Neonatal Fellowship Handbook 2011-2012 by huanghengdong

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									Neonatal Fellowship
    Handbook
                                   Neonatal Fellowship Handbook

Welcome to the Neonatal Perinatal Fellowship at the University of New Mexico!

Please COMPLETELY read the NICU Orientation Manual for the Residents-much of the information in
that document will NOT be repeated here so it is critical that you completely familiarize yourself with that
document, this document and the UNM Clinical Fellows Goals and Objectives document!

A Brief Introduction for the Fellows

This orientation manual for fellowship is meant to introduce you to the Neonatal Division and the Newborn
Intensive Care Unit (NICU) at the University of New Mexico Children's Hospital. The Neonatal Division
has 12 neonatal faculty and is actively involved in clinical care, neonatal research and education. The
Division also consists of the Neonatal Transport Team, the Developmental Care Program, Outreach
Education and the Neonatal Nurse Practitioner/Neonatal Physician Assistant Providers. The NICU at the
Children's Hospital opened in 1971. Before the program's inception in 1971, the neonatal mortality rate in
New Mexico was 15:1,000 live births, compared to 14.2 nationwide. As of 2006, the infant mortality rate
in NM was 5.7, compared to 6.7 nationwide.

The UNM Hospital has between 3,500 to 4,000 deliveries per year. Our neonatology service admits
approximately 700 infants per year, with about 75% originating from our own delivery service and 25% as
neonatal transports.

Our NICU encompasses 36 level III beds and 28 level II beds. Patient care in the NICU is
multidisciplinary and is provided by the attending Neonatologist, fellows, resident house-staff, neonatal
nurse practitioners (NNPs), physician assistants (PAs), sub-interns, nurses, respiratory therapists,
developmental care specialists, nutritionists, lactation consultants, social workers, etc. Patients are
distributed among three different areas: the Newborn Intensive Care Unit, and the Intermediate Care
Nursery (ICN-4), both located on the fourth floor of the Pavilion; and the ICN-3, located on the third floor
of the Pavilion. Pediatric residents rotate through the NICU for one month each year during their
residency.

The Fellows in Neonatal/Perinatal Medicine (PL-4, 5 and 6) will have exposure to and a breadth of
experience in all disorders encountered in neonatal/perinatal medicine. The intent of our
neonatal/perinatal medicine fellowship is to train pediatricians in the diagnosis and management of
disorders in premature and full-term newborns to provide up-to-date, comprehensive, compassionate
care in the training of the next generation of academic and clinical neonatologists. This training program
will provide the foundation necessary to become competent clinicians, researchers, teachers and leaders
within the field of neonatal/perinatal medicine.

The overall goals for the fellows in neonatal/perinatal medicine are:

1.      To develop and maintain a standard of excellence in the clinical practice of neonatal-perinatal
        medicine.
2.      To develop a broad knowledge base in neonatal-perinatal medicine.
3.      To develop a personal program of self-study and professional growth with guidance from the
        teaching faculty.
4.      To base clinical decisions upon scientific evidence-based medicine.
5.      To develop teaching skills.
6.      To develop administrative skills.
7.      To establish the basis for a research career.
8.      To initiate and complete at least one research project. This includes development of a
        hypothesis, research protocol, abstract, and presentation, regionally and/or nationally.

See “UNM Clinical Fellow Goals and Objectives” for more detail on requirements based on ACGME areas
       of competency.




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Year 1 of Fellowship

During the first year, the neonatal fellow will be on service 18 weeks, have protected research time for 30
weeks and take in house call 50 nights (14 weekend calls (24 hours), and 36 weeknight calls (16 hours)).
You are expected to attend at least one Pediatric Research Conference (Pediatric Academic Societies
(PAS), American Academy of Pediatrics (AAP) Section on Perinatal Pediatrics, Western Society for
Pediatric Research (WSPR), District VIII meeting, etc) and one Fellows conference (competitive selection
sponsored by AAP or NIH) per year. You receive 14 professional/education leave days annually. You
also receive 21 annual leave days and 21 sick leave days annually. Any days left at the end of the year
will not rollover to the next year; you must use them or lose them!

Year 2 of Fellowship

During your second year you will be on service for 18 weeks, have protected research time for 30 weeks,
and will take in-house call 50 nights/year (14 weekend calls and 36 weeknight calls). You are expected to
attend at least one Pediatric Research Conference (Pediatric Academic Societies (PAS), American
Academy of Pediatrics (AAP) Section on Perinatal Pediatrics, Western Society for Pediatric Research
(WSPR), District VIII meeting, etc) and one Fellows conference (competitive selection sponsored by AAP
or NIH) per year. You receive 14 professional/education leave days annually. You also receive 21 annual
leave days and 21 sick leave days annually. Again, any days left at the end of the year will not rollover to
the next year; you must use them or lose them!

Year 3 of Fellowship

During your third year of fellowship you will be on service for 16 weeks (52 weeks over 3 years), have
protected research time for 32 weeks, and will take in house call for 50 nights per year (14 weekend calls
and 36 weeknight calls). You are expected to attend at least one Pediatric Research Conference
(Pediatric Academic Societies (PAS), American Academy of Pediatrics (AAP) Section on Perinatal
Pediatrics, Western Society for Pediatric Research (WSPR), District VIII meeting, etc) and one Fellows
conference (competitive selection sponsored by AAP or NIH) per year. You receive 14
professional/education leave days annually. You also receive 21 annual leave days and 21 sick leave
days annually.

Duty Hours
The University of New Mexico is in full agreement with the new ACGME duty hours that start July 1, 2011.
Fellow Duty Hours ACGME Rules:
       Duty hours must be limited to 80 hours per week, averaged over a four-week period,
        inclusive of all in-house call activities and all moonlighting.
       Fellows must be scheduled for a minimum of one day free of duty every week (when
        averaged over four weeks).
       Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24
        hours of continuous duty in the hospital.
       It is essential for patient safety and resident education that effective transitions in care
        occur. Fellows may be allowed to remain on-site in order to accomplish these tasks;
        however, this period of time must be no longer than an additional four hours.
       Programs must encourage fellows to use alertness management strategies in the
        context of patient care responsibilities. Strategic napping, especially after 16 hours of
        continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly
        suggested.
       Fellows must not be assigned additional clinical responsibilities after 24 hours of
        continuous in-house duty.
       Fellows should have 10 hours free of duty, and must have eight hours between
        scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of
        in-house duty.
       Fellows must be scheduled for in-house call no more frequently than every-third-night

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                                   Neonatal Fellowship Handbook

          (when averaged over a four-week period).
You must keep track of your duty hours on a weekly basis in New Innovations as required by ACGME. If
your hours violate the above rules, you will be counseled by the Program Director. There should be no
instance when you will be scheduled so as to violate the above duty hours for clinical, research or
educational purposes. (see call schedule below).



