NEONATOLOGY (EOPC)
GOALS AND OBJECTIVES
General Objectives
I.
Obtain a broad understanding of the medical problems of preterm and term infants during
the first month of life.
II.
Acquire an understanding of the prenatal care of high risk patients.
III.
Understanding neonatal pathophysiology, neonatal ethics, review of recent neonatology
articles, and the use of the Medical Library to access relevant medical literature.
Specific Objectives
I.
Be adept in neonatal resuscitation procedures and obtain certification in neonatal
resuscitation (NRP) by the end of the R-1 year.
II.
Accurately obtain a history of pregnancy and intrapartum events relevant to the newborn
and understand the unique aspects of the physical examination of the premature and
newly born full term infant, including gestational age determination and assessment and
management of LGA and SGA infants.
III.
Understand the broad medical, social, and economic consequences of prematurity,
including factors related to, or influencing, its incidence and the incidence of disorders
unique to premature infants (e.g., Bronchopulmonary Dysplasia, ROP, Apnea and
Bradycardia of Prematurity, NEC, PDA, IVH).
IV.
Understand to broad medical, social, and economic consequences of congenital defects
including factors related to, or influencing, its incidence.
V.
Be familiar with birth weight and gestational age-related neonatal and infant morbidity
and mortality statistics and comparisons of perinatal, neonatal and infant mortality rates,
regionally, nationally, and internationally.
VI.
Be competent in the assessment and management of the infant in the delivery room with
knowledge of transitional physiology (cardiopulmonary, metabolic and temperature
changes).
VII.
Demonstrate knowledge of the clinical and laboratory diagnosis, pathophysiology, and
treatment of the following disorders of premature and full term infants.
a. Recognize the clinical presentation and provide appropriate management of
emergencies presenting the first month of life respiratory distress with/without
cyanosis, cardiovascular collapse, bleeding, or life threatening neurologic
abnormalities.
b. Understand the physiology, pathophysiology, diagnosis, and treatment of acute and
chronic respiratory disorders in the premature and full term infant, including hyaline
membrane disease, apnea, meconium aspiration, persistent pulmonary hypertension,
transient tachypnea, pneumonia, pneumothorax, pulmonary interstitial emphysema,
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
diaphragmatic hernia, pleural effusions, congenital pulmonary disorders, and
bronchopulmonary dysplasia.
Infection
i.
Neonatal sepsis (bacterial, viral fungal)
ii.
Congenitally acquired infections (HIV, CMV, toxoplasmosis, syphilis,
rubella)
iii.
Localized infections (omphalitis, skin, osteomyelitis, arthritis, urinary tract)
iv.
Understand the host defense mechanisms in the newborn and premature
infant.
Hyperbilirubinemia (physiologic, hemolytic, direct)
Metabolic disorders (hypoglycemia, infant of diabetic mother, hypo- and
hypercalcemia, inborn errors of metabolism)
Gastrointestinal disorders (necrotizing enterocolitis, bowel obstruction,
gastrointestinal bleeding, abdominal wall defects).
Cardiovascular disorders (presentation of congenital heart disease in the neonatal
period – cyanotic, noncyanotic, and congestive heart failure -, congenital
cardiomyopathies, hypertension).
Hematologic disorders (neonatal coagulopathy, polycythemia, anemia
thrombocytopenia).
Renal disorders (acute renal failure, congenital malformation of the urogenital tract
including agenesis, dysgenesis, cystic disease, obstructive uropathies, exstrophy of
bladder).
Endocrine disorders (congenital hypo- and hyperthyroidism, congenital adrenogenital
syndrome, ambiguous genitalia, hypoglycemia-persistent).
Thermoregulation
Neurologic disorders (seizures, hydrocephalus, hypoxic-ischemic encephalopathy,
perinatal depression, intraventricular hemorrhage, birth trauma).
Fluid and nutritional management of the premature and full term infant especially in
the first week of life. Awareness of long term management of the chronically ill
patient who may require increased calories and/or fluid restriction. Advantages and
containdications of breast milk with availability of the lactation consultant in the
NICU.
Discharge planning for the NICU patient.
Genetics disorders and their evaluation. In particular, the recognition of the 3 most
common trisomies (21, 18, 13).
Understands indications for and appropriate use of subspecialists.
Specific Skill Objectives for EOPC
I.
Attend all deliveries that EOPC is required to attend and actively participate in L&D area
able to be team leader by end of rotation.
II.
Complete NRP.
III.
Procedure skills: intubation, UAC and UVC placement, assist or perform needle
aspiration, chest tube insertion, lumbar punctures, radial arterial puncture, bladder tap.
IV.
Present and critique an original article at Journal Club.
Expectations for Residents
I.
Maintain positive attitude.
II.
Be available for learning and educational opportunities.
III.
Take new patients assigned in a.m. check-in rounds as needed.
IV.
Evaluate all new admissions when on call.
V.
Attend EOPC rounds, even on academic afternoon, if late, notify in-house personnel.
VI.
Check out patients to Senior Resident or NNP prior to leaving for Clinic, post-call, or
Academic afternoon. Do not leave post-call in the a.m. if educational opportunity
present.
VII.
Check out with attending neonatologists prior to morning clinic.
VIII.
Dictate discharge summary of primary patient the day of or 24 hours prior to discharge.
IX.
Cover all resident patients for other resident when on-call during off-shift.
X.
Participate in Journal Club/Mortality/Morbidity rounds.
XI.
Document all procedures in Resident Procedure Book.
Other Areas to Be Evaluated
I.
Organization of thoughts and plans in the written daily notes.
II.
Proficiency in performing diagnostic and therapeutic skills with supervision.
III.
Demonstrates communication skills with the Multidisciplinary Health Care Team.
IV.
Communicates with family regarding infants’ health care needs and status.
V.
Attends neonatology teaching rounds.
VI.
Attends deliveries and participates competently as member of Resuscitation Team.
VII.
Demonstrates ability to manage patient car with supervision while on-call.
VIII.
Attend social service rounds and multidisciplinary care conferences regarding discharge
plans and conferences to share and update parents regarding medical information.