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Neonatology

Medical care of newborns, especially the ill or premature

For the journal, see Neonatology (journal).

Not to be confused with Neontology.

Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, and is usually practised in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or require special medical care due to prematurity, low birth weight, intrauterine growth restriction, congenital malformations (birth defects), sepsis, pulmonary hypoplasia or birth asphyxia.

Historical developments[edit]

Though high infant mortality rates were recognized by the medical community at least as early as the s, advances in modern neonatal intensive care have lead to a significant decline in infant mortality in the modern era.[1] This has been achieved through a combination of technological advances, enhanced understanding of newborn physiology, improved sanitation practices, and development of specialized units for neonatal intensive care.[1][2] Around the midth century, the care of newborns was in its infancy and was lead mainly by obstetricians;[3] however, the early s, pediatricians began to assume a more direct role in caring for neonates.[1] The term neonatology was coined by Dr. Alexander Schaffer in [4] The American Board of Pediatrics established an official sub-board certification for neonatology in

In , the Russian physician Georg von Ruehl developed a rudimentary incubator made from two nestled metal tubs enclosing a layer of warm water.[5] By the mids, these "warming tubs" were in regular use at the Moscow Foundling Hospital for the support of premature infants.[5] , Jean-Louis-Paul Denuce was the first to publish a description of his own similar incubator design, and was the first physician to describe its utility in the support of premature infants in medical literature.[5] By , Dr. A Robert Bauer added more sophisticated upgrades to the incubator which allowed for humidity control and oxygen delivery in addition to heating capabilities, further contributing to improved survival in newborns.[6]

The s brought a rapid escalation in neonatal services with the advent of mechanical ventilation of the newborn, allowing for survival at an increasingly smaller birth weight.[2]

In , the anesthesiologist Dr. Virginia Apgar developed the Apgar score, used for standardized assessment of infants immediately upon delivery, to guide further steps in resuscitation if necessary.[7]

The first dedicated neonatal intensive care unit (NICU) was established at Yale-Newhaven Hospital in Connecticut in [8] Prior to the development of the NICU, premature and critically ill infants were attended to in nurseries without specialized resuscitation equipment.[8]

In , Dr. Jerold Lucey demonstrated that hyperbilirubinemia of prematurity (a form of neonatal jaundice) could be successfully treated through exposure to artificial blue light.[9] This lead to widespread use of phototherapy, which has now become a mainstay of treatment of neonatal jaundice.[10]

In the s, the development of pulmonary surfactant replacement therapy further improved survival of extremely premature infants and decreased chronic lung disease, one of the complications of mechanical ventilation, among less severely premature infants.[2]

Academic training[edit]

In the United States, a neonatologist is a physician (MD or DO) practicing neonatology. To become a neonatologist, the physician initially receives training as a pediatrician, then completes an additional training called a fellowship (for 3 years in the US) in neonatology.[11] In the United States of America most, but not all neonatologists, are board certified in the specialty of Pediatrics by the American Board of Pediatrics or the American Osteopathic Board of Pediatrics and in the sub-specialty of Neonatal-Perinatal Medicine also by the American Board of Pediatrics or American Osteopathic Board of Pediatrics.[12] Most countries now run similar programs for post-graduate training in Neonatology, as a subspecialisation of pediatrics.

In the United Kingdom, after graduation from medical school and completing the two-year foundation programme, a physician wishing to become a neonatologist would enroll in an eight-year paediatric specialty training programme.[13] The last two to three years of this would be devoted to training in neonatology as a subspecialty.

Neonatal Nurse Practitioners (NNPs) are advanced practice nurses that specialize in neonatal care.[14] They are considered providers and often share the workload of NICU care with resident physicians. They are able to treat, plan, prescribe, diagnose and perform procedures within their scope of practice, defined by governing law and the hospital where they work.[15]

Neonatal nursing is subspecialty of nursing that specialize in neonatal care.[16]

Spectrum of care[edit]

A 30 minutes old infant in Iran. The nurse is providing necessary care after birth.

Rather than focusing on a particular organ system, neonatologists focus on the care of newborns who require hospitalization in the Neonatal Intensive Care Unit (NICU). They may also act as general pediatricians, providing well newborn evaluation and care in the hospital where they are based. Some neonatologists, particularly those in academic settings who perform clinical and basic science research, may follow infants for months or even years after hospital discharge to better assess the long-term outcomes.

The infant is undergoing many adaptations to extrauterine life, and its physiological systems, such as the immune system, are far from fully developed. Diseases of concern during the neonatal period include:

Compensation[edit]

Neonatologists earn significantly more than general pediatricians. In , a typical pediatrician salary in the United States ranged from $, to $,, whereas the average salary for a neonatologist was about $, to $,[17]

Hospital costs[edit]

Premature birth is one of the most common reasons for hospitalization. The average hospital costs from – for the maternal and neonatal surgical services were the lowest hospital costs in the U.S.[18] In , maternal or neonatal hospital stays constituted the largest proportion of hospitalizations among infants, adults aged 18–44, and those covered by Medicaid.[19]

Between and , the number of neonatal stays (births) in the United States fluctuated around million stays, reaching a high of million in [20] Maternal and neonatal stays constituted 27 percent of hospital stays in the United States in However, the mean hospital costs remained the lowest of the three types of hospital stay (medical, surgical, or maternal and neonatal). The mean hospital cost for a maternal/neonatal stay was $4, in (as opposed to $8, for medical stays and $21, for surgical stays in ).[21]

References[edit]

  1. ^ abcLussky, Richard C.; Cifuentes, Raul F.; Siddappa, Ashajyothi M. (April ). "A history of neonatal medicine-past accomplishments, lessons learned, and future challenges. Part 1-the first century". The Journal of Pediatric Pharmacology and Therapeutics. 10 (2): 76– doi/ ISSN&#; PMC&#; PMID&#;
  2. ^ abcAvery, M. E. (June ). "A year overview of perinatal medicine". Early Human Development. 29 (1–3): 43– doi/(92)m. ISSN&#; PMID&#;
  3. ^Philip, Alistair G. S. (October ). "The Evolution of Neonatology". Pediatric Research. 58 (4): – doi/PDR ISSN&#; PMID&#;
  4. ^Vulliamy, David (). "Diseases of the Newborn, ed. 3, by Alexander J. Schaffer, M.D., and Mary Ellen Avery, M.D. Philadelphia/London/Toronto: W. B. Saunders, , pp., $". Pediatrics. 50 (3): – ISSN&#;
  5. ^ abcCone, Thomas E. (). "The First Published Report of an Incubator for Use in the Care of the Premature Infant ()". Archives of Pediatrics & Adolescent Medicine. (7): – doi/archpedi ISSN&#; PMID&#;
  6. ^Bauer, A. Robert (). "A Combination Resuscitator and Incubator for New-Born Infants". Journal of the American Medical Association. (22): doi/jamaa. ISSN&#;
  7. ^Calmes, Selma H. (May ). "Dr. Virginia Apgar and the Apgar Score: How the Apgar Score Came to Be". Anesthesia & Analgesia. (5): – doi/ANE ISSN&#; PMID&#; S2CID&#;
  8. ^ ab"Neonatal Intensive Care: A History of Excellence"(PDF). National Institutes of Health. October [October 7, ].
  9. ^Lucey, Jerold; Ferreiro, Mario; Hewitt, Jean (). "Prevention of hyperbilirubinemia of prematurity by phototherapy". Pediatrics. 41 (6): – ISSN&#; PMID&#;
  10. ^American Academy of Pediatrics Subcommittee on Hyperbilirubinemia (July ). "Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation". Pediatrics. (1): – doi/peds ISSN&#; PMID&#;
  11. ^"What is a Neonatologist?". HealthyChildren.org. Retrieved
  12. ^"Specialties & Subspecialties". American Osteopathic Association. Archived from the original on 13 August Retrieved 23 September
  13. ^"Training and development (paediatrics)". Health Careers. Retrieved
  14. ^"What is a Neonatal Nurse Practitioner (NNP)?". Top Schools Offering Nurse Practitioner Programs. Retrieved
  15. ^"What is a Neonatal Nurse Practitioner (NNP)?". Top Schools Offering Nurse Practitioner Programs. Retrieved
  16. ^"What is Neonatal Nursing". NANN. Retrieved
  17. ^" Compilation of Physician Compensation Surveys"(PDF). Merritt Hawkins. AMN Healthcare. Retrieved October 23,
  18. ^Weiss AJ; Barrett ML; Steiner CA (July ). "Trends and Projections in Inpatient Hospital Costs and Utilization, –". HCUP Statistical Brief #. Rockville, MD: Agency for Healthcare Research and Quality.
  19. ^Wiess, AJ & Elixhauser A (October ). "Overview of Hospital Utilization, ". HCUP Statistical Brief #. Rockville, MD: Agency for Healthcare Research and Quality.
  20. ^Witt WP, Wiess AJ, Elixhauser A (December ). "Overview of Hospital Stays for Children in the United States, ". HCUP Statistical Brief #. Rockville, MD: Agency for Healthcare Research and Quality.
  21. ^Moore B; Levit K & Elixhauser A (October ). "Costs for Hospital Stays in the United States, ". HCUP Statistical Brief #. Rockville, MD: Agency for Healthcare Research and Quality.
Sours: https://en.wikipedia.org/wiki/Neonatology

