The urge to protect and care for infants is a bone-deep instinct in most people, but few find ways to make a career of it. Neonatologists are in that relatively small group. They're pediatricians who specialize in the care of high-risk infants, from before birth until they reach two years of age. Under their care, the tiniest of infants have a fighting chance at surviving and living a normal life. It's a challenging job, but intensely rewarding.
There are lots of reasons why a birth might be considered high-risk. Multiple pregnancies often result in underdeveloped, low-weight infants, and so does pre-term birth. If the mother is ill, unusually young or physically handicapped, or addicted to drugs, these factors are also a concern. If you're a neonatologist, you're better prepared when these mothers are referred to you before the birth. You can collaborate with their family doctors or obstetricians to postpone delivery as long as possible, monitor fetal development, and administer steroids during the last days of the pregnancy to help the infant's lungs to develop. All of these things help improve the baby's odds.
Your main workplace as a neonatologist is the neonatal intensive care unit, or NICU, where high-risk infants are taken immediately after birth. Pre-term and low birth weight babies typically have underdeveloped lungs, and their breathing needs to be carefully managed. You'll give them steroids to help the lungs develop, and usually keep them on oxygen until the lungs are fully functional. The liver and digestive system are also often incomplete at birth, so the babies are often jaundiced and must be fed through an IV. Above all, you need to keep them warm in incubators.
You won't be alone as you fight for each baby's quality of life. Neonatologists are part of a large team of caregivers, including the mother's gynecologist or obstetrician, respiratory therapists and highly trained nurses or physician assistants. Infants who are transferred from other facilities on an emergency basis, or who have significant birth defects, might also require the help of a specialized pediatric surgeon. Like neonatologists, they're experts in the treatment of high-risk infants and understand the limitations of their tiny bodies.
Loving babies isn't one of the requirements for becoming a neonatologist, though it's a good motivator. You'll definitely need motivation, because you're looking at a lot of training. It starts with a four-year premedical degree at your choice of universities, then four more years in a medical or osteopathic college. When you graduate as a new doctor, you'll spend three years in a pediatric residency, learning to treat childrens' illnesses in a supervised setting. After you pass your board exams in pediatrics, you spend three more years in a neonatal fellowship where you'll learn neonatal care as part of the NICU team. Finally, you pass one more set of board exams for certification in neonatology.
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