Neonatology

Rotations and Training

FetusThe Fellowship in Neonatal-Perinatal Medicine at Children’s Hospital of New Mexico at the University of New Mexico has several rotations and experiences. They are:

Neonatal Intensive Care Unit In-Patient Service
The fellows have their clinical experience in a state-of-art Neonatal Intensive Care Unit at the University of New Mexico Children’s Hospital. This is a 52-bed Level IIIc unit that has a wide range of patients including all newborn surgical and cardiac patients. The NICU is a state-wide referral center for critically ill children and has a large high risk delivery service. The Labor and Delivery service is directly adjacent to the NBICU. The Maternal Fetal Medicine High-Risk OB service accepts high-risk pregnant women from Albuquerque and throughout the state for state-of-the-art management or their pregnancies. ECMO is also available in the NBICU for critically ill newborns with severe cardio-respiratory failure.

Special Baby Clinic and Follow-Up
The ACGME/ABP require that the educational goals for follow-up emphasize acquisition of knowledge about outcomes that will translate into skillful counseling of families and the practice of evidence-based neonatal care that enhances long-term outcome. Experiences in neonatal follow-up should enable fellows to understand the relationship between neonatal illnesses and later health and development and to become aware of the socioeconomic effects and psychosocial stress that may occur in families of NICU graduates.

To achieve these goals, each fellow spends time in a curriculum encompassing follow-up of NICU babies. All high-risk infants are followed by the Developmental Care Team and assessed over the first 2 years of life after discharge from the NBICU. Some time is spent with follow-up of babies in the Special Baby Clinic (fellows attend 8 clinics per year) and additional time is spent with the Developmental Care Team at a monthly Developmental Team Conference with hands on developmental evaluations in the NBICU. The Special Baby Follow-Up Clinic experience is part of the division of Neonatal-Perinatal Medicine under the direction of Dr. Andrea Duncan. The clinic is located at Carrie Tingley Hospital on the 3rd floor.

ICN3 Transition Nursery
The ICN3 Transition Nursery is a new 12-bed unit designed to admit newborn ill patients for evaluation/observation and short-term treatment. The fellows and the NBICU team are consultants to this service and manage the patients during night call.

ECMOECMO Experience
ECMO is an important procedure used to rescue a limited patient population in cardiac or respiratory failure. This procedure is used relatively infrequently in the Neonatal Intensive Care Unit (NICU) setting, but it is a major therapeutic intervention in severe conditions such as the pulmonary hypertension of the newborn. The ECMO rotation/experience is meant to help neonatology fellows with exposure to this procedure. This exposure to Extra Corporeal Membrane Oxygenation is in collaboration with the Pediatric Intensive Care Unit under the direction of Dr. Mark Crowley. The fellows may chose to follow this exposure/rotation at any time during their regular three-year training. The fellows will receive didactic training at the time the UNM ECMO training is offered, the clinical experience will depend on patient availability. Given that the availability of a patient receiving ECMO is intermittent, the experience/rotation will be done only on those days when such treatment is provided. The ECMO Program Coordinator Karen Milligan or the ECMO Director will maintain contact with the NBICU service in order to obtain this information. We will then contact the fellows for ECMO to arrange for this experience.

FetusMaternal-Fetal-Medicine/Perinatal Counseling Elective
The subspecialty of Maternal Fetal Medicine is involved in the management and care of high-risk pregnancies that include acute and chronic maternal medical disorders, fetal anomalies, and pregnancy complications. These pregnancies often lead to delivery of high-risk neonates requiring special care. The management considerations such as pharmacotherapy, timing of delivery, antenatal assessments, and route of delivery can impact on the follow-up and outcome of these neonates.

This 2-week rotation during the second year under Dr. Rebecca Moran and Dr. Jennifer Rael will participate in counseling and diagnostic testing of mothers with high risk pregnancies and fetuses at risk for adverse outcomes, genetic testing and genetic counseling.

Cardiothoracic Surgery
Cardiovascular pathology and physiology constitutes an important component of the management of neonates in the Neonatal Intensive Care Unit (NICU). The elective CVICU rotation is meant to supplement the experience of the neonatology fellows at Children’s Hospital of New Mexico with experience in a CVICU setting to support their medical knowledge and clinical practice skills.

This rotation is a 1-2 week elective at the Lucile Packard Children’s Hospital at Stanford to gain additional experience in Cardiothoracic Surgery and learn about pre and post-operative managements of infants with congenital cardiac disease. This may be combined with a two week elective with Cardiology at the Children’s Hospital of New Mexico.

The fellows may choose this rotation during the second or third year of their regular three-year training in Neonatal Perinatal Medicine. The goal for the fellows is to work under the direct supervision of Dr. Stephen Roth and the faculty of the Lucille Packard Children’s Hospital. The rotation is designed to be hands on with as much direct patient care as possible. The fellow will have patient assignments and participate in daily rounds, conferences and other educational activities as available.

Neonatal Skills Lab and High Fidelity SimulationBatcave
The BATCAVE Healthcare Simulation Program is a state-of-the-art simulation program for medical education, with space dedicated for neonatal teaching. The facilities include a Pediatric Simulation Lab, Three Infant Simulation Labs, Birthing Simulator Lab, and several breakout rooms.

At the beginning of each year, all fellows participate in an intensive skills and resuscitation lab over a 3 day period in the BATCAVE, the High Fidelity Simulation Lab at the University of New Mexico. Additional quarterly sessions in the BATCAVE are used to enhance technical and resuscitation skills.


Transport

Fellows are required to participate in 2 transports each year under the supervision of the Neonatal Transport Team. This CAMTS certified team of Neonatal Nurse Practitioners/Neonatal Physician Assistants, paramedics and respiratory therapists transport critically ill newborns with prematurity, surgical and cardiac problems and other illnesses from throughout the state to the UNM NBICU or other units as needed.