Newborn care and safety

Newborn care and safety are the activities and precautions recommended for new parents or caregivers. It is also an educational goal of many hospitals and birthing centers when it's time to bring their infant home.[1]

Newborn care[edit]

Taking a newborn care class during pregnancy can prepare caregivers. During the stay in a hospital or birthing center, clinicians and nurses help with basic baby care. These health providers will demonstrate basic infant care. Newborn care basics include:

  • Handling a newborn, including supporting the baby's neck crack
  • Bathing
  • Dressing
  • Swaddling
  • Soothing[1]
  • Feeding and burping
  • Cleaning the umbilical cord
  • Using a bulb syringe to clear the baby's nasal passages
  • Taking a newborn's temperature
  • Immunization

Before leaving the hospital, ask about home visits by a nurse or health care worker. Many new parents appreciate somebody checking in with them and their baby a few days after coming home. If breastfeeding, a mother can ask whether a lactation consultant visit in the home to provide follow-up support, as well as providing other resources in the community, such as peer support groups.[1]

Many first-time parents also welcome the help of a family member or friend who has "been there." Having a support person stay with the newborn for a few days can give the mother the confidence to go at it alone in the weeks ahead. This can be to arranged before delivery.[1]

The baby's first doctor's visit is another good time to ask about any infant care questions. Parents can ask about reasons to call the doctor and about what vaccines baby needs and when. Young children need vaccines because the diseases they protect against can strike at an early age and can be very dangerous in childhood. This includes rare diseases and more common ones, such as the flu.[1]

Caring for a newborn also includes the health screening of the newborn, most of the times this occurs in the hospital or pediatrician's office shortly after birth. Every state screens babies for more than two dozen disorders. Early detection can help treat the disorder.[2]

Safe nutrition[edit]

Main article: Infant food safety

Handwashing helps to prevent the spread of foodborne illnesses to children. Pathogenic microorganisms can be transmitted from other children and their diapers, and from uncooked meat, seafood, eggs, dogs, cats, turtles, snakes, birds, lizards, and soil.[3]

Sudden infant death syndrome[edit]

Main article: Sudden infant death syndrome

Since , the American Academy of Pediatrics has recommended that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS), also called crib death. SIDS is the sudden and unexplained death of a baby under 1 year of age. Even though there is no way to know which babies might die of SIDS, recommendations include:

  • Always place the baby on his or her back to sleep, even for naps. This is the safest sleep position for a healthy baby to reduce the risk of SIDS.
  • Place the baby on a firm mattress, such as in a safety-approved crib. Research has shown that placing a baby to sleep on soft mattresses, sofas, sofa cushions, waterbeds, sheepskins, or other soft surfaces raises the risk of SIDS.
  • Remove soft, fluffy, and loose bedding and stuffed toys from the baby's sleep area. Make sure all pillows, quilts, stuffed toys, and other soft items are kept away from the baby's sleep area.
  • Do not use infant sleep positioners. Using a positioner to hold an infant on his or her back or side for sleep is dangerous and not needed.
  • Do use infant sleep sacks that are designed to be used with zippers, snaps, or velcro for infants to wear during sleep in place of loose bedding and swaddle blankets which pose a greater risk.
  • Make sure everyone who cares for the baby knows to place the baby on his or her back to sleep and about the dangers of soft bedding. Talk to child care providers, grandparents, babysitters, and all caregivers about SIDS risk. Remember, every sleep time counts.
  • Make sure the baby's face and head stay uncovered during sleep. Keep blankets and other coverings away from the baby's mouth and nose. The best way to do this is to dress the baby in sleep clothing so there will not have to use any other covering over the baby. If using a blanket or another covering, make sure that the baby's feet are at the bottom of the crib, the blanket is no higher than the baby's chest, and the blanket is tucked in around the bottom of the crib mattress.
  • Do not allow smoking around the baby. Don't smoke before or after the birth of the baby and make sure no one smokes around the baby.
  • Don't let the baby get too warm during sleep. Keep the baby warm during sleep, but not too warm. The baby's room should be at a temperature that is comfortable for an adult. Too many layers of clothing or blankets can overheat the baby.[1]

Some parents worry if the baby rolls over during the night. However, by the time the baby is able to roll over by herself, the risk for SIDS is much lower. During the time of greatest risk, 2 to 4 months of age, most babies are not able to turn over from their backs to their stomachs.[1]

Car seats[edit]

Main article: Child safety seat

Newborns and older infants are to use rear-facing car seats. These are required until age 2 or when they reach the upper weight or height limit of that seat. After this, a forward-facing car seat is used.[4] Motor vehicle crashes are a leading cause of death for children in the US. Buckling up is the best way to save lives and reduce injuries. Child passenger restraint laws result in more children being buckled up. Only 2 out of every children live in states that require car seat or booster seat use for newborns and infants. A third of children who died in crashes in were not buckled up. Caregivers promote the safety their newborns by: Knowing how to use car seats, booster seats, and seat belts and using them on every trip, no matter how short.[5]

See also[edit]

References[edit]

External links[edit]

Sours: https://en.wikipedia.org/wiki/Newborn_care_and_safety
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Neonatal resuscitation

Neonatal resuscitation also known as newborn resuscitation is an emergency procedure focused on supporting the approximately 10%[1] of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death. Through positive airway pressure, and in severe cases chest compressions, medical personnel can often stimulate neonates to begin breathing on their own, with attendant normalization of heart rate. [2]

