Valley NICU – 5 Minute Curriculum
Rotation Director: Sudha Rani Narasimhan, M.D. email: SudhaRani.Narasimhan@hhs.sccgov.org
Associate Director: Monica Stemmle, M.D.
email: Monica.Stemmle@hhs.sccgov.org
Administrators: Evelyn DeLosReyes phone: 408-885-5420
NICU - 408-885-6428
Key Rotation Issues:
 Orientation: 1-3pm on 1st day includes orientation to del room, equipment, documentation, nutrition, lactation, nursing
expectations, discharge planning, and resources.
 Team: 2 NICU teams, divided evenly
o Cardinal Team: med student, junior, senior, attending; Attendings rotate q2 weeks.
o Shark Team: NNP, Attending +/- 2nd NNP or hospitalist
 Distribution: patients will be distributed evenly amongst junior and senior with the senior taking the sicker patients, cap for the
team is 15 patients. Admissions alternate between teams with one team being the admitting team for each day.
o Patients admitted to NICU on Resident Call Nights remain on resident team. Attendings will redistribute patients on
Monday mornings following a resident “golden weekend”.
 Nights: Attending always on call in house with resident and home call attending available to come in for specific situations.
o Residents should take this opportunity to function independently, knowing that an attending is available for back-up.
o Clarify each night how the attending wants to be called and expectations for night.
o “Midnight Rounds” –start at 1130 goal to be made aware of any updates/overnight issues. A complete systems
approach is not usually necessary for stable infants but may be useful for complex patients.
 Sign-out: 5pm daily, at bedside for sick neonates
 Post-call days: Residents to pre-round on their patients post-call on weekdays, and on all patients on the team on weekends.
Exceptions would be if there are complicated admissions early in the morning.
 Feedback/Evaluation:
 Group evaluation from Attendings in Medhub; RN’s have option of participating and their comments are included in the
Group eval. Medhub peer evals also issued.
 Seek feedback several times during the rotation, but no less than every Friday. Please set a time with the attending to sit
down and discuss the rotation.
 Senior resident expected to provide feedback to medical student and junior and visa versa.
Prior to 1st Shift:
 All residents should be NRP certified prior to this rotation.
 Review specific roles/responsibilities – see end of document
Unique Expectations:
 Deliveries: NNP covers deliveries during rounds, 8:30am -11am. M-F; rounds may need to be interrupted if there are
multiple deliveries. Residents should attend ALL other deliveries. occasionally break rounds for multiple deliveries.
o Junior must be supervised by Senior, NNP, Hospitalist or Attending
o Junior writes note after all deliveries
Weekly Schedule
Time
Monday
Tuesday
Wednesday
Thursday
Friday
Pre-rounds
Pre-rounds
Pre-rounds
Pre-rounds
Pre-rounds
0600-0800
Grand Rounds
0815-0930
Rounds
Rounds
Rounds
Rounds
Rounds
0830-1100
1030-1130
Clinical Roundsdiscuss all pts
admitted/discharged
within week.
Radiology
RoundsRadiology Rounds1130-1200
NICU Conf rm
NICU conf rm
Patient Care
Patient Care
Patient Care
Patient Care
Patient Care
1100-1200
Noon Conference
Patient Care
Noon Conference
Patient Care
Sign-out/evening
Sign-out/evening
rounds
rounds
*Residents must participate at least once during block
Sign-out/evening
rounds
1200-1300
1300-1700
1700
Updated 9-19-11
Noon Conference
Patient Care
Noon Conference
1330-1530
Multidisciplinary
Rounds*
Sign-out/evening
rounds
Noon Conference
Patient Care
Sign-out/evening
rounds
Valley NICU – 5 Minute Curriculum
WHAT YOU SHOULD LEARN:
Physical Exam & Procedures
 JUNIORS: recertify NRP. Discuss plan with Glenn Desandre, MD and Lynn Showalter, RN on day 1 rotation.
o Take the NRP certification test on the AAP website (http://www.aap.org/nrp/nrpmain.html) prior to starting the
rotation. Lynn or one of the other faculty members will observe your resuscitation skills during a delivery, thus
performing the clinical check-off required for certification.
