Nbn Sr Rotation
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NEWBORN NURSERY SUPERVISORY ROTATION
OVERVIEW:
This is a senior level rotation which builds upon skills previously attained on rotations in the
PAC/Newborn Nursery and NICU; the resident will have an opportunity to provide and supervise the care
for a variety of normal newborn diagnoses as well as acute newborn illnesses and the complications
thereof. During the rotation, the resident is part of a team, consisting of the newborn attendings and
Mother-Baby Unit staff and 1-2 interns or intermediate residents. Residents may also have the
opportunity to attend deliveries as part of the resuscitation team; this will be arranged on a case-by-case
basis.
Residents will provide and supervise care for newborns admitted to the Newborn Hospital Service (NHS)
in the normal newborn and Level 2 nurseries at Children’s Hospital of Illinois.
Residents will have progressive responsibility and autonomy as they advance through their training; at all
levels, they are responsible for the care of their patients throughout the newborn stay and for following
through on lab and test results, unless patient care has been officially handed off to another resident or
an attending when the resident is not on call. This includes, but is not limited to:
 Communicating effectively with patients, families, and other members of the team
 Performing age- and developmentally-appropriate H & P’s and developing a problem list, differential
diagnosis, assessment, and diagnostic/therapeutic plan
 Monitoring the patient’s response to treatment
 Coordinating outpatient care and follow-up, including transfer of care to another primary care provider
 Completing medical records thoroughly and promptly
Categorical pediatric residents complete this required one-month block rotation; combined medicinepediatric residents may choose this rotation as an elective, if desired.
Core Newborn Service Attending Physicians:
Mary Schultz, MD (nursery director)
Lisa Phillips, MD
Zohra Moeenuddin, MD
Gail Streater, MD, PhD
Teresa Lynch, MD
Jessi Hanks, MD
Bhavana Kandikattu, MD
Venkedesh Raju, MD
Bill Edwards, MD
Attendings are all available by
pager or cell phone via the
Physicians Access Line or
SmartWeb
Work Hours & Responsibilities:
Nursery: 7:00 AM** – 5:00 PM daily (**attending rounds @ 8:30-9 AM daily, except Thurs.)
Residents take call covering OSF Call Center (clinic patient phone calls) and Newborn Hospital Service
patients in the normal newborn nursery and Level 2 nursery; this is home call, not counting toward the 80hour limit. Occasionally, a patient’s condition may require coming in from home to evaluate the patient.
When this occurs, the resident must let his/her attendings know, as these hours spent in the hospital do
count toward total resident work hours.
We strictly adhere to the ACGME resident work hour rules; residents are given an average of 1 day off in
7, per ACGME guidelines; due to scheduling or resident work hour requirements, these days off may
occur during the week.
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Nbn Sr Rotation
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GENERAL GOALS (see Training Level Specific Learning Objectives, page 3):
 Competent supervision, coordination, and evaluation of care in the newborn and Level 2 nursery,
including refining examination skills and gestational age assessment
 Competence in effective communication and support with/for parents and families of the infants
 Competence in knowledge of common neonatal illnesses and their appropriate management,
including focused H & P, appropriate differential diagnosis, plan of care, and documentation of same
 Competence in recognition of those infants for whom subspecialty consultation and/or transfer to the
NICU would be appropriate, and to stabilize and treat such infants before transfer
 Competence in educating and mentoring junior residents
 Familiarity with the normal processes involved in transition to extra-uterine life, and to recognize those
infants who are not behaving normally
Common Newborn Nursery Problems / Illnesses:
 Prenatal growth / IUGR, SGA, & LGA
 Apgar scoring / Ballard-Dubowitz exam
 Infant nutrition & feeding dysfunction
 Parenteral fluids for newborns
 Lactation, including maternal medications
 Hyperbilirubinemia
 Hypoglycemia / Hypothermia
 Respiratory distress / TTN
 Lethargy
 Newborn sepsis
 Abdominal distension / NEC / GI obstruction
 GBS exposure & GBS treatment algorithm
 Circumcision
 Pain management in the newborn
 Newborn hearing & metabolic screening