About a quarter of all neonatal deaths globally are caused by birth asphyxia.[3] This dangerous condition of oxygen deprivation may begin before birth, for example if the umbilical cord, which supplies oxygen throughout fetal development, is compressed during delivery. Depending on how quickly and successfully the infant is resuscitated, hypoxic damage can occur to most of the infant's organs (heart, lungs, liver, gut, kidneys), although brain injury known as neonatal hypoxic-ischemic encephalopathy is of most concern.[citation needed]

The International Liaison Committee on Resuscitation (ILCOR) has published Consensus on science and treatment recommendations for neonatal resuscitation in , and Traditionally, newborn children have been resuscitated using mechanical ventilation with % oxygen, but there has since the s increasingly been debated whether newborn infants with asphyxia should be resuscitated with % oxygen or normal air, and notably Ola Didrik Saugstad has been a major advocate of using normal air.[4][5] It has been demonstrated that high concentrations of oxygen lead to generation of oxygen free radicals, which have a role in reperfusion injury after asphyxia.[6] Clinical trial evidence suggests that resuscitation using air probably reduces the risk of death[7] and the ILCOR guidelines recommend the use of normal air rather than % oxygen.[8]

For preterm infants, there may be little or no difference in risk of death or neurodevelopment disability when higher concentrations of oxygen are used compared to lower concentrations but the evidence from clinical trials is still relatively uncertain.[9]

References[edit]

  1. ^"Neonatal Resuscitation - Pediatrics". Merck Manuals Professional Edition. Retrieved
  2. ^Johnson, Peter A.; Schmölzer, Georg M. (23 February ). "Heart Rate Assessment during Neonatal Resuscitation". Healthcare. 8 (1): doi/healthcare
  3. ^Guidelines on basic newborn resuscitation, , World Health Organization
  4. ^Saugstad, OD; Rootwelt, T; Aalen, O (). "Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial: the Resair 2 study". Pediatrics. (1): e1. doi/pedse1. PMID&#;
  5. ^Davis, PG; Tan, A; O'Donnell, CPF; Schulze, A (). "Resuscitation of newborn infants with % oxygen or air: a systematic review and meta-analysis". The Lancet. (): – doi/S(04) PMID&#;
  6. ^Kutzsche, S; Ilves, P; Kirkeby, OJ; Saugstad, OD (). "Hydrogen peroxide production in leukocytes during cerebral hypoxia and reoxygenation with % or 21% oxygen in newborn piglets". Pediatric Research. 49 (6): – doi/ PMID&#;
  7. ^Tan, A; Schulze, A; O'Donnell, CP; Davis, PG (18 April ). "Air versus oxygen for resuscitation of infants at birth". The Cochrane Database of Systematic Reviews (2): CD doi/CDpub3. PMC&#; PMID&#;
  8. ^ILCOR Neonatal Resuscitation Guidelines
  9. ^Lui, K; Jones, LJ; Foster, JP; Davis, PG; Ching, SK; Oei, JL; Osborn, DA (4 May ). "Lower versus higher oxygen concentrations titrated to target oxygen saturations during resuscitation of preterm infants at birth". The Cochrane Database of Systematic Reviews. 5: CD doi/CDpub2. PMC&#; PMID&#;
Sours: https://en.wikipedia.org/wiki/Neonatal_resuscitation
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Birth weight

Weight of a human baby at birth

Baby weighed as appropriate for gestational age.

Birth weight is the body weight of a baby at its birth.[1] The average birth weight in babies of European heritage is kilograms (&#;lb), though the range of normal is between and kilograms ( and &#;lb). On average, babies of south Asian and Chinese heritage weigh about kilograms (&#;lb).[2][3] The birth weight of a baby is notable because very low birth weight babies are times more likely to die compared to normal birth weight babies.[4] As far as low birth weights prevalence rates changing over time, there has been a slight decrease from % () to % (), then a slight increase to % (), to current levels of % ().[4][5] The prevalence of low birth weight has trended slightly upward from to present day.[6]

There have been numerous studies that have attempted, with varying degrees of success, to show links between birth weight and later-life conditions, including diabetes, obesity, tobacco smoking, and intelligence. Low birth weight is associated with neonatal infection and infant mortality.

Abnormalities[edit]

Determinants[edit]

Genetics[edit]

There are two genetic loci that have been strongly linked to birth weight, ADCY5 and CCNL1, as well four that show some evidence (CDKAL1, HHEX-IDE, GCK, and TCF7L2).[10][11][12] The heritability of birth weight ranges from &#;%.[13][14] There is a complex relationship between a baby's genes and the maternal environment that the child is developing in. Foetal genes influence how the fetus grows in utero, and the maternal genes influence how the environment affects the growing fetus.[11]

Maternal health[edit]

The health of the mother during the pregnancy can affect birth weight. A pre-existing disease or acquired disease in pregnancy is sometimes associated with decreased birth weight. For example, celiac disease confers an odds ratio of low birth weight of approximately [15] Certain medications (e.g. for high blood pressure or epilepsy) can put a mother at a higher risk for delivering a low birth weight baby.[7] Women younger than 15 or older than 35 are at a higher risk to have a low-birth weight baby.[7][16] Multiple births, where a mother has more than one child at one time, can also be a determinant in birth weight as each baby is likely to be outside the AGA (appropriate for gestational age). Multiple births put children at a higher rate to have low birth weight (%) compared to children born in a single birth ( %).[4] Low birth weight can also vary by maternal age. In the rate of low birth weight was the highest in babies born to women younger than 15 years old (%).[16] Women aged 40–54 had a rate of low birth weight at percent. The lowest rates of low birth weight happened among babies whose mothers were between the ages of 25–29 years (%) and 30–34 years (%).[16]

Stress[edit]

Stressful events have been demonstrated to produce significant effects on birth weight. Those mothers who have stressful events during pregnancy, especially during the first and second trimester, are at higher risk to deliver low-birth weight babies.[17][18] Researchers furthered this study and found that maternal stressful events that occur prior to conception have a negative impact on birth weight as well, and can result in a higher risk for preterm and lower birth weight babies.[19][20][21] Women who experienced abuse (physical, sexual, or emotional) during pregnancy are also at increased risk of delivering a low-birth weight baby.[22] For example, in a study completed by Witt et. al, those women who experienced a stressful event (ie. death of close family member, infertility issues, separation from partner) prior to conception had 38% more of a chance to have a very low birth weight baby compared to those who had not experienced a stressful life event.[19] The theory is that stress can impact a baby based on two different mechanisms: neuroendocrine pathway or immune/inflammatory pathway.[23][24] Stress causes the body to produce stress hormones called glucocorticoids that can suppress the immune system., as well as raises levels of placental corticotropin-releasing hormone (CRH) which can lead to preterm labor.[25][24] These findings can pose evidence for future prevention efforts for low birth weight babies. One way to decrease rates of low birth weight and premature delivery is to focus on the health of women prior to conception through reproductive education, screening and counseling regarding mental health issues and stress, and access to primary care.[26]

Racial stress[edit]

Non-Hispanic Blacks have the highest infant mortality rate in the United States ( deaths per 1, live births compared to the national average of deaths per 1, live births).[27] Subsequently, there has been growing research supporting the idea of racial discrimination as a risk factor for low birth weight. In one study by Collins et. al, evidence suggested that African American mothers who experienced high levels of racial discrimination were at significantly higher risk of delivering a very low-birth weight baby compared to African American mothers who had not experienced racial discrimination.[28] Black infants (%) are more likely to have low birth weight compared to Asian and Pacific Islander (%), American Indian and Alaska Native (%), Non-Hispanic White (%), and Hispanic Infants (%).[4]

Environmental factors[edit]