I. NBICU Expectations by Fellowship Year

Year 1:

Service in the NICU:
The service week starts on Thursday and ends on Wednesday. There are 2 teams: Green and Red.
Admission duties alternate teams daily (i.e., if Green admits on Monday, Red admits on Tuesday, etc.).
Efforts will be made to keep the teams fairly even, so there may be some rearranging of admissions.
Each team is comprised of an attending, a fellow (if assigned), a mid-level practitioner (NNP/PA) and a
resident/intern/medical student. Frequently, medical students will rotate through the NBICU a one of their
 th
4 year required ICU rotations. The interns and medical students work in the NBICU for 12-hour day
shifts (6/week Mon-Sat) and the residents alternate 2 weeks of daytime shifts with 2 weeks of night-time
shifts (5/week). Residents are allowed to have a short day (leave one day a week at 2:00 after work is
done) A subset of long-term patients are taken care of by the Extended Care Service (NNP/PA service).

Your Day in the NBICU

Fellows arrive no later than 0800 and receive a brief checkout from the post-call fellow (if no fellow, either
the NNP/PA on that night or the attending on the night prior will give you checkout). The fellow should
then go and see any new patients, address any issues, and prepare for morning rounds.


During the day, you are expected to be aware of all clinical issues with all of the patients on your team.
You are expected to serve as a supervisor for the residents and interns: assist them with ventilator
management, teach them skills such as lines and intubations, and supervise them at deliveries (they
should attend all deliveries when their team is admitting). You are expected to supervise ALL admissions
to your team; you do not, however, have to write the admission note. If you are post call-you will round
on your team with the attending and then leave after rounds. You will not admit new patients if you are
post call and on service, even if you are on the admitting team, to comply with ACGME guidelines.

Teaching:
Teaching of the medical students and residents occurs at 0900, with morning rounds immediately
following, roughly at 0930. As a first year fellow you will be required to teach during this AM time once
per week on a non-admit day.

Rounds:
A first year fellow is required to observe rounds as the attending runs them, ask questions, and join in
discussions as appropriate. The attending carries the team book and writes the numbers/plans for the
day.
                                                                                                       st
Radiology rounds occur daily during the week at 1130 in the Pediatric Radiology Reading Room, 1 floor
of the hospital with the Radiologist and the NICU staff. If the team is not done with rounds, they will
continue patient rounds after Radiology rounds are complete.

The attending and fellow will round alone with the Extended Care practitioner in the morning, before or
after other rounds are completed.

Depending on the day, the afternoon is left for procedures, didactics, reading etc.

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Deliveries:
The first year fellow is expected to attend all deliveries that the team is paged to attend for 4-6 months,
even during morning rounds. Once comfortable with the routine delivery, the first year fellow should only
attend preterm deliveries and high-risk deliveries. The fellow should be aware of all impending high-risk
deliveries on the L and D board. The resuscitation team should be using the Resuscitation Checklist and
participate in debriefing.


Call and sign out:
The attendings and fellows on service will sign-out to the attending and fellow on-call Mon-Fri at 1600.
The fellow should be able to check-out their patients in a concise fashion (unless they are post-call; then
the attending will sign out the team’s patients). (See video clip of sign out process by a fellow). The
fellow should facilitate communication with the on-call team since the practitioners and residents are not
present at 1600 sign-out rounds and update them with all changes made during sign-out rounds. Either
team signs out when ready. The daytime people then leave and the nighttime team takes over. The
attending may leave if everything is quiet. The nighttime team should also be notified if the transport
team is out. The nighttime team is responsible for patients and admissions until 8:00 am the next
morning. The fellow will sign out to the fellows at 8:00 the next day and may also be asked to sign
out/call the daytime attendings. Check with your night call attending. There is a call room on the third
floor for the fellow, the 2 call rooms in the unit are for the resident/NNP/Pas on in the unit at night.


As a first year fellow on-call, you need to call the attending with any issues that come up during the call
night and in the morning review the events of the night and give an update. The daytime NNP/PAs and
residents will check out to the night team at 1900. Plan to check in with the attending after these rounds.
Most attendings will expect a “check-in” between 2100-2200 to discuss patients in the NBICU. Morning
sign-out happens by paging the attending at 0745. You will also check-out to the fellow on service. The
on-call attending may have you check-out to the attendings on service as well during the week or to the
on-call attending on the weekend. The night team (NNP/PA or resident) usually checks out at 0700 to the
oncoming team and it is beneficial to sit in on these check-out rounds, especially if it was a busy night.



On-call Notification of Neonatal Attendings (for all years of fellowship):

Notify the attending on call in a timely manner for the following:
1) All infants delivered at less than 30 weeks
   a) Notify within 1-2 hours of delivery
2) All infants delivered or admitted with cardiac disease or significant anomalies, including surgical
   abnormalities
3) All infants requiring intubation (new admissions or current patients)
4) All infants requiring high frequency ventilation
5) Acute deterioration or significant illness in any infant (new admissions or current patients)
   a) Shock
   b) Sepsis, including evaluation for sepsis
   c) Requiring pressors
   d) Possible NEC
   e) Significant change in laboratory values
        i) Severe acidosis (respiratory or metabolic)
        ii) Severe hypernatremia, hyponatremia, hyperkalemia, hyperglycemia, hypoglcemia
   f) Acute respiratory deterioration or apnea needing intubation
6) Need for transfusions
7) Need to contact another service (surgery, cardiology)

The on-call team can wait until the morning to notify the attending for:
1) Stable patients greater than 29 weeks
2) Admissions from NBN for hypoglycemia that are stable with IV fluids
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3) Admissions from NBN requiring oxygen
4) Anomalies not affecting clinical care
5) Prenatal consults

The attending may be notified by the Fellow, NNP/PA, or resident, but the Fellow or Senior
NNP/PA must make sure the attending has been notified.

In addition, all families should be notified for an acute deterioration in their baby.

Attending coming in at night:
If the patient is critically ill or there is a complex delivery expected (bad CDH or hydrops, etc.) the fellow is
expected to notify the attending to come to the hospital.

Post call:
If you are on-call during service Mon-Fri, on your post-call day you need to check out with your attending
between 1100 and 1200 and must leave no later than 1200 on your post-call day. If you are on-call for a
weekend or Holiday, you leave after checkout on the post-call morning (usually by 0900). On weekends
and holidays, the on-call attending and fellow will round on all the babies in the unit; rounds begin
between 0830 and 0900.


