St. Barnabas Hospital/Pediatric Residency Program
Neonatal Intensive Care Rotation
Competency-Based PL-1, 2, 3 Goals and Objectives
COMPETENCY 1. Patient Care. Provide family centered patient care that is developmentally
and age appropriate, compassionate, and effective for the treatment of health problems and the
promotion of health.
1) Learn to initiate basic resuscitation independently and to perform as a team during the
management of a depressed newborn following delivery and during an acute arrest.
(PL-1)
2) Demonstrate the capability to manage initial stabilization, laryngeal suction and bag and
mask ventilation of the depressed infant independently. (PL-2)
3) Demonstrate the capability of managing the complete resuscitation of a severely
depressed infant independently. (PL-2)
4) Demonstrate the capability of managing the complete resuscitation of a severely
depressed infant independently. (PL-3)
5) Explain and perform steps in resuscitation and stabilization, particularly airway
management, vascular access, volume resuscitation, indications for and techniques of
chest compressions, resuscitative pharmacology, and management of meconium
deliveries. (PL-1,2,3)
6) Learn to recognize indications of acute distress or impending serious clinical
deterioration necessitating immediate intervention. (PL-1)
7) Function appropriately in codes and neonatal resuscitations as part of the NICU team by:
a) Participating in resuscitations.
b) Completing Neonatal Resuscitation Program (NRP).
c) Using neonatal resuscitation drugs appropriately.
(PL-1,2,3)
8) Learn to develop and record a complete history and physical examination for a high-risk
newborn infant. (PL-1)
9) Learn and demonstrate appropriate documentation of the clinical course and plan of care
of assigned infants, including completion of a discharge summary. (PL-1)
10) Demonstrate the capability of completing the admission evaluation of an acutely ill infant
independently. (PL2,3)
11) Evaluate and manage patients, under the supervision of a neonatologist, with the signs
and symptoms that present commonly in the NICU: (PL-1,2,3)
a) General: Feeding problems, history of maternal infection or exposure,
hyperthermia, hypothermia, intrauterine growth failure, irritability, jitteriness,
large for gestational age, lethargy, poor post-natal weight gain, prematurity
(various gestational ages).
b) Cardiorespiratory: Apnea, bradycardia, cyanosis, dehydration, heart murmur,
hypertension, hypotension, hypovolemia, poor pulses, respiratory distress (flaring,
grunting, tachypnea), shock.
c) GI/surgical: abdominal mass, bloody stools, diarrhea, distended abdomen, failure
to pass stool, gastric retention or reflux, hepatosplenomegaly, vomiting.
d) Genetic/metabolic: Apparent congenital defect or dysmorphic syndrome,
metabolic derangements (glucose, calcium, acid-base, urea, amino acids, etc.).
e) Hematologic: Abnormal bleeding, anemia, jaundice in a premature or seriously
ill neonate, neutropenia, petechiae, polycythemia, thrombocytopenia.
f) Neurologic: Birth trauma related nerve damage, early signs of neurologic
impairment, hypotonia, macrocephaly, microcephaly, seizures, spina bifida.
g) Renal/urologic: Abnormal genitalia, edema, hematuria, oliguria, proteinuria,
renal mass, urinary retention.
12) Evaluate and manage patients, under the supervision the supervision of a neonatologist,
with conditions that present commonly in the NICU: (PL-1,2,3)
a) General: Congenital malformations.
b) Cardiovascular: Cardiomyopathy, congenital heart disease (cyanotic and
acyanotic-including common disorders: patent ductus arteriosus, ventricular septal
defect, tetralogy of Fallot, transposition of the great arteries, etc.), congestive
heart failure, dysrhythmias (e.g. supraventricular tachyarhythmia, complete heart
block), pericarditis.