Environmental factors, including exposure of the mother to secondhand smoke[29] can be a factor in determining the birth weight of child. In , 13% of children exposed to smoke were born with low birth weight compared with % of those children born to nonsmokers.[4] Children born to mothers who smoked or were exposed to secondhand smoke are more likely to develop health problems earlier in life such as neurodevelopmental delays.[30] When mothers actively smoke during pregnancy, their child is at a higher risk of being born with a low birth weight.[31] Smoking can also be a stress management tool used by expecting mothers.[32] There is some support for lower socioeconomic status of the parents being a determinant of low birth weight, but there is conflicting evidence, as socioeconomic status is tied to many other factors.[33][34][35]

Neonatal care[edit]

Most babies admitted to the NICU are born before 37 weeks of pregnancy or have low birth weight which is less than pounds.[36] They could also have a medical condition that requires special care. In the United States nearly half a million babies are born preterm. Because of this, many of these babies also have low birth weights.[36] There are four levels of care in the neonatal care units. Intensive Care, High Dependency Care, Low Dependency, and Transitional Care are the four levels:[37]

  • Intensive Care: For babies with serious problems. This includes babies born three months early and have extremely low birth weight.
  • High Dependency Care: For babies with less serious problem, but who still may not to be looked after or babies that are recovering from a critical illness.
  • Low Dependency Care: For babies that do not need a continuous supervision.
  • Transitional Care: For babies that still need medical treatment, but are well enough to be called for at their mother’s bedside.

Influence on the first few years of life[edit]

Poster from the Soviet Unionencouraging mothers to weigh their babies every week. ()

Children born with an abnormally low birth weight can have significant problems within the first few years of life. They may have trouble gaining weight, obtaining adequate nutrition, and supporting a strong immune system. They also have higher risks for mortality, behavior problems, and mental deficiencies.[33] Low birth weight babies are more likely to develop the following conditions after birth compared to normal birth weight babies:[7]

That said, the effects of low birth weight on a child's first few years of life are often intertwined with other maternal, environmental, and genetic factors and most effects of low birth weight are only slightly negatively significant on a child's life when these factors are controlled for.[38] When these factors are controlled, the only significant effect low birth weight has on a child's development is physical growth in the early years and the likelihood of being underweight compared to normal birth weight babies.[38]

Disability-adjusted life years out of , lost due to any cause in [39]

&#;&#;no data

&#;&#;less than 9,

&#;&#;9,–16,

&#;&#;16,–22,

&#;&#;22,–29,

&#;&#;29,–36,

&#;&#;36,–43,

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&#;&#;49,–56,

&#;&#;56,–63,

&#;&#;63,–70,

&#;&#;70,–80,

&#;&#;more than 80,

Influence on adult life[edit]

Studies have been conducted to investigate how a person's birth weight can influence aspects of their future life. This includes theorised links with obesity, diabetes and intelligence.

Obesity and diabetes[edit]

A baby born small or large for gestational age (either of the two extremes) is thought to have an increased risk of obesity in later life,[40][41] but it was also shown that this relationship is fully explained by maternal weight.[42] Middle aged adults with low birth weight present with a higher chance of obesity and diabetes. Children that are born under six pounds were times more likely to develop diabetes compared to babies born at a healthy weight over six pounds.

Growth hormone (GH) therapy at a certain dose induced catch-up of lean body mass (LBM). However percentage body fat decreased in the GH-treated subjects. Bone mineral density SDS measured by DEXA increased significantly in the GH-treated group compared to the untreated subjects, though there is much debate over whether or not SGA (small for gestational age) is significantly adverse to children to warrant inducing catch-up.[43] Babies that have a low birth weight are thought to have an increased risk of developing type 2 diabetes in later life.[44][45][46][47] Low birth weight is linked with increase rates of obesity, insulin resistance, and type 2 diabetes and it is shown that children with the low birth weights have increased leptin levels after they catch up growth during childhood.[48]Adiponectin levels are positively related with birth weight and BMI in babies with an increase of risk of type 2 diabetes.[48] The leptin and adiponection mechanisms are still being studied when involving low birth weight.[48]

Around the world[edit]

There is much variation regarding birth weight within continents, countries, and cities. Even though over 20 million babies are born each year with low birth weight, it is hard to know the exact number as more than half of babies born in the world are not weighed at birth.[49] The baby’s weight is an indicator of the mother and baby's health. In , 22 million newborns had low birth weight, around 16 percent of all babies globally.[50] Data on low birth weight is adjusted to account for under reporting. South Asia has the highest rate of babies not weighed at birth with 66 percent, but also have the highest low birth weight at 28 percent worldwide.[50] West and Central Africa and least developed countries are next with 14 percent low birth weight worldwide.[50]

More than % of low birth weight babies are born in developing countries around the world.[33] Because low birth weight babies can require more extensive care, it places a financial burden on communities.

Prevention[edit]

The World Health Organization (WHO) recently announced an initiative to have a thirty percent reduction in low birth weight worldwide. This is public health priority, as birth weight can have short and long term effects. WHO estimates that worldwide, &#;% of all births each year are considered low birth weight, which is about 20 million births.[51]

The start of prenatal care is very important to help prevent low birth weight and early medical problems. Going to regular doctor’s visits is very important for the health of the mother and the baby. At the visits the OB/GYN will be checking maternal nutrition and weight gain because that is linked with the baby’s weight gain. The mother having a healthy diet is essential for the baby. Maintaining good nutrition by taking folic acid, which can be found in fruits and vegetables, is linked to the prevention of[52][53] premature births and low birth weight. Alcohol, cigarettes, and drugs should also be avoided during pregnancy because they can also lead to poor growth and other complications. By seeing the doctor they are also able to monitor pre-existing medical illnesses to make sure they are under control during pregnancy. Mothers with high blood pressure and type 2 diabetes are more likely to have infants with low birth weights.[54] One essential action to increase normal birth weights is to have affordable, accessible, and culturally sensitive prenatal care worldwide. This is essential not just for treating low birth weight, but also preventing it. Other prevention efforts include: smoking cessation programs, food-distribution systems, stress reduction and social service supports.[51]

See also[edit]

References[edit]