Know indications, contraindications, complications for each.
 PIV
 Umbilical Lines
 ET intubation
 CPAP
 Bag-valve mask ventilation
 Neonatal resuscitation, including set-up
 Chest Tube
Newborn Exam including pathology associated with:
 Abnormal prenatal labs (e.g., HSV lesions, h/o HSV, unknown maternal labs)
 Maternal drug use (e.g., tobacco, ETOH)
 Maternal medications (e.g., insulin)
 Maternal conditions (e.g. diabetes)
Clinical Decision Making & Communication
 Recognize early signs of distress in the delivery room and support transition (differential for tachypnea in early neonatal
period, appropriate glycemic range and respond to abnormalities, normal temperature range)
 Review maternal charts in delivery room and extract information needed to prepare for resuscitation (GBS status,
medications in pregnancy or labor, ROM, amniotic fluid character, fetal heart tracing, etc)
 Lead a Smart Set Resuscitation or simulation
 Perform Prenatal Consultation (counsel on expected outcomes, implications of prematurity, document consultation
appropriately) -Senior
 Counsel families on risks and benefits of blood transfusion
Medical Knowledge:
 Delivery: List indications for attendance and how common conditions impact delivery, including prolonged ROM,
premature ROM, C-Section, Meconium-stained fluid, blood loss, diabetic mother, non-reassuring fetal heart tones, twins,
macrosomia, congenital defect, shoulder dystocia, floppy infant)
 Unique delivery room resuscitation aspects for VLBW (maintain euthermia, early CPAP)
 Late Preterm Infant Management (including fluid, nutrition, electrolyte requirements, hyperbilirubinemia)
 Epidemiology of Birth Defects
 Define Major and Minor birth defects and indications for Genetics Consult
 Watch lactation videos and understand impact of hospitalization on breastfeeding
 Preterm infants less than 34 weeks (management and complications including fluid management – rate/type, PDA, RDS,
ROP, IVH)
 ROP – pathophysiology, screening guidelines, grading system, risk reduction, and long term implications
 PDA – signs, symptoms (characteristics of murmur, wide pulse pressure)
 IVH – grading system, contributing factors, short and long term survivability
 NEC – clinical signs (including feeding intolerance, abdominal distension, vital sign instability, radiographic findings),
pathophysiology and management
 RDS – definition, risk factors, management
Updated 9-19-11
Valley NICU – 5 Minute Curriculum
Resident Roles and Responsibilities
Junior Resident
 Please arrive in the morning with time to pre-round on existing patients and any new admissions, no earlier than 6am. Prerounding should include: A review of the nursing flow sheet, an update on status from the bedside nurse, an examination of
the patient, and review laboratory data and x-ray information.
 Medical Charting: A daily progress note should be written on each patient PRIOR to rounds.
Please include subjective and objective information in a hand written note. The ASSESSMENT and PLAN portion of the
note should be written to the best of the residents’ ability and completed after rounds of each individual patient.
 Presentation: Presentations on rounds should be problem-oriented and an attempt should be made for an A/P prior to
rounds. The final plan can be completed after discussion at the bedside with the team. With time and experience you will be
able to form an essentially complete assessment and construct a plan for your patients.
 Patient Load: Approximately 1/2 of the patients on resident team are to be rounded upon by the junior resident physician.
The maximum number of patients on the resident team is to be approximately 15, but may temporarily exceed this number
before redistribution with the NNP team. Of note, the senior resident will have priority for acuity and patient delegation
based on individual experiences.
Senior Resident
 Please arrive in the morning with time to pre-round on existing patients and any new admissions, no earlier than 6am. Prerounding should include: A review of the nursing flow sheet, an update on status from the bedside nurse, an examination of
the patient, and review laboratory data and x-ray information.
 Medical Charting: A daily progress note should be written on each patient PRIOR to rounds.
Please include subjective and objective information in a hand written note. The ASSESSMENT and PLAN portion of the
note should be written to the best of the residents’ ability and completed after rounds of each individual patient.
 Presentation: Presentations on rounds should be problem-oriented and include an assessment and plan. Utilization of flow
sheets and labs sheets during presentation is encouraged to save time and avoid “rewriting”.