Supervision of Resident patients during their Education Day and at other times:
All residents and interns are excused from clinical responsibility each Thursday afternoon from 1200 to
1700 for educational activities. You are expected to cover their patients during this time. They will return
in the late afternoon to complete their work and write their notes. While the residents are at Continuity
Clinic one afternoon a week (1200-1700), they generally sign out their patients to the NNP/PA on the
team; you will be expected to help manage the patients if they are critically ill.

In order to ensure that residents/interns are finished with their work by 1900 and able to leave after
evening sign out, the fellow will cover patients so the residents/interns can complete their notes if they
have not been completed by 1700. If this is happening repeatedly, the fellow will inform the attending so
that the resident may be counseled about time management.

Procedure log:
Fellows should document each procedure (see Procedure Checklist) they perform or supervise in New
Innovations. Identify the supervising attending or NNP/PA so they can confirm the procedure.


Fellows Procedures Requirements

PIV                                        5/year
Arterial Sticks                            5/year
PAL                                        2/year
Chest Tube                                 2/year
Intubation               perform           4/year
         supervise       4/year
UAC/UVC                  perform           4/year
         supervise       4/year
Resuscitations           <28wk             4/year
         High risk       4/year
Bladder Tap                                1-2/year
LP                                         1-2/year (supervise)
PICC                                       2/year
Cutdown central line                       1/year
Partial Volume/Double Volume               1/year
         Exchange Transfusion
Surfactant administration                  2/year
Conscious sedation                         2/year
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Any procedures not done on patients in the NBICU will be performed in the BATCAVE simulation lab
during Core Curriculum sessions with Renate Savich.



Evaluations:
After each clinical rotation and you must have a formative clinical evaluation completed by EACH
attending you worked with for at least 3 days that evaluates your performance and where you are at in
meeting the expectations for each of the six ACGME core competencies: Patient care, Medical
knowledge, Practice-based learning, Interpersonal & communication skills, Professionalism and Systems-
based practice. This MUST be a face to face meeting discussing your evaluation either with a paper copy
or electronically. Renate Savich, Program Director, will then read the evaluations on line and discuss any
issues identified with the fellow.

ICN-4:
This unit is near the NBICU and is covered by a separate MD/NNP team. These patients are Level II
patients that are short-term chronic babies or growing preemies. You may be asked to identify
appropriate patients for this unit from the NBICU. This should be discussed with the attending and
charge nurse prior to, if possible.

Year 2:

Clinical:
During the day, you are expected to be aware of all clinical issues with all of the patients on your team.
As a second year, you are expected to manage some patients more independently, yet keep the
attending informed. You are expected to serve as a supervisor for the residents and interns: assist them
with ventilator management, teach them skills such as lines and intubations, and supervise them at
deliveries (they should attend all deliveries when their team is admitting). You are expected to supervise
ALL admissions to your team; you do not, however, have to write the admission note. If you are post call-
you will round on your team with the attending and then leave after rounds. You will not admit new
patients if you are post call and on service, even if you are on the admitting team, to comply with ACGME
guidelines.


Teaching
As a second year fellow on service you will be expected to give two morning talks or run a mock code
from 0900-0930 to the medical students/residents each week on your non-admit day.

Deliveries
Again, you will be expected to attend and supervise any preemie or high-risk deliveries and you should
examine every new admit to the unit. The fellow should be leading the resuscitation team in using the
Resuscitation Checklist and participate in debriefing.




Rounds:
As a second year fellow, you will be expected to run rounds under the direct supervision of your
attending. You will carry the team book, write the numbers/plans for the day, and are expected to come
up with patient plans and do bedside teaching.
                               nd      rd
On weekends and holidays, 2 and 3 year fellows will round on half of the children in the unit alone and
the attending will round on the other half. Following rounds, the attending and the fellow will talk about all
of the children that they rounded on one-on-one. Most attendings will expect to round together on very
sick children.

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                                  Neonatal Fellowship Handbook


Year 3:

Clinical:
As a third year fellow, you will run rounds independently without the on-service attending present. You
will pre and post-round with the on-service attending depending on the patients and day. The attending
will round with you once a week to observe your bedside teaching and clinical management. You will
also be expected to take all PALS calls and arrange transports with attending supervision and back up.

During the day, you are expected to be aware of all clinical issues with all of the patients on your team.
As a third year, you are expected to manage most patients independently, yet keep the attending
informed. You are expected to serve as a supervisor for the residents and interns: assist them with
ventilator management, teach them skills such as lines and intubations, and supervise them at deliveries
(they should attend all deliveries when their team is admitting). You are expected to supervise ALL
admissions to your team; you do not, however, have to write the admission note. If you are post call-you
will round on your team with the attending and then leave after rounds. You will not admit new patients if
you are post call and on service, even if you are on the admitting team, to comply with ACGME
guidelines.

Teaching:
As a third year fellow, you will be responsible for all resident lectures during your time on service. The
attending should be observing some of your talks. You are expected to supervise any preemie or high-
risk deliveries and you should examine every new admit to the unit.


Transport calls:
You need to notify PALS that you will be handling all PALS calls. Do not forget to fill out the transport
sheet, notify the attending, charge nurse, and Transport NNP/PA. The transport sheet needs to be filled
out even if the baby is not transferred. You should also keep in close contact with the referring doctor to
monitor the status of the patient.




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II. Fellow Conference Schedule

All conferences are mandatory unless otherwise noted and must be attended by all fellows, unless they
are on leave. Even if you are “working from home” you are expected to attend these conferences; they
are mandatory didactics that fulfill your educational requirements for fellowship. Sign-in sheets should be
signed weekly; binder is on Coordinator desk.

Monday           Second Monday of month – Fellow meeting 1200-1300 with lunch provided

Tuesday          0800-0900 - Peri/OB in Tully
                                                                    th
                 1200- 1300 - Neonatal Grand rounds except for the 4 Tuesday when it is at 1300 due to
                         Peds Department Faculty meeting
                 First Tuesday of month – M&M Conference 1300-1400
                 Second Tuesday of month – Division Meeting 1300-1400
                 Third Tuesday of month – Neon Hot Topics 1300-1400
                 Fourth Wednesday of month – Faculty Meeting 1300-1400 (Attendings only)

Wednesday        First and third Wednesday of month– SBC if assigned 1200-1600 (Must attend 8 each
                 year)
                 Second Wednesday NICC Meeting 1200-1300 (Must attend at least 1 each year)
                 Fourth Wednesday – Developmental Care rounds 1230-1400

Thursday         Peds Grand Rounds (optional) 1200-1300

Friday           0830-0900 – PALS conference front team room NICU
                 1230-1400 – Core Curriculum, with third Friday being Journal Club and lunch provided.

