Perinatal Medicine & Neonatal Medicine
A perinatologist, also known as a maternal-fetal medicine specialist, is a medical care provider who specializes in the care of high risk pregnancies. Women with pregnancies deemed high risk or a history of complications during pregnancy may be referred to the care of a perinatologist for their pregnancies. The goal of a perinatologist is to help a woman have a pregnancy which is as healthy as possible, and to address any problems with the pregnancy as soon as they emerge. To become a perinatologist, a doctor needs to complete a residency in obstetrics, followed by a fellowship in maternal-fetal medicine.
When a woman is referred to a perinatologist, the doctor usually starts by conducting routine ultrasound screening and a patient interview to get background on the pregnancy and the mother's history and to collect some basic information about the baby. The perinatologist can also conduct additional prenatal testing and diagnostic procedures to identify issues with the baby. After intake, the perinatologist will discuss the pregnancy and the situation with the parents, and develop a treatment approach which will protect both mother and child.
Perinatologists can conduct certain medical procedures such as the administration of medications through the placenta to manage a high risk pregnancy, and they also routinely monitor their patients. The doctor may write an order for bed rest or make other treatment recommendations to address concerns about the pregnancy, and he or she may also make recommendations about where the baby should be delivered.
When a woman goes into labor, the doctor may be part of the care team in the delivery room who work to keep the mother and baby healthy. If a baby does have complications which will need to be addressed shortly after birth, such as a congenital abnormality which requires surgery, the perinatologist will make plans ahead of time with the appropriate care providers, and work with the labor and delivery team to get the baby into surgery quickly. The perinatologist may also make recommendations to other care providers such as developmental psychologists who will help children with learning disabilities caused by genetic conditions.
The work of the perinatologist is focused on keeping mother and baby as healthy as possible, and keeping the baby inside for the duration of gestation, if possible, because babies have a better chance of survival if they are born at full term, rather than when they are premature. While the doctor may not be directly involved in care after the baby is born, he or she usually helps assemble the care team for the high risk baby in the hospital, and may provide recommendations for care providers the parents can work with if the baby requires continuing specialty medical care after birth.
A neonatologist is a physician who cares for premature and ill newborns. Neonatologists usually work in a hospital settings, in the neonatal intensive care unit (NICU) or special care baby unit (SCBU). These physicians train by completing a residency in pediatrics and following it with a fellowship in neonatology, the branch of medicine which focuses on caring for newborns. Work for neonatologists is generally steady, especially if they are willing to relocate for a job.
When a patient is brought to a neonatologist, he or she assesses the patient's health, and may run a series of tests to check on organ function and look for signs of infection. Once the patient has been evaluated, the neonatologist can decide what kind of treatment he or she needs, and what level of care will be required. Neonates often spend a long time in hospital if they are severely ill or very premature, as neonatologists do not want to send babies home before they are completely better, so neonatologists also need to think about issues like ensuring that infants get contact with their parents so that they can bond, providing infants with intellectual stimulation to promote development, and providing suitable nutrition for infants in the NICU or in pediatric care wards.
Newborns who are premature are usually admitted into the care of a neonatologist because they have some special needs, although they are not necessarily sick. Premature infants have not yet finished their development, and their organ systems may need support while they finish developing. A neonatologist assesses premature babies to determine their gestational age, and makes treatment recommendations. During their stay in the NICU, the infants gradually move to more general wards as they grow stronger and require less monitoring and less intensive care.
Neonatologists also work with infants who are ill or of low birth weight. They may work with neonatal surgeons to address infants with congenital birth defects which require surgery, and they also diagnose and treat sick infants. Some infants may be brought to a neonatologist at birth as illness or birth defects become obvious, while others may be brought back to a hospital after they have arrived home when parents observe emerging health problems which may require treatment.
Skilled neonatologists work with a team of health care providers including respiratory therapists, neonatal nurses, neonatal surgeons, and trainee neonatologists, in some hospitals. Being able to work effectively as part of a team is critical for these medical professionals, and they must also be skilled at communicating with parents and addressing parental concerns. Parents of premature and ill infants are often extremely worried, and the neonatologist must balance their needs with those of the infant in treatment.