c) Genetic, endocrine disorders: Abnormalities discovered from neonatal
screening programs as they affect the premature infant, common chromosomal
anomalies (Trisomy 13, 18, 21, Turner's), inborn errors of metabolism, infant of a
diabetic mother, infant of a mother with thyroid disease (e.g. maternal Graves
Disease), uncommon conditions such as congenital adrenal hyperplasia,
hypothyroidism, hyperthyroidism.
d) GI/nutrition: Biliary atresia, breast feeding support for mothers and infants with
special needs (high risk premature, maternal illness, multiple birth, etc.),
complications of umbilical catheterization, gastroesophageal reflux, growth
retardation, hepatitis, hyperbilirubinemia, meconium plug, necrotizing
enterocolitis, nutritional management of high risk neonates or those with special
needs (cleft lip/palate, other facial anomalies, etc.).
e) Hematologic conditions: Coagulopathy of the newborn, erythroblastosis fetalis,
hemophilia, hydrops fetalis, hyperbilirubinemia, splenomegaly.
f) Infectious disease: Central line infections, Group B Streptococcal infections,
hepatitis, herpes simplex, immunization of the premature neonate, infant of
mother with HIV, intrauterine viral infections, neonatal sepsis and meningitis,
nosocomial infections in the NICU, syphilis, ureaplasma, varicella exposure.
g) Neurologic disorders: Central apnea, CNS malformations (e.g. encephalocele,
porencephaly, holoprosencephaly), drug withdrawal, hearing loss in high risk
newborns (prevention and screening), hydrocephalus, hypoxic-ischemic
encephalopathy, intraventricular hemorrhage, retinopathy of prematurity, seizures,
spina bifida.
h) Pulmonary disorders: Atelectasis, bronchopulmonary dysplasia, meconium
aspiration, persistent pulmonary hypertension of the newborn, pneumonia,
pneumothorax, respiratory distress syndrome, transient tachypnea of the newborn.
i) Renal: Acute and chronic renal failure, hematuria, hydronephrosis, oliguria,
proteinuria.
13) Use the following evaluations that have specific application to neonatal care: (PL-1,2,3)
a) Direct and indirect Coomb's tests.
b) Cranial ultrasound for intraventricular hemorrhage.
c) Abdominal x-rays for placement of umbilical catheter.
d) Chest x-rays for endotracheal tube placement, air leak, heart size, and vascularity.
14) Order and use appropriately the following evaluations that may have specific application
to neonatal care: (PL-1,2,3)
a) CBC with differential, platelet count, RBC indices.
b) Blood chemistries: electrolytes, glucose, calcium, magnesium, phosphate.
c) Renal function tests.
d) Coagulation studies: platelets, PT/PTT, fibrinogen, fibrin split products, Ddimers, DIC screen.
e) Arterial, capillary, and venous blood gases.
f) Detection of bacterial, viral, and fungal pathogens.
g) Urinalysis.
h) CSF analysis.
i) Gram stain.
j) Toxicologic screens/drug levels.
k) Newborn screening tests.
15) Order and use appropriately imaging, radiographic, or other studies for patients in the
NICU: (PL-1,2,3)
a) Chest x-ray
b) CT scans
c) MRI
d) Electrocardiogram and echocardiogram
e) Cranial ultrasonography.
16) Use appropriately common monitoring and therapeutic techniques in the NICU:
(PL-1,2,3)
a) Physiologic monitoring of temperature, pulse, respiration, blood pressure.
b) Pulse oximetry.
c) Neonatal pain and drug withdrawal scales.
17) Use appropriately the following treatments and techniques in the neonatal intensive care
unit under the supervision of the attending neonatologist: (PL-1 with assistance of senior
resident or attending, PL2 & 3 independently)
a) Oxygen administration by hood, CPAP or assisted ventilation.
b) Endotracheal intubation.
c) Administration of surfactant therapy.
d) Positive pressure ventilation and basic ventilator management.
e) Phototherapy.
f) Umbilical arterial and venous catheterization.
g) Central hyperalimentation and parenteral nutrition.
h)
i)
j)
k)
l)
m)
Enteral nutrition.