Core Curriculum:
                                                               th
Core Curriculum is each Friday from 1230 to 1400 on the 6 Floor Tully of the BBRP, with Journal Club
                  rd
occurring each 3 Friday with lunch provided. Your attendance is required except if you are annual or
professional leave. he attending will cover for you if you are on service during this time. You should not
be leaving core curriculum to answer pages, etc. The format varies with lectures, case discussions,
seminars, skills labs, etc. and will cover all the topics you can expect to see on your subspecialty board
exam following fellowship.


Peri/OB Conference:
The Peri/OB Conference is a joint conference with MFM, Neonatology and genetic counselors held in
order to discuss high-risk pregnancies in the community, provide the MFM’s with follow-up on high-risk
infants that delivered, and to coordinate consults/come up with delivery plans. The conference is one
hour long, with the first 30 minutes devoted to patient discussion and the last 20-30 minutes dedicated to
a didactic lecture. The conference starts with the NICU fellow presenting a brief update on the clinical
status of any infant born to a high-risk mom that UNM MFM has been following pre-natally (see format
below for example NICU list). However this format may be changing this year-so you will be informed of
changes

Typically, the only infants that go on the NICU list are ones that stay in the NICU. For example, you will at
times have an infant that is delivered, admitted to the NICU, but transitions quickly and by the next
conference the infant has done well and is back in ICN-4 or in ICN-3. This infant does not need to be
placed on the NICU list.

The list is maintained by the Fellows on service, with each fellow adding infants to the list that are on their
team and admitted during the appropriate time frame. If there is an admit Monday night and the on-call
fellow has time, they will place that infant on the list also. If not, then the infant is placed on next week’s
list or just verbally reported on during the Conference. Infants that are transported in do not need to be
placed on the list. One of the Fellows on service will present the list at the Peri/OB conference.


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Name          DOB           GA (wks)      Bwt (gms)     Mat Hx        Delivery/Apgars/Resus       Clinical
                                                                                                  Status



Neonatal Grand Rounds:
When on service, you will be asked to go over 1-3 “interesting” newborns that you have on your team in
detail. It may be to discuss a rare diagnosis, go over a differential for the infant, or to discuss the course
and future plans of the infant. This conference is meant to create a discussion and discuss learning
points for 2-3 patients on the team. While this conference has an informal format (no PowerPoint, etc),
you should know the patient(s) that you are presenting very well and be able to present them in an
organized and concise fashion to the conference attendees so that a useful discussion will result. It is
often helpful (and impressive) to have looked up an article related to your patient.

M&M:
Monthly M&M cases will be divided between the fellows (each with an Attending supervisor) and
attendings. For those infants who received an autopsy, Pathology is contacted and asked to present their
findings. There are some cases where it may be beneficial for you to contact pathology and coordinate
your discussion. Your role is to review the pertinent history and hospital course for the infant via a
PowerPoint. You need to review the presentation with the assigned attending at least 1 week BEFORE
the M&M conference and to select a pertinent learning issue. At the end of the PowerPoint, you need to
review a learning point from the case (i.e. if it was a rare genetic disorder, you might discuss this or the
latest data or research in that area). The attending assigned to the case will assist with this. This is
meant to be a brief yet organized discussion, so the presentation should be about 10-15 minutes total.

Journal Club:
The third Friday of every month is Journal Club and lunch is provided. The fellows are assigned one
Journal Club presentation each year. You may pick any of the attendings to help you choose a topic of
interest, pick an appropriate article or articles and review the paper/papers in detail. The articles should
be chosen with the attending a minimum of 1-2 weeks before Journal Club. You may chose whichever
attending you want and 2-3 articles are typically reviewed. You may include a very brief review of the
articles to educate the audience on the scope of the problem, etc, but your presentation should not be
solely a review of the articles. The purpose of Journal Club is for you to learn how to evaluate and
critically review neonatology literature so you can stay current in your future clinical practice and can
decide if the available data and research methods used are sufficient to affect your clinical practice. You
should review the articles with the selected attending and go over the paper, including the statistics, in
great detail prior to your presentation at Journal Club. Once you have chosen your article(s), they should
be emailed to the Journal Club coordinator for electronic distribution. You will be evaluated on your
Journal Club presentation by those in attendance, which will go in your binder.

Special Baby Clinic:
                                      st       rd
Special Baby Clinic is held on the 1 and 3 Wednesdays of each month from 1200-1600 at Carrie
Tingley Hospital. Fellows are assigned to SBC based on call and service schedule (cannot go to SBC if
post-call or on service). You will be assigned to 8+ SBC per year. There are two fellows assigned for
each session and you are expected to arrive no later than 1300 and must stay until the clinic is over,
unless you are on call that night. The fellow role is to help evaluate the follow-up infant (examine, learn
which developmental assessments are appropriate for which infant, etc) with the developmental care
team. You should expect to see at least 2 to 3 patients during this time.

Developmental Care Rounds:
      th
The 4 Friday of every month is Developmental Care rounds with the Developmental Care team and
fellows. The purpose for these rounds is to discuss follow-up of our patient population. There will be
reading assignments and hands-on training. Part of the time will be spent in the NBICU.

PALS Conference:
Every Friday at 0830 the non-admitting attending on service will discuss a PALS case with the fellows.
The discussion is a review of the appropriate steps for working up a PALS call from an outlying area,

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deciding if and when a transport is needed, what goes into setting up a transport, and what you need to
address as the Consultant. This is in preparation for taking PALS calls       as a third year fellow. The
attending may also discuss case presentations, work-up, etc. during this conference.


Neonatal Skills Lab:

During the first week of fellowship there will be a 3 day (afternoons) skills lab in the BATCAVE. We will
review neonatal procedures and skills and participate in complex resuscitations (not basic NRP). This is
required for all fellows and will be repeated each year.

New Innovations:

All goals and objectives, evaluation forms, procedure logs, schedules duty hours etc etc. will be
located on New Innovations. It is critical that you keep your information on this site up to date.




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III. Other Information Related to Clinical Service

Call and Service Schedule Requests:
You will be asked to request specific calls and weeks on service that you cannot work around the first
couple months of the year for the next academic year schedule; the schedule starts 7/1 and runs through
6/30. Scheduling priority is given to the most senior fellows. You are to make your time off request list
and send it to the Coordinator (i.e. which weeks that you would not like to be on service and which days
that you would not like to be on call along with any other specific requests related to when you like or
dislike being on service/call). The required service and call time will be evenly distributed each 6 month
block. Service weeks are assigned in 2-3 week blocks for continuity of care. You may ask for a 4 week
service block for greater non-service time for research purposes, but you must receive approval from the
program director.