 Patient Load: The senior resident will be responsible for approximately 1/2 of patients on resident team. Again, the
maximum number of patients on the resident team is to be approximately 15, but may temporarily exceed this number before
redistribution with the NNP team. The senior will be expected during the first two weeks of their rotation to have carried a
certain number of patients with a variety of disease processes. See neonatology curriculum below.
 Additional: The senior will also be expected to have accomplished several procedural skills, if the opportunity is present. In
addition, the senior resident will have experience performing a prenatal consult and leading a family conference. After the
initial 2 weeks, the senior resident will meet with the attending and review goals and expectations.
Joint Responsibilities
 Admissions: A detailed history and physical exam performed and documented in chart under history and physical. An H&P
need only be completed by one resident physician. Please include patient’s weight, length, OFC and vital signs. A Ballard
exam must be performed and recorded on the form available for each patient. A pre-printed admission order form is
available for admission orders. Antibiotics and Radiographs/imaging must be ordered on separate individual forms.
 TPN-Total Parenteral Nutrition- These orders are available on preprinted forms and should be written daily on rounds or
after rounds
 Orders- Standard Order Sheet- written any time.
 Medication Re-Writes: Medications are reviewed weekly and rewritten as an order. This is a chance to review current list
of medications and adjust dosing according to growth if appropriate. The medication re-write day is typically the day of the
week the patient was admitted. Look at the ID card on the patient’s bed for the day of the week, or more directly, inquire
with the bedside nurse.
 Discharge Summaries: Discharges at VMC are very involved and often time consuming. It helps to be prepared and fill out
some of the paperwork several days in advance if possible. A standard discharge form is to be filled out in detail. All
referral appointments should be listed in this summary, such as Ophthalmology, Synagis, Neurology, Cardiology, lactation,
etc. and of course the primary care Pediatrician. Please include newborn screen results, hearing exam results, critical
congenital heart disease screening and any immunizations received. Document the discharge weight. Please notify the
Pediatrician by telephone of all discharges and follow-up. Fax the discharge summary if the PMD requests this service.
Please try to dictate discharge summary the day of discharge but no later than 1 day after discharge.
 Discharge Orders: There is a standard discharge order form available, and this serves as the actual discharge order. It is to
include all discharge appointments that need to be made by clerk.
 Synagis Clinic: Discharge appointments should include an appointment for the SCVMC Synagis Clinic for eligible patients.
 Discharge Medications: Discharge medications are to be ordered by the resident physicians 1-2 days prior to discharge. A
preprinted form is to be used for this purpose. Discharge medications can take some time to prepare, so please be sure to
order ahead of time, as this can delay discharge.
Updated 9-19-11
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Valley NICU – 5 Minute Curriculum
PMD Contact: Every effort should be made to contact the PMD or primary health care provider for infants who are to be
discharged to home and have had an extended stay in the NICU or have had a complex course. Whenever in doubt regarding
whom to contact, please inquire with the attending physician on service.
Off Service Summaries: When a resident rotates off-service a detailed dictated note must be placed in chart for all patients
that intern/resident is covering. Recently admitted patients do not need an off service note provided the progress notes are
detailed and explain the patient’s status and plan.
Nightly Sign Out Sheets: A brief identification, description of active on going issues and to do list for the on call person.
This sheet is kept current by residents on the computer station at the front desk and should be printed out for the 5pm sign out
rounds. This does not go in the medical chart. Please dispose of these papers properly in the shredding bin and do not leave
lying around.
ROUNDING RESPONSIBLITIES


Weekdays: If a resident is not post-call, then they should pre-round and write notes on all of their patients. If their coresident is post-call, they may also need to present some of the patients/notes for their co-resident on rounds. If a resident is
post-call, they should pre-round on all of their patients, discuss any patients with their co-resident and the oncoming
hospitalist at 8am. They should join rounds at 8:30am to present any new admissions or present any patients with active
issues overnight with goal to leave at ~ 9am.
Weekends: If a resident is on-call or post-call, they should pre-round and write notes on all the patients on the resident team.
They should stay to provide presentations on new admission or active patients overnight with the goal to leave at ~9am.
Updated 9-19-11