Analgesic, sedatives and paralytics.
Blood and blood product transfusions, including exchange transfusion.
Vasoactive drugs (pressors and inotropes).
Judicious use of antibiotics.
Administration of medications specific to the needs of the newborn (e.g., Vitamin
K).
n) Arterial puncture.
o) Venous access by peripheral vein.
p) Umbilical artery and vein catheterization.
q) Chest tube placement.
18) Learn to implement the essential components of discharge planning and the transition of
care to the primary care provider. (PL-1,2,3)
19) Use appropriate resources to facilitate the transition to home of the technology dependent
neonate. (PL-1,2,3)
20) Properly assess patient and develop plan of care. Properly organize and prioritize
patient’s problems. (PL-1,2,3)
COMPETENCY 2. Medical Knowledge. Understand the scope of established and evolving
biomedical, clinical, epidemiological and social-behavioral knowledge needed by a pediatrician;
demonstrate the ability to acquire, critically interpret and apply this knowledge in patient care.
1) Know the tests commonly used by obstetricians to measure fetal well being. (PL-1,2,3)
2) Recognize potential adverse outcomes for the fetus and neonate in common prenatal and
perinatal conditions: (PL-1,2,3)
a) Fetal exposure to harmful substances (alcohol, tobacco, environmental toxins,
medications, street drugs).
b) Maternal insulin-dependent diabetes and pregnancy-induced glucose intolerance
c) Pre-eclampsia, eclampsia.
d) Chorioamnionitis.
e) Polyhydramnios.
f) Oligohydramnios.
g) Premature labor, premature ruptured membranes.
h) Fetal distress during delivery.
i) Postpartum maternal fever or infection.
j) Maternal blood group incompatibilities.
k) Maternal thrombocytopenia.
3) Demonstrate knowledge and appropriate application of knowledge to the following:
(PL-1,2,3)
a) Prematurity
b) HMD
c) Sepsis
d) Apnea
e) Hyperbilirubinemia
f) Hypoglycemia
g) BPD
h) Anemia
i) Nutrition/Growth
j) PPHN
k) Meconium Aspiration Syndrome
l) Seizures
m) Inborn Errors of Metabolism
n) ROP
o) Electrolyte Disorders
p) PDA
q) IVH
r) Drug Withdrawal
s) NAS
t) Congenital Anomalies
u) NEC
v) Perinatal Asphyxia
4) Demonstrate understanding of common diagnostic tests and imaging studies used in the
NICU by being able to: (PL-1,2,3)
a) Explain the indications for and limitations of each study.
b) Interpret the results in the context of the specific patient.
c) Discuss therapeutic options for correction of abnormalities.
5) Develop an efficient approach to finding information resources related to a specialty or
organ system (e.g., information on the web, in the literature, text books, or PDAs) to
obtain rapid information that is relevant to a presenting patient problem. (PL-1,2,3)
6) In dealing with the patients with a new or unfamiliar disorder, recognize the limitations
of one’s knowledge and commit to expanding your knowledge base in a systematic
fashion. (PL-1,2,3)
COMPETENCY 3. Interpersonal Skills and Communication. Demonstrate interpersonal
and communication skills that result in information exchange and partnering with patients, their
families and professional associates.
1) Communicate appropriately to patient’s family about patient’s condition and plan of care.
(PL-1,2,3)
2) Learn and demonstrate the basic skills of communication with parents from admission to
discharge. (PL-1)
3) Demonstrate the capability to manage communication with parents, including those who
present difficult or emotionally challenging issues, i.e. demanding, distraught, or
disinterested. (PL-2,3)
4) Communicate plan of care to other members of the health care team. (PL-1,2,3)
5) Maintain accurate, timely, and legally appropriate medical records in the critical care
setting of the NICU including clear and appropriate medical orders and daily progress
notes. (PL-1,2,3)
6) Communicate effectively with unit staff. (PL-1,2,3)
7) Communicate effectively with medical and surgical consultants. (PL-1,2,3)
8) Provide emotional, social, and culturally sensitive support to the NICU infant and family,
including those at home. (PL-1,2,3)
COMPETENCY 4. Practice-based Learning and Improvement. Demonstrate knowledge,
skills and attitudes needed for continuous self-assessment, using scientific methods and evidence
to investigate, evaluate, and improve one’s patient care practice.
