Delivering a baby is an intense process that requires a full team of medical professionals working together to ensure the safety of the baby and the mother and a successful delivery. Among these professionals, neonatal nurse practitioners and neonatologists often stand out as key individuals. While their roles are often similar, there are many important distinctions to be made between the two.

Roles and Responsibilities

The most immediate difference between neonatal nurse practitioners and neonatologists is the fact that one is a nurse and the other is a medical doctor. Neonatal nurse practitioners (NNPs) are advanced-practice nurses who specialize in the care of newborns at all levels of acuity. While they are much more specialized than a typical nurse and have undergone a high level of training, they don’t always have the same authority as a doctor. Here are a few key differences between neonatal nurse practitioners and neonatologists.

Neonatal Nurse Practitioners (NNPs)

NNPs are advanced practice registered nurses (APRNs) who specialize in caring for newborns, particularly those who are premature, critically ill, or have complex medical conditions. Their roles encompass a wide range of responsibilities, including:

  • Assessment and Diagnosis: NNPs conduct comprehensive health assessments of newborns, including physical examinations, medical histories, and diagnostic tests.
  • Treatment Planning: They formulate and implement individualized care plans, which may include administering medications, performing procedures, and coordinating with other healthcare professionals.
  • Monitoring and Intervention: NNPs closely monitor the progress of newborns in neonatal intensive care units (NICUs), adjusting treatment plans as needed and providing immediate interventions in emergencies.
  • Family Support and Education: They offer emotional support to families, educate them about their baby’s condition and care needs, and involve them in decision-making processes.


Neonatologists are medical doctors who specialize in the care of newborns, particularly those who are premature, have low birth weights, or have medical complications. Their roles and responsibilities typically include:

  • Medical Management: Neonatologists diagnose and treat newborns with a variety of medical conditions, ranging from respiratory distress syndrome to congenital anomalies.
  • Consultation and Collaboration: They consult with other specialists, such as pediatric surgeons, cardiologists, and neurologists, to develop comprehensive treatment plans for newborns with complex medical needs.
  • Procedures and Surgeries: Neonatologists perform specialized procedures, such as intubation, chest tube placement, and umbilical catheterization, to stabilize and treat newborns.
  • Research and Education: Many neonatologists are involved in clinical research to advance the field of neonatology, and they also educate medical students, residents, and fellows.


Neonatal nurse practitioners and neonatologists have very different educational paths. As nurse practitioners, NPPs are required to acquire:

  • Bachelor of Science in Nursing (BSN): Aspiring NNPs first complete a BSN program, which typically takes four years to complete. During this program, students gain foundational knowledge in nursing practice, physiology, pharmacology, and other relevant subjects.

  • Registered Nurse (RN) Licensure: Upon completing their BSN program, graduates must pass the NCLEX-RN exam to obtain licensure as registered nurses.

  • Nurse Practitioner Program: NNPs then enroll in a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) program with a specialization in neonatal nursing. These programs focus on advanced nursing practice, including coursework in neonatal health assessment, pharmacology, pathophysiology, and advanced practice nursing principles.

  • Certification: After completing their nurse practitioner program, aspiring NNPs must obtain certification as Neonatal Nurse Practitioners through organizations such as the National Certification Corporation (NCC) or the Pediatric Nursing Certification Board (PNCB). Certification typically involves passing a comprehensive exam.

Neonatologists on the other hand are medical doctors. They complete medical school (about four years of school), residency (about three years), and a neonatology fellowship (about three years). Here is the full educational trajectory of a neonatologist:

  • Bachelor’s Degree: Like NNPs, aspiring Neonatologists begin by completing a bachelor’s degree, typically in a science-related field. This undergraduate education provides the foundation for medical school.

  • Medical School: Neonatologists must attend medical school to earn either a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Medical school typically takes four years to complete and includes both classroom instruction and clinical rotations in various medical specialties.

  • Residency in Pediatrics: After graduating from medical school, aspiring Neonatologists must complete a residency program in pediatrics, which typically lasts three years. During this residency, physicians receive specialized training in the medical care of infants, children, and adolescents.

  • Fellowship in Neonatology: Following residency, physicians who wish to specialize in neonatal medicine must complete a fellowship in neonatology, which typically lasts three years. During this fellowship, physicians gain advanced training in the care of newborns, including premature infants and those with complex medical conditions.

  • Board Certification: Upon completing their fellowship, Neonatologists are eligible to obtain board certification in neonatal-perinatal medicine through the American Board of Pediatrics (ABP) or the American Osteopathic Board of Pediatrics (AOBP). Board certification demonstrates a physician’s expertise and competency in neonatal medicine.

Scope of Practice

It goes without saying that, as physicians, neonatologists have a full scope of practice. The neonatal NP's scope of practice is a bit more complicated.

Each state governs the scope of practice for an NP. Some states allow for a full scope of practice, other states have a limited scope of practice, and some have a restricted scope of practice. The specifics on which tasks are limited or restricted are delineated in each state’s board of registered nursing. It usually involves prescribing, and whether the NP needs to establish a collaborative agreement with a physician who will provide oversight to the NP’s practice.

To further complicate things, different facilities and organizations may further limit the scope of practice for NPs.



An MD has extensive training in medicine. This means that they tend to focus on disease processes and how to treat them. NPs begin their careers as nurses and use the nursing model of care to treat patients. They view patients holistically, providing comprehensive care to not only the patient but to families as well. Education is also a crucial part of an NP’s practice.


Salaries for Neonatal Nurse Practitioners and Neonatologists vary based on factors such as experience, geographic location, and employer type.

According to the U.S. Bureau of Labor Statistics (BLS), the median annual wage for nurse practitioners, including NNPs, was $128,490 as of May 2023. However, it’s essential to note that NNPs specializing in neonatal care may earn higher salaries due to the specialized nature of their work and the demand for skilled neonatal nurses.

Neonatologists, as specialized physicians, typically earn higher salaries compared to NNPs. While the BLS doesn’t have specific info for neonatologists, physicians specializing in pediatrics made an average of $205,860 in 2023. However, salaries can vary widely based on factors such as years of experience, practice setting (academic medical center vs. private practice), and geographic location.

Read more about nurse practitioner salaries and all forms of RN salaries.

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