  1. ^"Definitions". Georgia Department of Public Health. 4 December Archived from the original on 2 April
  2. ^"New birth weight curves tailored to baby's ethnicity | Toronto Star". thestar.com. 15 February Retrieved 22 September
  3. ^Janssen PA, Thiessen P, Klein MC, Whitfield MF, Macnab YC, Cullis-Kuhl SC (July ). "Standards for the measurement of birth weight, length and head circumference at term in neonates of European, Chinese and South Asian ancestry". Open Medicine. 1 (2): e PMC&#; PMID&#;
  4. ^ abcde"Low and very low birthweight infants". Child Trends Databank.
  5. ^"FastStats". www.cdc.gov. 8 August Retrieved 25 November
  6. ^Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Drake P (January ). "Births: Final Data for ". National Vital Statistics Reports. 67 (1): 1– PMID&#;
  7. ^ abcd"Low birthweight". Retrieved 25 November
  8. ^"Birth Weight". medlineplus.gov. Retrieved 29 October
  9. ^Mendez-Figueroa H, Truong VT, Pedroza C, Chauhan SP (June ). "Large for Gestational Age Infants and Adverse Outcomes among Uncomplicated Pregnancies at Term". American Journal of Perinatology. 34 (7): – doi/s PMID&#; S2CID&#;
  10. ^Freathy RM, Mook-Kanamori DO, Sovio U, Prokopenko I, Timpson NJ, Berry DJ, et&#;al. (May ). "Variants in ADCY5 and near CCNL1 are associated with fetal growth and birth weight". Nature Genetics. 42 (5): –5. doi/ng PMC&#; PMID&#;
  11. ^ abYaghootkar H, Freathy RM (May ). "Genetic origins of low birth weight". Current Opinion in Clinical Nutrition and Metabolic Care. 15 (3): – doi/mco.0bef PMID&#; S2CID&#;
  12. ^Ryckman KK, Feenstra B, Shaffer JR, Bream EN, Geller F, Feingold E, et&#;al. (January ). "Replication of a genome-wide association study of birth weight in preterm neonates". The Journal of Pediatrics. (1): 19–e4. doi/j.jpeds PMC&#; PMID&#;
  13. ^Clausson B, Lichtenstein P, Cnattingius S (March ). "Genetic influence on birthweight and gestational length determined by studies in offspring of twins". BJOG. (3): – doi/jtbx. PMID&#; S2CID&#;
  14. ^Lunde A, Melve KK, Gjessing HK, Skjaerven R, Irgens LM (April ). "Genetic and environmental influences on birth weight, birth length, head circumference, and gestational age by use of population-based parent-offspring data". American Journal of Epidemiology. (7): – doi/aje/kwk PMID&#;
  15. ^Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, et&#;al. (). "Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms". Human Reproduction Update. 20 (4): – doi/humupd/dmu PMID&#;
  16. ^ abc"Low Birth Weight". Child Health USA . Retrieved 25 November
  17. ^Hedegaard M, Henriksen TB, Secher NJ, Hatch MC, Sabroe S (July ). "Do stressful life events affect duration of gestation and risk of preterm delivery?". Epidemiology. 7 (4): – doi/ JSTOR&#; PMID&#; S2CID&#;
  18. ^Zhu P, Tao F, Hao J, Sun Y, Jiang X (July ). "Prenatal life events stress: implications for preterm birth and infant birthweight". American Journal of Obstetrics and Gynecology. (1): e1–8. doi/j.ajog PMID&#;
  19. ^ abWitt WP, Cheng ER, Wisk LE, Litzelman K, Chatterjee D, Mandell K, Wakeel F (February ). "Maternal stressful life events prior to conception and the impact on infant birth weight in the United States". American Journal of Public Health. Suppl 1 (1): S doi/AJPH PMC&#; PMID&#;
  20. ^Khashan AS, McNamee R, Abel KM, Mortensen PB, Kenny LC, Pedersen MG, et&#;al. (February ). "Rates of preterm birth following antenatal maternal exposure to severe life events: a population-based cohort study". Human Reproduction. 24 (2): – doi/humrep/den PMID&#;
  21. ^Class QA, Khashan AS, Lichtenstein P, Långström N, D'Onofrio BM (July ). "Maternal stress and infant mortality: the importance of the preconception period". Psychological Science. 24 (7): – doi/ PMC&#; PMID&#;
  22. ^Murphy CC, Schei B, Myhr TL, Du Mont J (May ). "Abuse: a risk factor for low birth weight? A systematic review and meta-analysis". CMAJ. (11): – PMC&#; PMID&#;
  23. ^Wadhwa PD, Culhane JF, Rauh V, Barve SS (June ). "Stress and preterm birth: neuroendocrine, immune/inflammatory, and vascular mechanisms". Maternal and Child Health Journal. 5 (2): – doi/A PMID&#; S2CID&#;
  24. ^ abWadhwa PD, Culhane JF, Rauh V, Barve SS, Hogan V, Sandman CA, et&#;al. (July ). "Stress, infection and preterm birth: a biobehavioural perspective". Paediatric and Perinatal Epidemiology. 15 Suppl 2 (s2): 17– doi/jx. PMID&#;
  25. ^Rich-Edwards J, Krieger N, Majzoub J, Zierler S, Lieberman E, Gillman M (July ). "Maternal experiences of racism and violence as predictors of preterm birth: rationale and study design". Paediatric and Perinatal Epidemiology. 15 Suppl 2 (s2): – doi/jx. PMID&#;
  26. ^Cheng TL, Kotelchuck M, Guyer B (). "Preconception women's health and pediatrics: an opportunity to address infant mortality and family health". Academic Pediatrics. 12 (5): –9. doi/j.acap PMC&#; PMID&#;
  27. ^"Infant Mortality | Maternal and Infant Health | Reproductive Health | CDC". www.cdc.gov. 3 August
  28. ^Collins JW, David RJ, Handler A, Wall S, Andes S (December ). "Very low birthweight in African American infants: the role of maternal exposure to interpersonal racial discrimination". American Journal of Public Health. 94 (12): –8. doi/AJPH PMC&#; PMID&#;
  29. ^"The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General". Surgeon General of the United States. 27 June p.&#;– Retrieved 16 June
  30. ^Lee BE, Hong YC, Park H, Ha M, Kim JH, Chang N, et&#;al. (May ). "Secondhand smoke exposure during pregnancy and infantile neurodevelopment". Environmental Research. (4): – BibcodeERL. doi/j.envres PMID&#;
  31. ^Pereira PP, Da Mata FA, Figueiredo AC, de Andrade KR, Pereira MG (May ). "Maternal Active Smoking During Pregnancy and Low Birth Weight in the Americas: A Systematic Review and Meta-analysis". Nicotine & Tobacco Research. 19 (5): – doi/ntr/ntw PMID&#; S2CID&#;
  32. ^Damron KR (May ). "Review of the Relationships Among Psychosocial Stress, Secondhand Smoke, and Perinatal Smoking". Journal of Obstetric, Gynecologic, and Neonatal Nursing. 46 (3): – doi/j.jogn PMID&#; S2CID&#;
  33. ^ abcMahumud RA, Sultana M, Sarker AR (January ). "Distribution and Determinants of Low Birth Weight in Developing Countries". Journal of Preventive Medicine and Public Health = Yebang Uihakhoe Chi. 50 (1): 18– doi/jpmph PMC&#; PMID&#;
  34. ^Parker JD, Schoendorf KC, Kiely JL (July ). "Associations between measures of socioeconomic status and low birth weight, small for gestational age, and premature delivery in the United States". Annals of Epidemiology. 4 (4): –8. doi/(94) PMID&#;
  35. ^Martinson ML, Reichman NE (April ). "Socioeconomic Inequalities in Low Birth Weight in the United States, the United Kingdom, Canada, and Australia". American Journal of Public Health. (4): – doi/AJPH PMC&#; PMID&#;
  36. ^ ab"The Neonatal Intensive Care Unit". Stanford Children Health. Retrieved 15 November
  37. ^"What is neonatal care?". Liverpools Womens NHS Foundation Trust. Retrieved 25 November
  38. ^ abDatar A, Jacknowitz A (November ). "Birth weight effects on children's mental, motor, and physical development: evidence from twins data". Maternal and Child Health Journal. 13 (6): – doi/s PMC&#; PMID&#;
  39. ^"WHO Disease and injury country estimates". World Health Organization. Retrieved 11 November
  40. ^"3 stages of childhood may predict obesity risk - Fitness - NBC News". 3 June Retrieved 28 November
  41. ^Singhal A, Wells J, Cole TJ, Fewtrell M, Lucas A (March ). "Programming of lean body mass: a link between birth weight, obesity, and cardiovascular disease?". The American Journal of Clinical Nutrition. 77 (3): – doi/ajcn/ PMID&#;
  42. ^Parsons TJ, Power C, Manor O (December ). "Fetal and early life growth and body mass index from birth to early adulthood in British cohort: longitudinal study". BMJ. (): –5. doi/bmj PMC&#; PMID&#;
  43. ^"GH Treatment Effects on Body Composition in SGA". Growth, Genetics & Hormones. 24 (1). May [permanent dead link]
  44. ^"Low birth weight diabetes link". BBC News. 25 February Retrieved 28 November
  45. ^Gillman MW, Rifas-Shiman S, Berkey CS, Field AE, Colditz GA (March ). "Maternal gestational diabetes, birth weight, and adolescent obesity". Pediatrics. (3): e doi/pedse PMID&#;
  46. ^Rich-Edwards JW, Colditz GA, Stampfer MJ, Willett WC, Gillman MW, Hennekens CH, et&#;al. (February ). "Birthweight and the risk for type 2 diabetes mellitus in adult women". Annals of Internal Medicine. (4 Pt 1): – doi/_part_ PMID&#; S2CID&#;
  47. ^Li Y, Ley SH, Tobias DK, Chiuve SE, VanderWeele TJ, Rich-Edwards JW, et&#;al. (July ). "Birth weight and later life adherence to unhealthy lifestyles in predicting type 2 diabetes: prospective cohort study". BMJ. : h doi/bmj.h PMC&#; PMID&#;
  48. ^ abcJornayvaz FR, Vollenweider P, Bochud M, Mooser V, Waeber G, Marques-Vidal P (May ). "Low birth weight leads to obesity, diabetes and increased leptin levels in adults: the CoLaus study". Cardiovascular Diabetology. 15: doi/s PMC&#; PMID&#;
  49. ^"Low birthweight - UNICEF DATA". UNICEF DATA. Retrieved 25 November
  50. ^ abc"Low BirthWeight". UNICEF DATA. Retrieved 25 November
  51. ^ ab"Global Nutrition Targets Low birth weight policy brief". World Health Organization. Retrieved 25 November
  52. ^"New study examines effect of timing of folic acid supplementation during pregnancy". ScienceDaily.com.
  53. ^Hodgetts VA, Morris RK, Francis A, Gardosi J, Ismail KM (March ). "Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates: a population study, systematic review and meta-analysis". BJOG. (4): – doi/ PMID&#; S2CID&#;
  54. ^"Low and Very Low Birth Weight Babies:Prevention Tips for Expectant Mothers". HealthXchange. Retrieved 16 November

