What Is a Neonatologist?

A neonatologist is a physician who specializes in treating critically ill newborns. Neonatologists usually work in the neonatal intensive care unit (NICU) in a hospital.

Newborn babies can have unique medical challenges, especially when they are born before their bodies are ready to leave the womb. Neonatologists have the specialized training to diagnose and treat serious illnesses in newborns.

This article will describe the work a neonatologist performs and the education needed to become one.

Concentrations

Neonatologists are responsible for providing the comprehensive care of critically ill newborns. This means that they are a member of the care team when a newborn requires extra support. They may be involved in a baby’s care from the prenatal period (before birth) through their treatment and discharge from the hospital.

Neonatologists often work in the NICU but may be present in the labor and delivery unit or during patient transport as well. 

To conduct their specialized role, neonatologists need to provide a high level of technical skill, along with emotional support for families. There is a wide variety of conditions that neonatologists treat in very young infants, such as:

• High-risk pregnancies and deliveries 
• Preterm birth
• Chromosomal abnormalities like Down syndrome (genetic disorder in which a person has a third copy of chromosome 21)
• Congenital abnormalities, such as omphalocele (birth defect in the abdominal wall), spina bifida (part of the spinal cord and spinal nerves protrude through the backbone), or congenital heart defects (heart conditions present at birth)
• Breathing disorders
• Infections like cytomegalovirus (CMV, common virus that causes few symptoms in healthy adults but can cause lifelong problems in babies)

Procedural Expertise

Neonatologists are an invaluable part of the care team for seriously ill newborns. In addition to providing highly specialized care, they work with families to help them understand their child’s illness and treatment plan. 

Neonatologists provide care in the following ways:

• Diagnose serious medical conditions in newborns
• Develop a treatment plan and coordinate care with other healthcare professionals, including obstetricians, pediatricians, surgeons, nurses, respiratory therapists, and dietitians
• Ensure proper nutrition during the treatment period 
• Monitor a baby’s temperature control 
• Stabilize life-threatening conditions in newborns 
• Counsel families on their child’s medical condition, prognosis, and recommended care plan

Procedures that a neonatologist is trained to perform include:

• Extracorporeal membrane oxygenation (ECMO) (inserting a tube into a large vein to add oxygen to the blood and remove carbon dioxide)
• Intubation (inserting a tube down the throat to help move air in and out of the lungs)
• Central line placement (inserting a tiny tube in a vein to allow fluid to move in and out of the body)
• Lumbar puncture (spinal tap, placing a hollow needle in a space within the lower spine to withdraw cerebrospinal fluid)

Subspecialties

Neonatology is a subspecialty itself and does not have specific subspecialty options. However, neonatologists have the choice of concentrating on a specific disease or birth defect. For example, a neonatologist may specialize in pediatric cardiology to treat congenital heart defects. 

If a neonatologist is interested in teaching, they have the opportunity to train medical students, residents, fellows, nurse practitioners, and physician's assistants. 

Training and Certification

Neonatology requires several years of training. The training periods and certifications needed to become a neonatologist include: 

• Four years of medical school
• Three years of residency training in pediatrics
• Three years of fellowship training in newborn intensive care
• Certification in general pediatrics by the American Board of Pediatrics (ABP)
• Certification in neonatology by the ABP and by the Sub-Board of Neonatal-Perinatal Medicine

Appointment Tips

Neonatologists usually practice in hospitals, academic medical centers, and specialty children’s hospitals. Expecting parents may be referred to neonatology by their obstetrician if the pregnancy is considered high risk. When meeting with a neonatologist before labor and delivery, parents have the opportunity to ask questions about their child’s health risks, condition, and prognosis. It may help to write questions down before the appointment and take notes during it. 

Some newborns are referred to neonatology when they are born. Because critically ill newborns are so fragile, their medical team will work quickly to involve a neonatologist in the care. The neonatologist may come to the labor and delivery room or may meet the family in the NICU. 

Expecting parents can prepare for labor and delivery by finding out if their hospital has neonatologists on staff. Neonatologists usually work in the NICU, and these units vary in the care that they provide. Ask your hospital which level their NICU is designated as, including one of the following:

• Level 1 centers provide care for healthy newborns and low-acuity conditions.
• Level 2 centers provide intermediate care for stable infants who do not require mechanical ventilation. 
• Level 3 centers provide a high level of care and offer surgical subspecialties, ECMO treatment, and mechanical ventilation. 
• Level 4 centers offer the highest level of care for babies who may need special surgery for birth defects and other disorders. This nursery has a full range of pediatric subspecialists, specialized nurses, and equipment to care for very sick babies.

Summary

A neonatologist is a doctor who specializes in treating critically ill newborns. This specialist usually works in the neonatal intensive care unit (NICU) of a hospital. Neonatologists are highly specialized and require four years of medical school, three years of residency, and three years of fellowship before they are eligible for certification. Neonatologists treat newborns who have a birth defect, genetic abnormality, or any serious condition.

A Word From Verywell

A neonatologist is a type of medical doctor that parents hope to never need. Having a critically ill newborn is a terrifying experience, and neonatologists are able to provide compassionate care to families while treating a complex birth defect or condition in their child.