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 125-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’s Parkview Tower which is attached by a 110 foot bridge to the NICU. More than 1,300 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 medical control and real time 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 concurrently in the NICU each month. Fellows rotate every four weeks on one of the six teams in the NICU during their service blocks. A clinical team typically consists of an attending neonatologist, a clinical fellow, pediatric residents and 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:
On service fellows take in-house calls approximately every 5th night during their service blocks and an additional night float fellow is also available in-house. An attending neonatologist provides in-house back up to both of the on call fellows and medical teams. Off service fellows will be on call either Saturday or Sunday for an average of 10 days in a year.
Service break for General Pediatrics Certifying Examination:
First year fellows will get a 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’s Parkview Tower is a high-risk obstetrical service with approximately 4,000 deliveries per year which gives 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. Mothers transported from outside Saint Louis to the Labor and Delivery by the Maternal – Fetal Transport Team provide opportunities to anticipate, plan for delivery, and resuscitate neonates at extremely preterm gestations, at 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 coordination 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:
The cardiac intensive care unit rotation for 2 weeks provides an excellent opportunity to learn the physiology of pre and postoperative care of neonates with complex congenital heart disease.
Fetal Care Rotation:
The Fetal Care rotation is arranged to meet the educational needs of trainees in the arena of developing expertise in fetal imaging, counseling of and treatment for a variety of congenital anomalies. The two-week rotation allows fellows to participate in a multidisciplinary approach to counseling and care for families referred to the Fetal Care Center. During these two weeks, Neonatal and Perinatal Medicine fellows participate in OB Ultrasound clinic, Fetal Heart Center echocardiography and counseling, bimonthly conferences and any fetal procedures that may occur during the rotation.
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 ex-NICU graduates for neurodevelopmental impairment and provide appropriate intervention if needed and counsel families about ongoing and new medical problems.