Further reading[edit]

  • Peleg D, Kennedy CM, Hunter SK (August ). "Intrauterine growth restriction: identification and management". American Family Physician. 58 (2): –60, –7. PMID&#;
  • Jornayvaz FR, Vollenweider P, Bochud M, Mooser V, Waeber G, Marques-Vidal P (May ). "Low birth weight leads to obesity, diabetes and increased leptin levels in adults: the CoLaus study". Cardiovascular Diabetology. 15: doi/s PMC&#; PMID&#;

External links[edit]

Sours: https://en.wikipedia.org/wiki/Birth_weight

Wikipedia new born

New Born

single by Muse

This article is about the song by Muse. For other uses, see Newborn (disambiguation).

single by Muse

"New Born" is a song by English rock band Muse from their second studio albumOrigin of Symmetry, released in It was released as the second single from the album on 4 June

The song proved to be a commercial success, peaking at number 12 on the UK Singles Chart.[2] The song was also featured on the Hullabaloo live DVD.

Background and content[edit]

"New Born" is written in the key of E minor. The song starts out at a relatively fast tempo of bpm, and then increases pace during each verse. The melodic introduction features some modern minimalist style piano work. The song is also recognizable for its distinct guitar riff, which is based on a circle of fifths progression.

Regarding the meaning of the song, Matthew Bellamy has said: "It's about a semi-fear of the evolution of technology, and how in reality it's destroying all humanity. My fear is that we can't control it because it's moving faster than we are, so the song's setting myself in a location in the future where the body is no longer important and everyone's plugged into a network. The opening line is 'link it to the world', so it's connecting yourself on a worldwide scale and being born into another reality."[citation needed]

Chris Wolstenholme also said: ""New Born", I think between the three of us is probably one of our favourite tracks off Origin of Symmetry. It is a good live track. I think it's one of the songs which showcases the experimental side of the band. It is not really a conventional pop song. I think a lot of the reason for choosing these songs is that we went for the heavier more direct kind of songs rather than going for anything too mellow".[3]

Recording[edit]

"New Born" first started out as a guitar-based piece played in soundcheck during the Showbiz tour back in , and the piano intro was written afterwards. During the recording of the album in the David Bottrill sessions, the band experimented with using Bellamy's voice for the arpeggios instead of the piano, but decided that this was too "abstract" and removed it during post-recording.

Live performances[edit]

The live versions of the song are often modified and feature some improvisation and embellishments. In particular, Matt Bellamy usually plays a slightly re-worked piano melody during the introduction. Much of the guitar work is also notably different, the guitar solo is usually extended and more elaborate, and features a "tapping" section before the tremolo. Live versions can also last notably longer, such as the Wembley Stadium (as seen on the HAARP DVD).[citation needed] "New Born" was a live staple from its debut in until the end of The Resistance Tour. After this, the song made occasional appearances during The 2nd Law, Psycho Tour, and Drones World Tour. On the band's Simulation Theory World Tour, the song was played in the form of a medley including "Stockholm Syndrome", "Assassin", "Reapers", and "The Handler".

Legacy[edit]

"New Born" was notably featured in the French horror filmHaute Tension. A remixed version of the song can also be heard on the soundtrack for the thrillerSwordfish.

Track listing[edit]

'CD1'
  1. "New Born" –
  2. "Shrinking Universe" –
  3. "Piano Thing" –
'CD2'
  1. "New Born" –
  2. "Map of Your Head" –
  3. "Plug In Baby" (Live) –
7"
  1. "New Born" –
  2. "Shrinking Universe" –

Personnel[edit]

  • Matthew Bellamy – lead vocals, rhythm & lead guitar, keyboards
  • Chris Wolstenholme – bass, backing vocals
  • Dominic Howard – drums

EP[edit]

"New Born" was released as an extended play (EP) on 5 June in Greece and Cyprus by Columbia Records.

Track listing[edit]

  1. "New Born"
  2. "Shrinking Universe"
  3. "Piano Thing"
  4. "Map of Your Head"
  5. "Plug In Baby" (Live)
  6. "New Born" (Oakenfold Perfecto Remix)

Charts[edit]

References[edit]

External links[edit]

Sours: https://en.wikipedia.org/wiki/New_Born
Vlad and Niki 24 Hours Overnight Tent Challenge

Baby (disambiguation)

Look up baby in Wiktionary, the free dictionary.

A baby, or infant, is the very young offspring of human beings. Or, by extension, it can refer to a young animal.

