Neonatal Intensive Care - Professional Education
Neonatal Intensive Care - Professional Education
The Neonatal-Perinatal Medicine Fellowship provides fellows with an education and broad-based clinical training in fetal and neonatal medicine.
We accept applications through ERAS. Learn more about the ERAS process.
Our three-year Neonatal-Perinatal Medicine Fellowship offers comprehensive clinical training in the care of high-risk mothers and infants at the Milton S. Hershey Medical Center. Support and opportunity for training and experience in both clinical and laboratory research is conducted within the Pennsylvania State College of Medicine.
The program will provide an opportunity for the fellow to develop skills as an educator, including presentation skills and curriculum evaluation. Fellows participate in the education of pediatric residents and in the continuing education of practicing pediatricians. Depending on background and interests, each fellow will be prepared for a successful career in clinical and academic neonatology. Fellows are expected to be eligible for certification by the Sub-board of Neonatal-Perinatal Medicine of the American Board of Pediatrics.
The faculty involved with teaching, mentoring, and evaluating the progress of the fellows reports regularly to the program director. The program director and the fellow meet at regular intervals to discuss progress and objectives.
As a fellow, you’ll have the opportunity to practice neonatology at a high standard, manage problem cases that cannot be handled outside an academic framework, and apply new techniques at the advancing edge of neonatal-perinatal medicine.
You’ll remain in direct, active, and close contact with patient care to become an authority on the subject, and you’ll be expected to handle many problem cases. HMC has an active transport service that is operated by nurse clinicians, with neonatal fellows participating in the transport of critically ill neonates who require a more advanced level of expertise.
Supervision and teaching
Day-to-day patient care of NICU patients assigned to the pediatric residents is, in part, supervised by the fellow in neonatal-perinatal medicine. As the on-service fellow, you’ll:
- Attend and supervises the resuscitation deliveries
- Participate in the teaching of medical students and house staff
Each of the three years is similarly structured in terms of the time allocated to research and clinical duties. You’ll spend four months of each year on clinical service in the NICU. One month is allocated to vacation, and the remainder of the year is applied to research.
During the course of the program, you’ll participate in at least 12 months of full-time clinical work as the fellow on-service. Each fellow rotates on the night and weekend call schedule, together with the senior pediatric residents and neonatal nurse practitioners.
The evening on-call and weekend on-call schedule is spread evenly throughout the year. You’ll be on after-hours call between five and six nights a month. Call is on-site in-house. Weekend days are regarded as after-hour calls and are included in the five to six days a month.
When you’re on NICU service, you won’t take call for both weekend days. This ensures that you’ll have a monthly average of one day in seven away from program duties.
When you’re not on clinical service, you’ll attend follow-up clinic, journal club, executive rounds (rounds with the neonatologists), perinatal conferences, and staff meetings.
There are approximately 2,200 deliveries per year at the Medical Center, with a perinatal service serving the high-risk community of the surrounding hospitals as well as high-risk referral patients. The prenatal care of the fetus includes a full range of services, such as maternal transport, fetal diagnostics, fetal therapy, prevention of prematurity, and a multispecialty interdisciplinary team to manage the high-risk pregnancy with active involvement of the neonatology team.
Currently, the newborn intensive care unit (NICU) has a capacity of 42 patients and greater than 600 admissions per year. Medical care in the NICU is provided by residents, neonatal nurse practitioners, fellows, and attending physicians. As a fellow, you’ll be responsible for teaching routine procedures to the residents. The fellow is in turn supervised by the attending neonatologist. There are five attending neonatologists. During NICU service, you’ll have an opportunity to learn and teach the care of critically ill neonates, including:
- Endotracheal intubation
- Central venous and arterial line placement
- Umbilical vessel cannulation
- Neonatal ventilation, including high frequency ventilation
The Medical Center offers a full range of pediatric sub-specialties, and Neonatal-Perinatal Medicine offers state-of-the-art technology in a Level IV NICU and a comprehensive newborn follow-up program. Working at a university-based hospital, you’ll have access to current treatment protocols.
Our neonatal-perinatal specialists attend international and national meetings, where they present and share information. The staff has experience in:
- High-frequency oscillatory ventilation
- Extracorporeal membrane oxygenation (ECMO)
- Inhaled nitric oxide therapy
- Pulmonary function testing used to help determine appropriate ventilator settings
More than 150 infants are ventilated annually. A training course in ECMO is held annually.
As a fellow, you’ll be supervised by a neonatologist who makes rounds each morning. The fellow, residents, nurse practitioner, and neonatal attending see each patient together every morning. Rounds last from two to three hours each morning seven days a week (i.e., a total of 14-21 hours a week for morning rounds).
The attending leads discussion during the first training year, and as you gain experience, you’ll assume more of a leadership role during rounds. Teaching is done at the bedside, and emphasis is placed on physical examination and the interpretation of physical signs. The pathophysiology of the sick neonate is discussed in reference to the patient. The differential diagnosis and management plans are also discussed at the bedside.
When necessary, subspecialist consultation is included. This occurs frequently with cardiology, endocrinology, and nephrology.
At 1:15 p.m. Monday through Friday, the NICU team is supervised in the interpretation of radiographs by pediatric radiologists at a regular conference. At 4 p.m. each weekday afternoon, sign-out rounds occur at the bedside. These last about 1 ½ hours (5-7 ½ hours per week).
Trainees are supervised by the attending on call for the night and with the attending on clinical service. When a patient is admitted, the trainee documents the history and examination. The neonatologist also examines the patient, and the differential diagnosis and management plan is discussed.
At the NICU Development clinic, you’ll see patients that you’ve discharged during your clinical months in the NICU (inpatients). Patients are seen at:
- Six weeks post-discharge
- Six months
- One year of corrected age
Patients are also seen with a physical therapist who assesses motor development and tone.
A neonatal attending is present at each clinic so that patients can be discussed. Frequently, the attending will see the patient with the trainee, especially during the early months of training, until the trainee is comfortable performing the follow-up assessment. The fellow dictates a letter to the primary physician after every visit. The letter is approved and countersigned by a neonatologist.