Once the call and service schedule is published in AMION then you will be responsible for finding
coverage for any shifts that you cannot work. There is a possibility the call can be offered as a paid call if
you are unable to find someone to cover your shift, but this is not ideal since the division will have to pay
2 people for 1 shift. While this is not a fellow-dependent program, there are many other schedules
created off of the fellow schedule so you must keep that in mind. Any scheduled calls or service times
that are missed for any reason must be made up. Any and all schedule changes must be emailed to the
Program Director and Program Coordinator so records can be kept and AMION can be updated
accurately.

Holiday Call:
There are three major holidays and three minor holidays during the academic year. As a fellow, you are
required to do one major holiday service week each year, with call on the holiday (24 hours) and one
other night that week. You are also required to work a service week and call over each minor holiday
over your three years. You will get “comp time” for working on any holidays; the comp day should be
noted on your fellow tracking sheet as well as which day you take for comp.

The three major holidays are (6 days total):
        Thanksgiving Day / Day after Thanksgiving
        Christmas Eve / Christmas Day
        New Year’s Eve / New Year’s Day

The three minor Holidays are:
             th
        The 4 of July
        Labor Day
        Memorial Day

Holidays are assigned by the Program Director or Coordinator. You can switch your assigned holiday
with another fellow, if they are willing, but you must do a major and minor holiday each year.

Moonlighting:
You will have the opportunity to take paid calls in the NICU, either during the day or the night. If doing a
day paid call you need to arrive at 0700, will be assigned patients, you are to collect the numbers, write
patient notes, present those children on rounds, and follow them during the day. Your patients for that
day will be checked out to the night team at 1900 (13 hour shift). Fellows get paid $42.00 per hour for
paid calls. Once a fellow has done five paid calls, they will receive a $500.00 “bonus”; Neonatology
accountant keeps track of this. The night paid calls are also 13 hours, starting at 1900 and ending after
check out at 0700 the next morning.

Paid calls do not count toward your fellow required calls and you cannot take a fellow call and paid call in
the same night. Paid calls do count toward your duty hours and must be noted and taken into account
accordingly. You cannot take paid calls when on service, unless you are not on service the following day.




                                                                                                           12
                                    Neonatal Fellowship Handbook

Consults:
While on service or on call, you will be asked to do neonatal consults in OB for high-risk patients. In
general it is nice to print out the NICHD database on outcomes and give that to the parents so that they
have something in hand to refer back to. You may also refer to the UNM ELBW Outcome Data cards.
Typically the consult is based on how much information the family wants and why the consult was
requested (i.e., prematurity vs. CDH). In general, you should introduce yourself and the team and review
what the parents understand about their baby’s condition and any prenatal consults they have already
had. It is important to understand what the parents/family expects of the delivery and birth. Once you are
aware of the family’s understanding and emotional state, you should then go over the overall prognosis,
risks of the condition, and expectations at the delivery itself. It is important that families of high-risk
pregnancies know that we are a team that is dedicated to their child and will be available 24/7 should their
infant deliver or to answer further questions. You should also go over expectations of subspecialists who
will be consulted and may talk to families after delivery. Depending on the time frame/gestational age,
you might offer a tour of the NICU to family members if this has not yet been done. A palliative care plan
may need to be created as well. In this case, the Palliative Care Service should be contacted and
included in the planning in order to make a delivery plan appropriate for the family’s needs.

Other important points to include in all consults:
    Who will be present at the delivery specifically to tend to their infant (i.e. number of team
        members and what their roles are)
    The initial assessment
    Possible scenarios after delivery
    When they will meet their baby
    Where the NICU is and who can follow the team back to the NICU
    The family should be told that we are always available to answer their questions and that we will
        continue to talk to them on a regular basis as the pregnancy progresses or conditions change
    It is important to give the family opportunities to ask all of the questions that they have

For those infants who are premature you should also mention the following things as part of your outline
of the overall prognosis and plan:
      Increased risks for: infection, surfactant deficiency and need for assisted ventilation, blood
         transfusions, ROP, IVH, NEC, and feeding intolerance,
      Duration of stay expected: ROUGHLY until the date of expected delivery
      Long term risk of neurodevelopmental delay
      Lines (note: when families first visit their infants in the NICU, it is often helpful to point out each of
         the “things” attached to their child and tell them what they are for)

Transport:
As a fellow you will be required to go on two transports per year (either ground or air) with the transport
team. You are also required to keep a log of the transports you attend and place this in your fellow binder
kept at the Coordinator’s desk.

Call Pager:
The fellows on service will be given a Fellow Call Pager (one per team) to be carried at all times. The
pager informs the neonatal team of deliveries. This pager will be passed on to the fellow on-call and to
the next fellow starting service.
 st
1 number tells you what Floor
    th
0= 4 floor: Main OR for c/s
    st
1= 1 floor: ED
    nd
2= 2 floor: MICU
    rd
3= 3 floor: Mother-Baby Unit
    th
4= 4 floor: L& D
 nd
2 three numbers: EGA
000= Term
111= Preterm
                                                                                                              13
                                   Neonatal Fellowship Handbook


 rd
3 Numbers state which room

Other:
911= Emergency
911911= Additional NBICU staff needed

Example pages:
                                       th
4111-13: Preterm infant in room 13 on 4 floor L&D
                                          th
4000 911-14: Emergency term delivery in 4 floor L&D room 14
                                                       rd
3000 911911-10: Emergency term delivery in room 10 of 3 floor mother-baby unit and additional NBICU
staff is needed.
              th
Note: the 4 floor room numbers 13, 14 and 15 are the C/S rooms.
There are laminated cards with these codes next to the L & D pagers that are kept in the back team room.

Procedures:
The neonatal faculty, senior fellows and NNP/PA’s will teach you procedures you are not proficient in. It
will also be required that these procedures are signed off on once proficiency is met. The NNP/PA’s will
sign off on your procedures; it may be that occasionally an attending will teach and sign off for very
specialized procedures, such as cut-down PICC placement. The NNP/PA’s or Program Director will run
skills labs each year to help fellows gain proficiency in procedures that they are not comfortable with. Any
procedure attempted, whether successful or not, needs to be documented, in New Innovations. All
procedures you do, attempted and completed, should be noted and tracked in New Innovations. You are
responsible for keeping New Innovations up-to-date and accurate. This is how you will be verified and
credentialed following fellowship.

There is also a packet of information that needs to be completed for central line insertions; you can
review this with the NNP/PA you are doing the line with at that time.

Teaching Education

Educational Seminars from the UNM School of Medicine are required in the curriculum. The fellows are required to
attend 3-4 teaching seminars over the 3 years sponsored by the Teaching and Education Development office at
UNM SOM on topics of:

             How to Be a More Effective Inpatient Teacher (required)
             The Art of Lecturing and Making Presentations (required)
             How People Learn (required)

And either:

         PowerPoint 202; Taking the next Steps to Quality Presentations
         Promoting Learning through Formative Assessment
         Constructive Feedback: Developing Skill and Overcoming Barriers

ECMO Experience:
Exposure to Extra Corporeal Membrane Oxygenation is in collaboration with the Pediatric Intensive Care
Unit. There is a formal didactic experience and participation in newborns and pediatric patients on
ECMO.