Baby, Babies, or The Baby may also refer to:

Aircraft[edit]

  • Avro Baby, a British single-seat light sporting biplane
  • Sopwith Baby, a seaplane used by the British Royal Naval Air Service from
  • Supermarine Baby, a British flying boat fighter aircraft of the First World War
  • Wight Baby, a British seaplane fighter which first flew in

Arts and entertainment[edit]

Characters[edit]

Film and theatre[edit]

  • Baby ( film), an American silent comedy starring Oliver Hardy
  • Baby, a German film starring Anny Ondra
  • Baby: Secret of the Lost Legend, a American film directed by Bill L. Norton
  • Baby ( film), an American television film featuring Alison Pill
  • Baby ( film), a German drama film
  • Baby ( film), an American independent film starring David Huynh
  • Baby ( film), a British short film
  • Baby ( Tamil film), a horror film
  • Baby ( Hindi film), an Indian action spy thriller film starring Akshay Kumar
  • Baby ( film), an Indian Odia film
  • Babies (film), a documentary by Thomas Balmes
  • The Baby (film), a American horror thriller film starring Anjanette Comer
  • Baby (musical), a musical by David Shire and Richard Maltby, Jr

Literature[edit]

Music[edit]

Groups and labels[edit]

Albums[edit]

  • Baby (The Burning Hell album),
  • Baby (The Detroit Cobras album),
  • Baby (White Hinterland album) or the title song,
  • Baby (Yello album),
  • Baby, by Bosque Brown,
  • The Babies (album), by the Babies,
  • The Babys (album), by the Babys,

Songs[edit]

  • "Baby" (Angie Stone song),
  • "Baby" (Anton Powers and Pixie Lott song),
  • "Baby" (Ashanti song),
  • "Baby" (Brandy song),
  • "Baby" (Clean Bandit song),
  • "Baby" (Fabolous song),
  • "Baby" (Justin Bieber song),
  • "Baby" (LL Cool J song),
  • "Baby" (Madame song),
  • "Baby" (Pnau song),
  • "Baby" (Quality Control, Lil Baby and DaBaby song),
  • "Baby" (Royal Republic song),
  • "Baby" (Wilma Burgess song),
  • "B-A-B-Y", by Carla Thomas,
  • "Baby (You've Got What It Takes)", by Dinah Washington and Brook Benton,
  • "Baby: Drive Me Crazy", by Chantay Savage,
  • "Babies" (song), by Pulp,
  • "I Wanna Have Your Babies", first released as "Babies", by Natasha Bedingfield,
  • "The Baby", by Blake Shelton,
  • "Baby", by Alcazar from Disco Defenders,
  • "Baby", by Bakermat,
  • "Baby", by the Bird and the Bee from Ray Guns Are Not Just the Future,
  • "Baby", by Bishop Briggs,
  • "Baby", by Brittany Howard from Jaime,
  • "Baby", by Caetano Veloso and Gal Costa from Tropicalia: ou Panis et Circenses,
  • "Baby", by Celine Dion from Courage,
  • "Baby", by Eminem from The Marshall Mathers LP 2,
  • "Baby", by Exo from XOXO,
  • "Baby", by Joker Bra (Capital Bra) and Vize,
  • "Baby", by Kylie Minogue, a B-side of "Love at First Sight",
  • "Baby", by Logic from Supermarket,
  • "Baby", by Madison Beer from Life Support,
  • "Baby", by Martha Wainwright from Martha Wainwright,
  • "Baby", by Melody Club from Face the Music,
  • "Baby", by Prince from For You,
  • "Baby", by Ridsa,
  • "Baby", by Rufus Wainwright from Rufus Wainwright,
  • "Baby", by Sage the Gemini,
  • "Baby", by Serj Tankian from Elect the Dead,
  • "Baby", by Tenacious D from The Pick of Destiny,
  • "Babies", by Kyle from Light of Mine,

Sculpture[edit]

Television[edit]

Series[edit]

Episodes[edit]

People[edit]

  • Baby (nickname), a list of people
  • Baby (surname), a list of people
  • Baby (director), A. G. Baby (fl.&#;–), Indian film director
  • Baby (rapper) or Birdman, Bryan Williams (born ), American rapper
  • Baby, Shannon McNeill, performer with the World Championship Wrestling dance team the Nitro Girls
  • Baby Halder (born ), Indian writer
  • Baby Huwae (–), Indonesian actress and singer
  • Baby Spice, Emma Bunton (born ), from Spice Girls
  • DaBaby, Jonathan Lyndale Kirk (born ), American rapper

Places[edit]

  • Baby, Gmina Odolanów in Greater Poland Voivodeship, west-central Poland
  • Baby, Gmina Ostrów Wielkopolski in Greater Poland Voivodeship, west-central Poland
  • Baby, Kutno County in Łódź Voivodeship, central Poland
  • Baby, Masovian Voivodeship, east-central Poland
  • Baby, Piotrków County in Łódź Voivodeship, central Poland
  • Baby, Seine-et-Marne, a commune of the Seine-et-Marne département, France
  • Baby, Silesian Voivodeship, south Poland

Other uses[edit]

See also[edit]

Topics referred to by the same term

Sours: https://en.wikipedia.org/wiki/Baby_(disambiguation)

You will also like:

Neonatal nursing

Neonatal nursing is a sub-specialty of nursing care for newborn infants up to 28 days after birth. The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin". Neonatal nursing requires a high degree of skill, dedication and emotional strength as the nurses care for newborn infants with a range of problems, varying between prematurity, birth defects, infection, cardiac malformations and surgical problems. Neonatal nurses are a vital part of the neonatal care team and are required to know basic newborn resuscitation, be able to control the newborn's temperature and know how to initiate cardiopulmonary and pulse oximetry monitoring.[1] Most neonatal nurses care for infants from the time of birth until they are discharged from the hospital.

Levels of the Neonatal Nursery[edit]

There are four different levels of neonatal nursery where a neonatal nurse might work.[2] The updated classification of neonatal levels by the American Academy of Pediatrics (AAP) includes a Level IV.

  • Level I consists of caring for healthy newborns. Level I nurses are now uncommon in the United States. Healthy babies typically share a room with their mother, and both patients are usually discharged from the hospital quickly.[3]
  • Level II provides intermediate or special care for premature or ill newborns. At this level, infants may need special therapy provided by nursing staff, or may simply need more time before being discharged.
  • Level III, the Neonatal intensive-care unit (NICU), treats newborns who cannot be treated in the other levels and are in need of high technology to survive, such as breathing and feeding tubes. Nurses comprise over 90 percent of the NICU staff.[4]
  • Level IV includes all the skills of the level III but involves the extensive care the most critically and complex newborns. This facility will have hour resident neonatologists and surgeons. They are involved with intricate surgical repairs like congenital cardiac issues and acquired malformations.[5]

Changes in neonatal care[edit]

Neonatal care became a specialty in the United States in and that is the same year that the first NICU was established in the United States. There have been some major changes in the Neonatal Care over the past years. Some of these changes include the invention of the incubator, changes in respiratory care, and the development of surfactants.

The incubator[edit]

An incubator is a plastic dome-shaped machine designed as a crib that regulates a newborn infant's body temperature. The incubator is designed to allow the temperature to be adjusted according to the state of the baby's current body heat. A range of five types of incubators all serve different purposes in the neonatal intensive care unit. The closed-box incubator is used to prevent infection that could be contracted the outside of the box; it filtrates the air and keeps the moisture fresh. The double-walled incubator keeps heat inside the box. Servo-controlled incubators are controlled by skin detectors which are designed to recognize the loss or gain of body heat and make adjustments to maintain the correct temperature. The open box incubator produces heat from beneath the baby to keep it warm. Portable incubators transport the newborn to and from different parts of the hospital.[1] In , Dr. Tarnier was convinced that the maintenance of internal temperature was key to the premature infant's survival. This led him to introduce the first human incubator. Inspired by chicken eggs hatching in an incubator, he asked a zoo keeper to design a similar incubator for premature infants. Dr. Delee expanded the use and function of the incubator by incorporating an oxygen chamber and an electric controlled thermostat which allowed the incubator to be transported in ambulances.[6]

Incubator-tahrir.jpg

Respiratory care[edit]

Administration of oxygen assists and generates oxygen intake for neonates. Oxygen administration began with a metal forked device in the nostrils, and it is now administered through thin plastic tubes in the nostrils, also known as nasal cannula. The first ventilation of an infant was in in a positive pressure situation, and mechanical ventilation was improved in Mechanical ventilation is the process in which a machine, attached to the patient, regulates breathing by pumping air in and out of the lungs. Another type of breathing mechanism used is the continuous positive airway pressure (CPAP) mask which attaches to the face to help with breathing. These masks were first used in as an alternate less invasive form of support.[1]

Note: the CPAP mask shown in the photo is an adult model.

