Neonatologist or Pediatrician for Preemie: What Are Their Roles?

I am 18 weeks pregnant and have degenerating fibroids. To manage the pain, my OB has prescribed Demerol. We are going to try to get me to 30 to 32 weeks and prior to delivery, take me off the pain medication. What role would a pediatrician and or a neonatologist play for a preemie baby?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

I am sorry to hear of the pain you are experiencing with your pregnancy but delighted that you have thought well ahead about the care your baby will receive.

There are number of aspects of care that are special to babies born prematurely. Pregnancy usually lasts anywhere from 38 to 41 weeks. Babies born at 42 weeks or later are considered past due. Babies born prior to 37 weeks are considered premature.

One of the biggest roles the pediatrician or neonatologist serves is to give you anticipatory guidance. There are a number of things that might occur with your baby depending upon exactly how far along you are in your pregnancy, whether there are any complications with your labor, and whether you deliver vaginally or by cesarean. Giving birth to a premature infant can be a scary thing if you do not have the tools of knowledge working for you. Therefore, getting to know the pediatrician or neonatologist prior to birth can help ease your anxiety. It is a good idea to do this early on because while you anticipate delivering at 30 to 32 weeks, if you don't make it that far, you'll want a familiar face to talk to and answer your questions.

Some of the information about your premature infant that you should find out from the pediatrician/neonatologist include:

When will your baby be able to feed?
While babies have the reflex to suck and the reflex to swallow early on in gestation, the coordination of these two movements does not occur until about 34 weeks. Therefore, the baby may not be able to eat on his own. This means that the baby will need to get his nutrition with help. This is usually done by placing a feeding tube through the mouth and depositing breastmilk or formula in the stomach and then removing the tube. This would be done about every two hours by the nursing staff.

What is the risk of infection?
Full term infants have a decreased ability to fight infection, and this is only increased in premature infants.

How well will your baby be able to breathe?
This is probably of biggest concern in premature infants. Babies born prior to 35 weeks have an increased risk of not having produced a substance in the lungs called surfactant. Surfactant allows for the lungs to move easily and move oxygen easily to the body. Steroids given to the mother increase the maturation of the fetus's lungs. Therefore, a baby born at 28 weeks, for instance, may have excellent production of surfactant prior to birth if the mother had received steroids. If the baby's lungs are not mature and there is not enough surfactant, he may need to have a ventilator assist him to breathe for a while.

The next big role for the pediatrician/neonatologist is to take care of the infant immediately following delivery. Getting a premature infant to take that first big breath is sometimes difficult. Therefore, having an expert with the airway of a premature infant at hand is important. In addition, other interventions requiring secure intravenous (IV) access may be needed. This is usually done by threading special tubing through the vessels of the umbilical cord. Obviously, having an expert such as a pediatrician or neonatologist to do this is ideal.

Having someone to answer all of your questions about what to expect from your premature infant is half the battle. The other half is having that expert at hand to take care of your infant should, heaven forbid, emergency interventions need to take place.

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