Maternal-Fetal-Medicine/Special Delivery Service Counseling elective
This is a requiredelective in Maternal Fetal Medicine at the University of New Mexico under the direction
                                                        nd
of Dr. Rebecca Moran and Dr. Lisa Moore during the 2 year. This experience involves prenatal
diagnosis and counseling, as well as Palliative Care.



                                                                                                         14
                                  Neonatal Fellowship Handbook

Other Things:

Written and Electronic Goals and Objects/Evaluation Forms:
All Goals and Objectives for each educational experience are kept in binder in the fellow’s office. They
can also be found electronically on the Fellowship website and in New Innovations. In addition, each
Evaluation Form for each educational experience is kept in the binder, on the website and in New
Innovations. The fellows will meet with the Program Director (Renate Savich) each 6 months to review
progress and discuss the information kept on New Innovations.

Cardiology Rotation at Stanford:
                                                                              nd   rd
Fellows will have the opportunity (pending availability of funds) during the 2 or 3 year of fellowship to
spend 2 weeks at the Lucile Packard Children’s Hospital at Stanford University in the CVICU to obtain
clinical experience in post-operative management of babies with congenital heart disease. This will count
towards the required 52 weeks of ICU experience.

Moonlighting:
Moonlighting is allowed by fellows as long as it does not violate the 80 hour work week rule (see
moonlighting section above).

Funds for Research:
$5000 is provided to each fellow to use for research/scholarly activity expenses during the three year
fellowship. Any equipment or materials purchased with UNM funds remains UNM property at the
conclusion of the fellowship.

Funds for Professional Development:
Each fellow will receive $2000 per academic year for all professional development related expenses,
including travel expenses, membership fees, educational material, professional supplies, etc. Please see
the recommended book list below. Any equipment or materials purchased with UNM funds remains UNM
property at the conclusion of the fellowship.

Sick Leave, Annual Leave and Professional Leave:
Each fellow receives 21 annual leave, 21 sick leave days, and approximately 14 professional leave days
annually. You must complete and submit annual & professional leave request form to the Program
Coordinator, who will get the appropriate signatures, BEFORE the requested time off. Sick leave forms
are completed the next time you are in. Leave days do not rollover, so you must use them before the end
of the academic year. Professional leave days are to be used for conference attendance, outreach
presentations, any interviews for post-fellowship positions, etc.

Important People:
Neonatology Faculty:
Renate Savich - Fellowship Program Director - Office 272-6855; pager 951-1224; mobile 400-8174; home
823-1774

Vlad Ianus - Assistant Fellowship Program Director – Is also in charge of ventilator education and is the
respiratory therapy liaison. Office 272-0902; pager 951-1225; mobile 401--1225

Janell Fuller - Neonatology Interim Division Chief and Medical Director of NBICU and Transport - Call her
with any questions about how any part of the nursery is run. Office 272-6409; pgr 951-1223

Becca Moran - Medical Director of the Palliative Care Program and Special Delivery Program - Call her
with any questions about palliative care or those really hard cases. Office 272-8602; pgr 951-1282

Jenn Rael – Website Liaison - Office 272-1098; pgr 951-1200

Erika Fernandez – Medical Director of Outreach Education – the fellows will have opportunities to give
talks throughout the state on neonatal topics of interest to the medical community. Office 272-5981; pgr
951-1222

                                                                                                           15
                                  Neonatal Fellowship Handbook


Andi Duncan - Fellow-NNP Liaison - if you have any questions about NNP role or specific issues with any
practitioner, go to Andi. Really. Don’t wait. Office 272-0901; pgr 951-0121

Robin Ohls – Medical Director of Pediatric Research – Good resource for research. Office 272-6410; pgr
951-1221

Carlos Ramos – Research labs – Office 272-6669; pgr 951-1271

Tara Dupont – Assistant professor – Office 955-4080; pgr 951-

Krisit Watterberg – Former Division chief of Neonatology – Office 272-6141; pgr 951-1228

Other Neonatology Folks:
– Fellowship Coordinator - is the gate keeper…all schedule/call issues and changes go through her
initially and she can point you in the right direction with any questions you might have. Handles anything
related to fellowship. Will order any and all items, equipment, etc. Will book all travel and handle
registration and reimbursement. Monitors research and professional development balances. Office 272-
8955

Ann-Marie Yaroslaski – NICU dietician - she has the answers for any TPN/nutrition questions or issues.
See her the first day to get your TPN/nutrition guidelines. pgr 951-3371

John Arthur – Database Administrator - He controls daily baby (office 2-8618; pgr 951-1267) Daily Baby
will be going away December 2011

MFM Fellow – the MFM fellow on call is listed on the board in L & D, along with Attendings, etc

Kay Davis – Neonatology Program Manager – Keep of the money! Office 272-0972

Darlene Gonzales - Neonatology Account tech – Office 955-7627

Ann Chavez – Admin supervisor – Office 272-8609

Charge Nurse Phone: 410-6606




                                                                                                       16
                                   Neonatal Fellowship Handbook

IV. Research Expectations
Competencies in Research:
Each year the fellows will attend the Fellows Fundamentals in Research Seminar Series, which includes
topics in statistics, research design, IRB, ethics, preparing abstracts, presentations, manuscripts, writing
grants, and other topics (see Research Seminar Series Curriculum). A research project and mentor will
be selected during the first year and research will be completed over the three years of fellowship. The
Scholarship Oversight Committee will meet with each fellow 1-2 times per year to monitor progress in the
research endeavors.
 ST
1 YEAR:
Research
The first year fellow is expected to select a research mentor in an area of research that is relevant to
Neonatal-Perinatal medicine, to develop a hypothesis and research protocol, and to begin the process of
data collection.

Each fellow chooses a Research Mentor with the help of the Program Director. The mentor does not
need to be in the Division of Neonatology. The Program Director and mentor assist the fellow in selecting
a project and their Scholarship Oversight Committee (SOC) members. The Program Director monitors
the Scholarship Oversight Committee (SOC), which has at least 3 members: two members from the
Division of Neonatal-Perinatal Medicine and one member outside of the Division of Neonatal-Perinatal
Medicine. The mentor is expected to attend each committee meeting. The SOC meets once per year of
the fellowship. The meeting is arranged by the fellow in conjunction with his/her mentor and with the
assistance of the fellowship coordinator.