1) Demonstrate incorporation of the medical literature into medical decision making and
formation of care plans. (PL-1,2,3)
2) Utilize resources such as web-based information, published peer-reviewed journal
articles, and textbooks to improve patient care practices. (PL-1,2,3)
3) Use scientific methods and evidence to investigate, evaluate, and improve one’s patient
care practice in the NICU setting. (PL-1,2,3)
4) Respond to feedback; demonstrate a willingness to learn from errors. (PL-1,2,3)
5) Identify personal learning needs, systematically organize relevant information resources
for future reference, and plan for continuing acquisition of knowledge and skills.
(PL-1,2,3)
6) Become an active educator of patients, families, students, and other health professionals.
(PL-1,2,3)
7) Recognize and initiate alternative care plans when appropriate. (PL-1,2,3)
8) Respond and adapt to systems and individual errors. (PL-1,2,3)
9) Respond to criticism and advice when warranted. (PL-1,2,3)
10) Participate in and become aware of the newest studies in neonatal intensive care targeted
to improve outcome. (PL-1,2,3)
COMPETENCY 5. Professionalism. Demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to diversity.
1) Demonstrate caring and respectful behaviors when interacting with patients, families,
staff and colleagues. Follow hospital procedures for preventing and reporting
errors/adverse effects. (PL-1,2,3)
2) Be punctual, reliable and accountable for actions and responsibilities. (PL-1,2,3)
3) Demonstrate accountability for patient care (orders, progress notes, etc.)
(PL-1,2,3)
4) Work in collaborative fashion with healthcare team and staff. (PL-1,2,3)
5) Demonstrate sensitivity to the unique situation of parents of premature or critically ill
infants, including issues related to end of life care. (PL-1,2,3)
6) Show honesty and integrity in professional duties. Follow hospital procedures for
preventing and reporting errors/adverse effects. (PL-1,2,3)
7)
8) Demonstrate sensitivity to patients and colleagues in areas such as culture, religion and
other personal traits. (PL-1,2,3)
9) Maintain patient’s/family confidentiality. (PL-1,2,3)
10) Show awareness and sensitivity to ethical issues in the NICU. (PL-1,2,3)
11) Demonstrate compassion and empathy in dealing with patients and their families.
(PL-1,2,3)
12) Use consults appropriately. (PL-1,2,3)
13) Follow hospital procedures for preventing and reporting errors/adverse effects. (PL-1,2,3)
COMPETENCY 6. Systems Based Practice. Understand how to practice quality health care
and advocate for patients within the context of the health care system.
1) Practice cost effective health care that does not negatively affect health care. (PL-1,2,3)
2) Develop knowledge of the cost of high-risk neonates, available funding mechanisms for
needy families, and understand the role of the pediatrician in limiting the cost of care.
(PL-1,2,3)
3) Develop knowledge of community health resources. (PL-1,2,3)
4) Work effectively with health care team to provide proper discharge planning (may
include Home Care). (PL-1,2,3)
5) Understand key aspects of health care systems, cost control and mechanisms for payment
in the NICU setting. (PL-1,2,3)
6) Clarify how documentation and billing/charges differ for consultations vs. referrals vs.
on-going management of children treated by neonatologists. (PL-1,2,3)
7) Recognize the limits of one’s knowledge and expertise and take steps to avoid medical
errors.(PL-1,2,3)
8) Follow hospital procedures for preventing and reporting errors/adverse effects. (PL-1,2,3)