Your baby may have more medical professionals than you have encountered in your entire lifetime. In every NICU, a member of the medical team is present in the NICU 24 hours a day, and a neonatologist is always on-call for that unit.
A neonatologist is a physician who specializes in the diagnosis and treatment of sick newborns. Neonatologists have 3 years of specialized training, specifically to treat newborns, beyond that required for general pediatricians. The neonatologist is usually the most knowledgeable member of the team treating your newborn and directs the medical care of your baby. The lead physician in most NICUs is a neonatologist and, in the hierarchy of the medical team, is referred to as the attending physician.
The neonatologist’s availability varies from NICU to NICU. In some units, care is directed by a team of neonatologists. That team then shares the responsibility for providing care on a 24-hour basis with a different member of the team being responsible for your baby’s care each day. In other facilities, especially in large centers that are also accredited for training the next generation of neonatologists or pediatricians, the neonatologist may be present in the unit for only a portion of each day (and will usually be present during patient rounds). During rounds, members of the health care team discuss and review your baby’s current condition and determine a medical plan of care. The neonatologist makes recommendations to ensure that the NICU team provides the best care for your infant based on a daily plan. If unexpected problems arise, the neonatologist is available to the health care team 24 hours a day.
The neonatologist is responsible for overseeing the medical decisions regarding your baby. The attending neonatologist may also supervise other physicians, some of whom are in varying levels of their professional training, including residents, and fellows. In many large centers the medical team is supported by clinical directors or chiefs of the NICU who may not have direct care of your child at all times but who work with the entire team of neonatologists as well as the nurse managers to oversee the general operations of the whole unit.
Neonatal Nurse Practitioner
An NNP or advanced registered nurse practitioner (ARNP), also called an advanced practice registered nurse, or APRN, is an RN who has completed advanced education and training in the care and treatment of newborns and their families. In most institutions, a nurse practitioner must have a master’s degree in nursing. Working in collaboration with a neonatologist or attending physician, the NNP is an expert in neonatal resuscitation; examines, diagnoses, and designs a care plan for your baby; and serves as an education resource for all members of the NICU team. The NNP may also perform procedures such as intubation, central line placement, chest tube insertion, and lumbar puncture. In most US states, NNPs (and ARNPs or APRNs) may prescribe medications.
Neonatal Physician Assistant
A neonatal physician assistant (NPA) is a specialist who has earned a certificate or degree from an accredited school and passed a state licensing examination. An NPA has the same general background as other physician assistants, but has completed education and training in the care and treatment of infants and their families. The NPA works under the supervision of a neonatologist or attending physician. An NPA performs delivery room resuscitation and has been trained to assess, diagnose, and design a care plan for your baby. The NPA may also perform procedures such as intubation, central line placement, chest tube insertion, and lumbar puncture and may serve as an education resource for members of the NICU team. An NPA may prescribe medications in most US states.
A pediatric hospitalist is a physician who has completed a pediatric residency and has developed specific skills and interest in caring for infants and children who require inpatient hospital care. Some hospitalists choose to spend part or all of their time working in a NICU. Hospitalists work under the supervision of a neonatologist and are capable of performing many of the procedures and care for babies in the NICU.
A resident is a physician who has graduated from medical school and is enrolled in a hospital-based program of specialized training called a residency program. Residency programs vary according to specialty (pediatrics, obstetrics, surgery, and so on) and in the amount of time required to complete the training. Pediatric residencies usually take 3 years to complete. A resident can be in his or her first year of training or a physician in the second or third year of the program. You may also hear a resident called an R-1, R-2, or R-3 (denoting a first-, second- or third-year resident) or PGY-1, PGY-2 or PGY-3 (for postgraduate year 1, 2, or 3) or PL-1, PL-2, or PL-3 (for post-licensure year 1, 2, or 3). Most residents in the NICU are enrolled in pediatric residencies, but residents from other specialties, such as family practice, anesthesia, or obstetrics, may be involved as well. Residents are usually very visible on the unit. They are closely involved with your baby’s daily care as members of the medical team. Residents assess your infant daily, then plan and revise the medical care. Residents perform many NICU procedures, such as intubation, placement of IV and arterial lines, lumbar puncture, and chest tube insertion Resident teams may be composed of members in varying years of their residency training; often senior residents will help supervise junior residents.
A neonatal fellow is a physician who has completed medical school as well as a pediatric residency and is currently training to become a neonatologist. The fellow works closely with the attending neonatologist and may be more visible on the unit than the neonatologist.
Responsibilities of a fellow vary widely. In some units, a fellow may be there all day overseeing the daily plans for each baby in the NICU and at delivery room resuscitations. In other units, the fellow makes rounds in the mornings and provides consultation for residents, NNPs, and NPAs during the rest of the day or night.
A pediatrician is a physician who has completed a pediatric residency and who provides medical care for children from birth to 18 years (sometimes up to 21 years). In some hospitals, pediatricians with interest in the care of babies with special needs may provide care for babies in the NICU. Other pediatricians may not have special training in NICU care and may therefore refer your baby to a neonatologist. After your baby is discharged from the NICU, your pediatrician commonly becomes your baby’s primary care provider.
Depending on the needs of your baby, a family practitioner may also be your baby’s primary care provider.
Other Medical Personnel
Your baby’s medical team may call on other specialists to assist them in providing care for your baby. These consultants may be present in your hospital, available on an intermittent basis, or by telephone.
- Cardiothoracic surgeon: specializes in performing surgery on the heart
- Pediatric cardiologist: specializes in diagnosis and treatment of heart problems (nonsurgical)
- Pediatric gastroenterologist: specializes in treatment of stomach and intestinal problems (nonsurgical)
- Geneticist: studies birth defects and their causes
- Pediatric hematologist: specializes in diagnosis and treatment of blood problems
- Pediatric nephrologist: specializes in the diagnosis and treatment of kidney problems
- Pediatric neurologist: specializes in diagnosis and treatment of the nervous system
- Neurosurgeon: specializes in surgery of the brain and nervous system
- Pediatric surgeon: specializes in performing general surgery for newborns and children
- Otolaryngologist: specializes in ear, nose, and throat surgery
- Pediatric pulmonologist: specializes in diagnosis and treatment of certain lung conditions
- Urologist: specializes in surgery of the urinary tract