The fellow presents his/her research area, a review of the literature, and his/her overall plan for the
research project to the SOC towards the end of the first year of training. Any data obtained to that point is
presented; the presentation and any other materials must be distributed to the SOC members a minimum
of one week prior to the review meeting. The SOC members will discuss the research plan and make
recommendations for his/her review of the literature, revisions to the protocol, and provide suggestions for
future directions.
 nd
2 YEAR:
Research
The second year fellow is expected to continue on his/her research endeavors begun during the first year.
In addition, it is expected by the second year that they have enough data to submit abstracts to regional
and national meetings; the second year fellow is expected to attend national conferences to present their
research. Research funds can be utilized for this travel and related expenses.
                             nd
At the SOC meeting in the 2 year, the fellow presents data that he/she has collected. It is reviewed by
the SOC and suggestions for new directions are made.
 rd
3 YEAR:
Research
The third year fellow is expected to have his/her research project completed, present their data at national
meetings, and submit a completed manuscript to a peer-reviewed journal.
                              rd
At the SOC meeting in the 3 year, the fellow presents the most current data collected and reports on
presentations he/she has made since the last SOC meeting and reports on his/her progress in writing
their manuscript(s). Suggestions for his/her manuscripts are made by the Scholarship Oversight
Committee.

Below is the general Fellowship Curriculum, including the Fellows Fundamentals in Research Seminar
Series. It is a requirement for fellows and must be completed by their final year. The curriculum includes:

            o   Biostatistics
            o   Clinical and laboratory research methodology
            o   Study design

                                                                                                          17
                                 Neonatal Fellowship Handbook

           o   Preparation of applications for funding and/or approval of clinical research protocols,
           o   Critical literature review
           o   Principles of evidence-based medicine
           o   Ethical principles involving clinical research
           o   Achievement of proficiency in teaching for all subspecialty fellows
           o   Principles of adult learning
           o   Curriculum development
           o   Delivery of information
           o   Provision of feedback to learners
           o   Assessment of educational outcomes
           o   Conferences dealing with complications and death
           o   Scientific, ethical, and legal implications of confidentiality and of informed consent
           o   Bioethics including attention to physician-patient, physician-family, physician-
               physician/allied health professional, and physician-society relationships
           o   Economics of health care and current health care management issues, such as cost-
               effective patient care, practice management, preventive care, quality improvement,
               resource allocation, and clinical outcomes
           o   Prevention of medical errors

Overall Research Goals and Objectives by Competency
   1. Knowledge
           The fellow should demonstrate an understanding of the concepts involved in the topic studied
              o Is able to describe the concepts involved with their area of study
              o Understands how their project is important to the topic under study

           Competent in Data Analysis
              o Defines key statistical concepts
              o Identifies and performs an appropriate statistical analysis of data collected
              o Demonstrates the ability to interpret information
              o Develops a conclusion and speculation based upon data gathered during research

           Lab Bench Abilities (if applicable)
               o Ability to use basic lab equipment appropriately

   2. Communication
         Disseminates results of research completed
             o Abstracts written: ___
             o Clearly written papers: ___
             o Invited scientific presentations:
             o Type of presentation:          platform or poster

   3. Professionalism
         Punctual and regularly present in lab
             o Diligent in completing projects or stages of work

           Works well with the Laboratory staff
              o Ensures that common work areas are returned to original state when finished using
                  them
              o Shares common Equipment and common resources

           Demonstrates commitment to ethical principles
              o Works within the approval of IACUC or IRB
              o Sensitive to laboratory animals if applicable

           Uses feedback to identify areas for improvement
              o Welcomes feedback
              o Uses feedback as a way to improve their skills as a physician researcher


                                                                                                    18
                              Neonatal Fellowship Handbook

4. Practice-Based Learning and Improvement
      Locates, appraises, and assimilates evidence from the scientific literature related to research
      topic of interest
           o Able to critically review a paper to decide if conclusions are justifiable
           o Able to analyze a body of literature

        Facilitates the learning of students and other health care professionals
            o Discusses with students, research staff, peers, and attending staff new ideas or
                 approaches to studies being performed in a way that is conducive to learning
            o Teaches skills to others that support life-long learning – lab bench techniques,
                 computer skills, research and statistical methodology, etc

        Uses information technology, peer review, and self-assessment to promote life-long learning
           o Able to search the medical literature electronically about area of interest
           o Identifies weaknesses in his/her knowledge database and supplements his/her
                reading in the area.

5. Systems Based Practice
      Demonstrates commitment to the practice of cost-effective research
         o Performs studies after thorough understanding of procedures and attempts to
             minimize waste of reagents

        Identifies and works with other health researchers, disciplines and organizations
            o Seeks out investigators doing similar work for scientific discourse




                                                                                                  19
                                   Neonatal Fellowship Handbook

Admission Criteria:

To Newborn Nursery:
   o 36 weeks gestation
   o 2000 grams unless > 36 weeks (SGA, IUGR)
   o Stable infant without signs of respiratory distress. Infants who are grunting, flaring, and
      retracting, or who are cyanotic will be transitioned in NBICU.
   o Infant without any serious anomalies.
   o Infant of a diabetic mother greater than 37 weeks and maintaining a blood sugar of 45 or greater.

To Observation and ICN 3 Nursery:
There are 4 observation beds and 8 level II beds.

ADMISSIONS
Observation beds:
To be used for a maximum of 6 hours immediately post-partum (i.e. time of birth) for evaluation and
stabilization until status is determined. Eligible infants would be any infant with maternal or infant risk
factors, unless the infant is sick enough to require direct admission to the NBICU. Once status of clinical
condition is determined the infant will be triaged to the appropriate unit for admission: Mother-Baby unit
                                                                 th
(MBU), Newborn Intensive Care Unit (NBICU), ICN 4 (on the 4 floor with NBICU), or ICN 3 (on the third
floor, the new nursery).

Patient population for observation beds:
           a. All infants should be 35 weeks or greater by first trimester ultrasound (up to 16-18 weeks)
               or Ballard Exam if no ultrasound is available and have a birth weight of at least 1800
               grams—any infant with an earlier gestation or weight less than 1800 grams should
               be a direct admission to the NBICU. Only those infants who are 36 weeks or greater
               and with a birth weight > 2 kg will be candidates to go to the MBU. The 35 week infants
               will be admitted to ICN3, ICN4, or NBICU.
           b. Infants of Diabetic Mothers (IDM) who fall into the below listed categories to monitor initial
               glycemic regulation:
                      i. Macrosomic GDMA1 infants
                     ii. GDMA2 or higher classification infants
               GDAM1 infants who are AGA will go to the MBU.
               Infants should be brought to the transitional area from L&D within 45 minutes of
               birth.
           c. All infants with mild respiratory distress that have the potential for a successful transition.

