Clinical training consists of clinical rotations supplemented by a robust series of conferences. This curriculum includes 12 months in the Level IV neonatal-intensive care unity at Monroe Carell Jr. Children's Hospital at Vanderbilt with clinical experiences in the Neonatal Developmental Clinic, The Fetal Center at Vanderbilt, and the Pediatric Cardiac Intensive Care Unit. Night call is in-house.
Approximately 1,500 newborns are admitted annually to the Vanderbilt NICU, which consists of 114 intensive and intermediate beds. Medical teams care for a combined average daily census of over 94 patients.
NICU at Monroe Carell Jr. Children's Hospital at Vanderbilt
Fellows spend approximately two-thirds of their clinical experience in the state-of-the-art single patient room NICU, caring for critically ill infants with a wide range of medical and surgical conditions. Approximately two-thirds of infants are inborn. The full range of treatment modalities includes advanced respiratory support, ECMO, and therapeutic hypothermia. There is a high exposure to pre-operative congenital heart disease and surgical conditions. Babies with congenital heart disease are cared for in the NICU pre-operatively.
One-fourth of the clinical experience is spent on the Delivery Service. The delivery service is in Vanderbilt University Hospital, which is connected to the Children's Hospital through an interior walkway. The delivery NICU provides neonatal support for an obstetrical service with approximately 5,000 annual deliveries, including a substantial proportion of high-risk pregnancies. Fellows attend high-risk deliveries, become proficient in delivery room resuscitation and stabilization, and provide perinatal and newborn consultation.
The four teaching teams consist of an attending neonatologist, neonatal fellow, pediatric residents, neonatal nurse practitioners, physician assistants, and NICU hospitalists. Under attending supervision, fellows direct patient care and provide bedside teaching for pediatric residents and medical students. Multidisciplinary rounds are conducted daily and include dieticians, pharmacists, respiratory therapists, lactation consultants, social workers, and case managers.
Fellows provide medical control for neonatal transport. Fellows receive focused didactic and simulation education in transport physiology and management and participate in transports when assigned to one of the inpatient teams. Additional tailored experience in transport medicine is available for fellows who wish to pursue this as a career focus.
During this clinical experience rotation, fellows observe the evaluation and management of high-risk pregnancies in the ambulatory and inpatient settings, including labor and delivery; participate in the counseling of women with high risk pregnancies in The Fetal Center at Vanderbilt; observe ultrasounds and fetal interventions; and attend a weekly multidisciplinary fetal conference. Additional tailored experience in fetal medicine is available for fellows who wish to pursue this as a career focus.
Neonatal Follow-up Clinics
Second year fellows have a cross-sectional follow-up experience in which they see infants across a spectrum of ages and conditions, some of whom they cared for in the NICUs. In the Neonatal Development Clinic, fellows perform developmental assessments and recommend appropriate services. In the BPD Clinic, fellows participate in the ongoing care of NICU graduates with bronchopulmonary dysplasia. Additional tailored experience in neonatal development is available for fellows who wish to pursue this as a career focus.
Pediatric Cardiac Intensive Care
Third year fellows gain additional exposure to the postoperative care of newborns with congenital heart disease in the Pediatric Cardiac Intensive Care Unit rotation. Fellows round with the pediatric cardiac intensivist and cardiologist in the PCICU, observe cardiac surgery, observe the post-operative management of newborns, and attend multidisciplinary conferences in which upcoming surgeries, clinical status, and complications are discussed. This rotation supplements experiences during NICU rotations, which include delivery room stabilization and pre-operative management of more than 130 infants each year with congenital heart disease and management of infants with problems including cardiac arrhythmias and patent ductus arteriosus.