Newborn Medicine | Fellowships | Clinical Training

Fellows have twelve months of inpatient service commitment during their thirty-six months of fellowship.

Training in the NICU:

Clinical training in neonatal-perinatal medicine takes place in the 127 bed neonatal intensive care unit at St. Louis Children’s Hospital and on the labor and delivery service at the Woman and Infant’s Pavilion at Barnes-Jewish Hospital Parkview Tower which is attached by a 110 foot bridge to the NICU. More than 1,600 annual NICU admissions come from within the medical center, throughout Missouri and Illinois, as well as nationally and internationally for the highly specialized care available at St. Louis Children’s Hospital. Diagnoses range from extreme prematurity to complex genetic syndromes giving fellows a wide-breadth of experience in caring for critically ill newborns. All major therapies, including NICU based extracorporeal membrane oxygenation and solid organ transplantation, are available. All pediatric and surgical sub-specialists are readily available to enhance the learning environment.

Fellows also obtain experience in the transport of critically ill newborns by air and ground from referring hospitals throughout the region by their participation with the St. Louis Children’s Hospital Critical Care Transport Team.

NICU Day Time Service:
Five fellows are on service simultaneously in the NICU each month.

Fellows rotate every four weeks on one of the six teams in the NICU during each 3-6 month service block. A clinical team typically consists of an attending neonatologist, a clinical fellow and either pediatric residents or nurse practitioners. Neonatal pharmacists, dietitians, lactation consultants, respiratory therapists, occupational and physical therapists, and social workers provide appropriate support and are integral members of each team.

NICU Nights and Weekends:
Fellows take in –house calls every 5th night during their service blocks. An attending neonatologist provides in-house back up to the on call fellows. Fellows have two out of five weekends off while on service.

Off service fellows will be on call either Saturday or Sunday for an average of 10 days in a year.

An attending neonatologist will provide in-house back up to the on-call fellows from July 1 2017. A guideline listing the situations when the fellows are recommended to summon the in-house attending for help is available in the fellow’s handbook.

Service break for General Pediatrics Certifying Examination:
First year fellows will get 2 weeks break from service to prepare for the initial General Pediatrics Certifying Examination offered by the American Board of Pediatrics. The 2nd year fellows will cover the service which will be reciprocated by the first year fellows later on during the training.

Training on the labor and delivery service:

The labor and delivery service at the Woman and Infant’s Pavilion at Barnes-Jewish Hospital Parkview Tower is a high-risk obstetrical service with approximately 4,000 deliveries per year giving fellows experience in resuscitating and stabilizing the most critically ill newborns. Fellows work closely with the maternal-fetal medicine service in providing antenatal consultation to women with high-risk pregnancies. Some of the mothers are transported from outside Saint Louis to the Labor and Delivery by the Maternal – Fetal Transport Team providing an opportunity to anticipate, plan for delivery and resuscitate neonates at extremely preterm gestations, at one of multiple order gestations or with complex congenital anomalies. Fellows also develop expertise in antenatal counseling, resuscitation and care of neonates with prenatal diagnoses of complex congenital anomalies whose mothers are cared for in the Fetal Care Center and learn co-ordination of expeditious multispecialty care.

Fellows have a great deal of responsibility on the clinical services planning the evaluation and management of patients under the guidance of more than 30 faculty members. This provides an excellent environment for not only the development of clinical skills but also leadership and teaching skills.

Cardiac intensive care unit:

Cardiac intensive care unit rotation for 2 weeks provides an excellent opportunity to learn physiology of and pre and postoperative care of neonates with complex congenital heart diseases.

Selective rotation:

Fetal Care Center: rotation can be arranged to meet the fellows’ educational needs of developing expertise in fetal imaging and counselling families about a variety of congenital anomalies.

Follow up clinic:

The Follow Up Clinic meets once every week and allows fellows to provide ongoing care after their patients are discharged from the NICU. The clinic provides an opportunity to screen the ex-NICU graduates for neuro developmental impairment and provide appropriate intervention.

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