 Discharge criteria for the newborn
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TORCH infections
Apnea & bradycardia
Infant of the diabetic mother
Polycythemia / anemia
Developmental dysplasia of the hip
GU anomalies
Brachial plexus injury & other orthopedic
problems
Cyanosis / congenital heart disease
Congenital anomalies / syndromes
HIV exposure
Neonatal seizures
Maternal substance abuse & neonatal
abstinence syndrome
Postpartum depression
RESOURCES:
Textbooks & Journals:
2006 Red Book
Schmitt, B. Pediatric Telephone Advice
Vaughn & McKay,
Nelson’s Textbook of Pediatrics
Pediatric Clinics of North America
Medications and Mother’s Milk
Online:
CDC website: www.cdc.gov
AAP website: www.aap.org
Pediatrics in Review:
http://pedsinreview.aappublications.org/
UpToDate: available via the SFMC library
homepage
Handouts:
PAC Newborn Packet
Newborn Reading List
PAC Sr. Resident Orientation Checklist
Your attendings, nursery staff, & other
residents:
Please ask us if you need additional references, or
have a specific question
EVALUATIONS:
Written evaluations, based on completion of the expectations listed above, are completed as a group (at
rotation’s end) by the nursery attendings for all residents on this rotation. Attendings and supervisory
residents are encouraged to provide feedback to residents on the team throughout the rotation. Residents
are encouraged to ask questions and actively participate in patient care discussions, not only to
demonstrate their abilities, but to engage in the learning process.
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Newborn Supervisory Resident
Specific Learning Objectives
Obtain a complete data base; synthesize data
in problem oriented format so that clinical
problems can be efficiently managed
Establish appropriate assessments and
differential diagnoses for clinical problems.
Compare and contrast treatment alternatives;
determine appropriate treatment for clinical
problems.
Document findings promptly, thoroughly, and
accurately
Diagnose and appropriately manage common
newborn illnesses and problems
(see list, page 2)
Establish a continuum of care, linking inpatient
and outpatient providers
Appropriately utilize consultants in the diagnosis
and management of clinical problems
Lead discussion of indications for common tests
and procedures, including newborn metabolic &
hearing screening
Demonstrate/model appropriate utilization and
interpretation of clinical tests
Primary
Competency
Domain
Teaching
Method
Evaluation
Method
PC / PBL
clinical
encounters
H&P review,
direct observation
clinical
encounters
reading list,
clinical
encounters
clinical
encounters
reading list,
clinical
encounters
clinical
encounters
clinical
encounters
reading list,
clinical
encounters
reading list,
clinical
encounters
direct observation,
feedback
didactic
discussions, direct
observation
H&P review,
direct observation
didactic
discussions, direct
observation
PC / MK
MK / PBL
PC / ISC / SBP
PC / MK
SBP
PC / SBP
MK
PC / MK
direct observation
direct observation
didactic
discussions, direct
observation
didactic
discussions, direct
observation
Demonstrate/model effective communication
clinical
direct observation,
skills with patients, parents, nursing staff,
ISC
encounters
feedback
attendings/consultants, and peers
Evaluate junior residents' competence in
clinical
direct observation,
provision of care and communication with
ISC / PRO
encounters
feedback
patients, parents, and staff
Lead discussion of common newborn problems
reading list,
didactic
and illnesses, including their diagnosis and
MK / PBL
clinical
discussions, direct
management
encounters
observation
Demonstrate/model independent use of
reading list,
didactic
educational resources to explore clinical
PBL
clinical
discussions, direct
problems
encounters
observation
Implement effective triage of patients of varying
clinical
direct observation,
levels of acuity; coordinate work rounds and
PC / MK
encounters
feedback
attending rounds
Actively assume ownership of patient care &
clinical
direct observation,
PC / PRO
nursery administrative responsibilities
encounters
feedback
Accept and act upon constructive criticism and
clinical
direct observation,
PRO / ISC
advice
encounters
feedback
Lead the nursery team, including providing
clinical
direct observation,
constructive criticism and feedback to junior
ISC / PRO
encounters
feedback
residents
Competency Domains:
PC = patient care
ISC = interpersonal skills & communication
MK = medical knowledge
PRO = professionalism
PBL = problem based learning & improvement
SBP = systems based practice
533562280; revised 6/10