multidisciplinary expertise aimed at optimal care and protection of the new born brain—whether for premature infants or sick infants born at full term. Neonatal neurologists who regularly monitor babies’ developmental progress and perform research in all areas of brain injury prevention and management. Neurosciences Intensive Care Nursery (NICN) provides comprehensive and coordinated assessment and treatment for new-born’s who are at high risk of neurological injury or who have clinical evidence of developmental brain abnormalities.

Neonatal/paediatric pathology is a medical subspecialty with particular expertise in diseases affecting the placenta, fetus, infant and child. The duties of pediatric pathologists can be broadly separated into two fields:

• Surgical pathology; examining and reporting tissue biopsies and specimens.

• Performing autopsies and placental examinations.

Neonatal pharmacology setting is unique effective, result-oriented and safe drug administration in neonates should be based on two parameters:

• Integrated knowledge on the evolving physiological characteristics of the newborn.

• Pharmacokinetics and pharmacodynamics of the given drug.

Understandably, clinical pharmacology in neonates is as dynamic, varied and diverse as the new-born’s. Advances in the basic science research have improved our understanding of use of drugs.

Over and above all that, pharmacovigilance is needed to recognize specific adverse drug reactions (ADRs).

Paediatric radiology is a subspecialty of radiology involving the imaging of foetuses and infants. Although some diseases seen in paediatrics are the same as that in adults, there are many conditions which are seen only in infants. The specialty has to take in account the dynamics of a growing body, from pre-term infants to large adolescents, where the organs follow growth patterns and phases.

Neonatal anesthesia includes general anesthesia for term babies in the first month of life, as well aspremature babies (born before the 37th week of pregnancy). The first 30 days after birth are the time when most congenital and genetic defects are discovered and when babies are most susceptible to birth-acquired infections. During surgery, anesthesiologists focus on: Preventing and treating apnea (when breathing stops for 10 seconds or longer, a condition more common in neonates and former premature infants), meticulous fluid replacement, managing blood loss, Monitoring and maintaining blood glucose levels, Controlling temperature and Managing pain.

Neonatal Nephrology is a sub specialty of medicine and paediatrics that concerns itself with the kidneys- the study of normal kidney function and kidney problems. Clinical complications include renal function in the fetus and neonate, blood pressure and hypertension in the neonate, renal failure in the term and preterm infant, and the causes and the consequences of fetal urinary obstruction. A nephrologist is a physician who specializes in the care and treatment of kidney diseases in new-born babies.

Stem cell transplantation (SCT) is rare in neonates or infants, there has been some research reporting an encouraging survival rate; as well as there are studies pointing SCT in infants as a controversial treatment.

Lung diseases remain one of the main causes of morbidity and mortality in neonates. Cell therapy and regenerative medicine have the potential to revolutionize the management of life-threatening and debilitating lung diseases that currently lack effective treatments.