Surfactants[edit]

A surfactant allows a substance to get "wet" to help another substance dissolve. In , the first study of the use of surfactants on infants took place in Japan. Surfactant therapy since has improved the infant mortality rate by 50%. Surfactants combined with the least invasive respiratory therapy (bubble CPAP or nasal CPAP) has greatly improved the infant mortality rate in the US.[citation needed]

Qualifications and requirements[edit]

United States[edit]

Healthcare institutions have varying entry-level requirements for neonatal nurses. Neonatal nurses are Registered Nurses (RNs), and therefore must have an Associate of Science in Nursing (ASN) or Bachelor of Science in Nursing (BSN) degree. Some countries or institutions may also require a midwifery qualification.[7] Some institutions may accept newly graduated RNs who have passed the NCLEX exam; others may require additional experience working in adult-health or medical/surgical nursing.[2]

Some countries offer postgraduate degrees in neonatal nursing, such as the Master of Science in Nursing (MSN) and various doctorates. A nurse practitioner may be required to hold a postgraduate degree.[7] The National Association of Neonatal Nurses recommends two years' experience working in a NICU before taking graduate classes.[2]

As with any registered nurse, local licensing or certifying bodies as well as employers may set requirements for continuing education.[2]

There are no mandated requirements to becoming an RN in a NICU, although neonatal nurses must complete the Neonatal Resuscitation Program. Some units prefer new graduates who do not have experience in other units, so they may be trained in the specialty exclusively, while others prefer nurses with more experience.

Intensive care nurses receive intensive didactic and clinical orientation, in addition to their general nursing knowledge, to provide highly specialized care for critical patients. Their competencies include the administration of high-risk medications, management of high-acuity patients requiring ventilator support, surgical care, resuscitation, advanced interventions such as extracorporeal membrane oxygenation or hypothermia therapy for neonatal encephalopathy procedures, as well as chronic-care management or lower acuity cares associated with premature infants such as feeding intolerance, phototherapy, or administering antibiotics. NICU RNs undergo annual skills tests and are subject to additional training to maintain contemporary practice.

Europe[edit]

Becoming a neonatal nurse isn't a simple task, as it requires a great deal of hard work and an interest in biology in order to be successful. A college degree is not needed. All neonatal care nurses are registered nurses or midwives with The Nursing and Midwifery Council.

The first step to qualify is to complete a nursing degree. To gain entry into a nursing degree, it is required to have at least GCSE (A-C) in English, Mathematics and a science-based subject, and two to three A-levels with one being in a biological science.[8]

United Kingdom[edit]

You must complete a 3 year degree programme in nursing or midwifery and be either a RN(adult), RN(child) or a RM. Once a registered practitioner you can work in special care and some high dependency areas. It is a requirement to complete a recognised neonatal intensive care course to become qualified in speciality (QIS) to care for intensive care babies and to supervise other nurses.

Australia[edit]

In Australia, a neonatal nurse first needs to be a Registered Nurse (RN) or Midwife.

Two years of nursing experience are needed, as is practical experience and employment in the neonatal unit before being eligible to undertake postgraduate studies in neonatal nursing. This usually requires undertaking a Graduate Diploma Degree in Clinical Nursing.[9]

A Neonatal nurse examining a newborn baby.

Roles and responsibilities[edit]

Duties of a neonatal nurse usually include supplying vital nutrients to newborns, changing feeding tubes, administering medication, observing vital signs, performing intubations and using monitoring devices. In the common situation where premature and sick newborns' lungs are not fully developed, they must be certain infants are breathing and maturing properly. Neonatal nurses work together with upper-level nurses and physicians to facilitate treatment plans and examinations. Neonatal nurses can also work with speech-language pathologists who specialise in the assessment and treatment of feeding, swallowing and communication in preterm infants. They have regular interaction with patients' families, therefore are required to educate parents or relative on the infant's condition and prepare care instructions after the infant is discharged from the hospital. If parents have questions which neonatal nurses are incapable of answering, they may direct them to another medical staff member who is able to.[10][11]

Academy of Neonatal Nursing[edit]

Main article: Academy of Neonatal Nursing

The Academy of Neonatal Nursing was founded in and serves as a professional organization for neonatal nurses. Nurses who belong to the organization have the ability to locate continued education, apply for scholarships and awards, and receive other benefits. They can also receive the Academy's healthcare journal, Neonatal Network.

APGAR scoring[edit]

All nurses working in a birthing centre have an important role in assessing the newborn immediately after birth. The assessment of the neonate's appearance (colour), pulse (heart rate), grimace (in response to unpleasant stimuli such as bulb suctioning the pharynx), activity (muscle tone and/or movement), and respiratory effort via the APGAR scoring system is essential to guide the baby's care (see Understanding the APGAR scoring system). The nurse is often directly responsible for assigning the APGAR scores at 1 and 5 minutes of life. Each of the five assessment areas is given a score of 0, 1, or 2. The maximum score possible is Scores of 7 or above are considered normal for full-term newborns. If the total score is below 7, or any area is scored 0 at 5 minutes of life, resuscitation efforts and scoring should continue every 5 minutes until 20 minutes of life. At 10 minutes neonates with an APGAR score of 3 or lower are at risk of having neurological dysfunctions and cerebral palsy in the future although there is no guarantee. Despite how every individual's case varies; as time goes by with the score not improving the risk becomes higher. However, there are numerous other factors to take into consideration when determining future complications, an APGAR score cannot do it alone.[12]

Beyond assessing the five components that make up the APGAR score, it's essential to understand its meaning. The APGAR score assigned at 1 minute of life reflects how the fetus tolerated the in utero environment and/or the labor and delivery process. All subsequent APGAR scores reflect the newborn's response to interventions during the transition from intrauterine to extra-uterine life. There are, however, multiple different factors that can impact the APGAR score which include anesthesia, gestational age and initial lower oxygen.[12] These nursing interventions include keeping the baby warm, stimulating the baby to breathe, giving breaths to the baby who isn't breathing well, and performing chest compression if needed.[1]

References[edit]

  1. ^ abcdPieron, Petri (). "Nursing made incredibly easy!". Neonatal Nursing Care . 10 (5): 30– doi/NME
  2. ^ abcd"Neonatal Nurse". Nurses for a Healthier Tomorrow. Nurses for a Healthier Tomorrow. Retrieved October 26,
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  7. ^ ab"Frequently Asked Questions". Global Unity for Neonatal Nurses. Boston: Council of International Neonatal Nurses. Archived from the original on August 26, Retrieved October 26,
  8. ^"Neonatal Nurse". Plotr. Retrieved 16 May
  9. ^"Neonatal Nursing". ACNN.
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External links[edit]

Sours: https://en.wikipedia.org/wiki/Neonatal_nursing


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