Not anticipated to be primary area for:
    o premature infants <35 weeks gestation
    o infants less than 1800 grams at birth
    o infants with potentially life threatening cardiac anomalies
    o infants with life threatening anomalies requiring stabilization and evaluation (such as a newborn
        with Trisomy 18 without a prenatal palliative care plan)
Not anticipated to be primary location for invasive procedures such as partial exchange transfusion (less
invasive procedures, such as lumbar punctures, may be performed in this nursery).

Level II Beds:
ALL POTENTIAL ADMISSIONS/TRANSFERS NEED TO BE DISCUSSED AND ACCEPTED BY THE
ATTENDING IN THE ICN3 PRIOR TO THEIR TRANSFER.

The Level II nursery beds will be for babies who need a higher level of care than mother/baby unit can
provide and for those who need to stay after their mother is discharged from the hospital. This unit can
also care for the well, late preterm infant who is ineligible to be placed in the Mother-Baby Unit.
Depending on the census in the ICN4 and the census in the ICN3 special care nursery, we can also move
some ICN4 patients to the ICN3 unit, to increase the availability of Level III beds in the NICU. These
beds will not be used for chronic infants—i.e., short gut infants, chronic lung disease infants > 2 weeks of
age, etc.
                                                                                                          20
                                  Neonatal Fellowship Handbook

Patient population of level II beds:
        In summary the Level II nursery beds will be occupied by four different categories of infants:

        1) infants who need to stay after their mother is discharged from the hospital:
            d. All infants who are stable and initially admitted to the MBU but need to stay longer than
                48 hours (or after mother is discharged)—to include all of the following but not exclusive
                to:
                       i. Continuing care of infants who require a septic workup and need antibiotics for
                          longer than 48 hours or length of maternal stay
                      ii. Continuing care of infants with hyperbilirubinemia
                     iii. Continuing care of IDM whose glucose regulation is stable but continue to be
                          poor feeders
                     iv. Continuing care of near term infant (36-37 weeks gestation) who are poor
                          feeders
                      v. Continuing care of infants going through drug withdrawal if not a candidate for a
                          Carrie Tingley bed
                     vi. Continuing care of infants with clefts or other congenital anomalies with poor
                          feeding
                    vii. Continuing care of infants requiring further work-up/studies (VCUGs, MRIs, etc.)
                    viii. Continuing care of infants with social problems (teen mothers, infants awaiting
                          CYFD placement, infants being adopted, infants on hospice whose families are
                          preparing to take home, etc.)

        2) infants who need a higher level of care than mother/baby unit can provide:
            a. Includes any infant who is 35 weeks gestation or older who is stable and weighs >1800
                grams at birth. These infants would be those infants initially transitioned in one of the 4
                observation beds, and then directly admitted. Any infant who has a continuing
                oxygen requirement at the end of the 6 hours of transition should be admitted to
                NBICU for diagnosis and work-up. These infants would be eligible to return to
                ICN3        after       24      hours       if       stable     on       nasal     cannula.
                Infants admitted to this area include all of the following but not exclusive to:
                       i. Mild IDM with the need for dextrose infusion via PIV for glucose control. Infants
                          needing a central line for higher glucose infusion rates (requiring D12.5 or
                          higher) will need to go the NBICU.
                      ii. Late preterm infants (35 weeks or older) who are stable and in room air, weigh
                          at least 1800 grams at birth, but need to learn to nipple feed and gain weight
                     iii. Care of infants going through drug withdrawal who need to be monitored

        3) stable preterm infants who are transferred from the NBICU/ICN:
            a. Includes any stable ex-premature infant who is less than 14 days of age, who is at least
                34 weeks corrected gestational age and > 1500 grams, who is stable in RA or ¼ liter
                NC or less, and learning to nipple feed. These infants will be stabilized and monitored in
                     th
                the 4 floor NBICU/ICN for a minimum of 36-48 hours prior to being eligible for transfer
                to ICN3.

        4) infants who are readmitted for hyperbilirubinemia.


        Infants admitted or transferred into this unit may require peripheral IV lines and PICCs. Infants
        may require administration of IV fluids and medications. Infants may require nasogastric tube
        feedings.

        This unit will not have infants requiring umbilical catheters or surgically placed central lines.
        Invasive procedures (i.e. exchange transfusions) will not occur in this unit. Umbilical line
        placement and intubation may need to occur in this unit in emergent situations with NBICU back-
        up/assistance with the infant transferred to the NBICU once stable for transport. Less invasive
        procedures can be done here, i.e. lumbar puncture.

                                                                                                         21
                                  Neonatal Fellowship Handbook


        These beds will not be used for chronic infants—i.e., short gut infants, chronic lung disease
        infants > 2 weeks of age, etc.


MEDICAL DIRECTOR AND PROGRAMMATIC OVERSITE
The medical director for this unit will be jointly under General Pediatrics and Family and Community
Medicine.

The programmatic oversite of the physicians and residents will be coordinated through ? (Pediatrics) and
Larry Leeman (Family Practice) with consultation from Neonatology as needed. Overall, it will be a
collaborative effort between Pediatrics, Family Practice and Neonatology.

STAFFING
Nurses
Nurses for this unit will be staffed from the Special Care Nurseries ICN4. Policies and procedures for
nursing must therefore be compatible with those in the ICN4.

Medical Providers
Medical attending coverage for this unit is currently planned to be provided by a core group from general
pediatrics and family practice, and rarely neonatology with the majority provided by general pediatrics and
family practice. MCH fellows will also cover, with their respective Attendings as back-up. Neonatology
will be on consult as needed.

Resident Coverage
Upper level pediatric and family practice residents will be staffing the unit. This should provide an
excellent nursery experience, especially those planning to practice in the community. The goal is to give
residents experience with those infants that are increasingly being kept in the community.

Night coverage:
The three NBICU individuals currently on call to cover the NBICU, Labor and Delivery, and MBU will also
to cover this additional unit, with its increased number of patients. We have an additional person
(practitioner) to have a total of three at night to cover the ICN3 as well as the NBICU, ICN4, L&D, and
MBU.


 Suggested book list for fellows:
                                            th
 Neonatology: Management, procedures, 6 Edition
 Atlas of Procedures in Neonatology
 How to Read Pediatric EEG’s
 Neonatology Review
 Workbook in Practical Neonatology
 Neonatal Physiology
 Neonatal Infectious Diseases
 Maternal, Fetal & Neonatal Physiology
 Smith’s Recognizable Patterns of Human Malformation
 Rudolph’s Brief Atlas of the Newborn
 Diseases of the Newborn
 Pathophysiology & Management of the Newborn
 Pediatric Heart Surgery: A ready reference pocket size
 Fanaroff & Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus & Infant
 Harriet Lane Handbook
 Neonatal Secrets

Rev. June 30, 2011
Renate Savich, MD.

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