Sick and premature infants are evaluated, examined, and under the close supervision of attendings and fellows, therapeutic and diagnostic management plans are formulated.
During this rotation, you will assume increasing responsibility for the care of sick and premature infants and are primarily responsible for the care of all patients. There are full-time attending neonatologists who round daily with the house staff. There are also neonatal fellows involved with neonatal care and who are available to assist in the care of sick neonates.
You will be the first one to evaluate the presenting neonate. Abnormal physical findings, complications and therapeutic implications are discussed in depth. The input of the perinatal staff and neonatal nurse practitioners is sought. Discussions with parents about prognosis and anticipatory guidance is encouraged and guided by the attendings.
Common diagnoses or problems seen during this rotation are:
- congenital malformations
- chronic lung disease
- hypoxic ischemic encephalopathy
By the end of the first rotation you will be expected to be able to:
- extract from the perinatal record relevant information to develop a differential diagnosis and initiate a plan of management for sick newborns
- detect major functional and morphologic abnormalities based upon physical examination of the newborn
- understand and apply the general principles of nutritional and thermal requirements of newborn infants
- interpret microbiological, biochemical, hematological and pharmacological lab values in the monitoring and management of the newborn patient
- participate in the delivery room resuscitation of high-risk newborns following AAP/AHA Neonatal Resuscitation Program Guidelines
- demonstrate knowledge of the indications and complications of common neonatal procedures including umbilical catheterization, peripheral arterial sampling, percutaneous central venous lines, needle thoracenthesis, endotracheal intubation and achieve some success at umbilical venous catheter and peripheral IV insertion
At the end of the second rotation, you should, in addition to the previous achievements, be able to:
- communicate the pertinent positive and negative historical information to support an assessment or differential diagnosis and communicate this evaluation and plan as appropriate to the neonatal health care team, the parents and the primary care physician
- elicit the pertinent physical and laboratory findings that pertain to the assessment of differential diagnosis
- initiate appropriate management regimen for newborn patients with the common disorders of the respiratory, cardiovascular, metabolic and nervous systems
- interpret blood gas results and routine chest and abdominal x-rays to initiate appropriate changes in patient management
- provide initial delivery room resuscitation of high-risk newborns, including bag mask ventilation and management of the meconium stained amniotic fluid delivery
- successfully place peripheral IV’s and umbilical venous catheters, obtain peripheral arterial blood samples, and gain experience in placement of umbilical arterial catheters, needle thoracocentesis and endotracheal intubation
- independently evaluate the sick newborn infant to develop and implement an appropriate plan of care
- efficiently and effectively utilize time in focused patient care evaluation, documentation and communication
- analyze complex information, evaluate response to initial support management and develop procedures for altering the plan of care in a broad range of acutely ill neonatal patients
- appropriately monitor the plan of care to assure appropriate utilization of resources and response to intervention
- manage the cardiopulmonary resuscitation of the newborn infant in the delivery room including endotracheal intubation, vascular access, emergency medications, needle thoracocentesis and external cardiac massage
- successfully place umbilical artery catheters and participate in chest tube placement for tension pneumothorax
- provide for the initial resuscitation and stabilization of high-risk newborns
- recognize and determine which neonatal patient can be effectively managed based upon the neonatal care services available and provide for timely initiation of referral
- become knowledgeable in the appropriate post-discharge follow-up and care needs of the high-risk neonatal patient and family
- provide leadership, direction and teaching to junior members of the health care team in a constructive and academic manner
- utilize the various pediatric medical, surgical, nursing and allied health specialists in optimizing the care for the patient and family
- improve knowledge and care through independent review of the medical literature and apply this knowledge to patient care
Patient care rounds occur daily (seven days) with the neonatal attending and fellow. Patients are presented and discussed in detail. Other members of rounds can include a nutritionist, clinical pharmacist, respiratory therapist and neonatal nurse practitioner.
These are made every day with assigned attendings and formal presentations done ad hoc.
Topics relating directly to the potential problems or complications of premature infants are discussed weekly, and on an ad hoc basis daily.
About 10 patients per day.