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Neonatal-Perinatal Fellowship Clinical Training

The Johns Hopkins Hospital neonatal intensive care unit (NICU) is the primary site for clinical experiences during the training program. The NICU is a 49-bed Level IV unit, with admissions that include newborns of all gestational ages, with the full range of medical and surgical problems, including those requiring prenatal surgery and interventions, surgical subspecialty care, cardiac surgery and extracorporeal membrane oxygenation (ECMO). (Potential ECMO candidates are stabilized and managed in the NICU. When the need for ECMO is determined, infants are transferred to the PICU for ECMO management. After decannulation, they are transferred back to the NICU.) The JHH NICU admits approximately 850 infants per year — 75% from the delivery room and full-term nursery, and 25% through transport from hospitals throughout the state of Maryland and the mid-Atlantic region. Labor and Delivery rooms and operating rooms are immediately adjacent to the NICU, facilitating coverage of high-risk deliveries. The fellow provides a critical leadership role for a multidisciplinary team that includes pediatric residents, nursing, respiratory therapy, pediatric pharmacy, nutrition and social work. Nighttime coverage is provided by fellows who are not on service, in a night float schedule.

Our secondary site for the training program is Johns Hopkins Bayview Medical Center NICU, a community-based, 25-bed Level III unit that cares for high-risk infants. The patients are primarily inborn infants with a variety of conditions, but also transport patients from other Maryland hospitals. A special area of expertise includes management of infants with neonatal abstinence syndrome. Infants who require general or subspecialty surgery are transferred to the Johns Hopkins Hospital NICU for evaluation and management. The Johns Hopkins Bayview NICU offers the experience of working in a unit run entirely with the help of nurse practitioners rather than pediatric residents. While on service, the fellow takes call twice a week, which can be from home depending upon the acuity in the unit.

Rotations occur as two-week blocks: First-year fellows have seven or eight blocks, second-year fellows have five or six blocks, and third-year fellows have four or five blocks. Approximately two-thirds of the rotations are at the Johns Hopkins Hospital NICU, with the remainder at Johns Hopkins Bayview.

The outpatient high-risk follow-up clinic is directed by Marilee Allen, M.D., who is board-certified in both neonatal-perinatal medicine and developmental pediatrics. The follow-up clinic is adjacent to The Johns Hopkins Hospital in the Kennedy Krieger Institute, which provides resources for outpatient and inpatient care of children with developmental disabilities. Psychometric testing is provided, along with occupational and physical therapy assessments. The fellows rotate in the clinic throughout their fellowship, with one fellow assigned per clinic, which is held once each week. A special program is our Neurosciences Intensive Care Nursery (NICN) led by Frances Northington, M.D., a virtual unit within the NICU focused on multidisciplinary care of newborns with neurological disorders, including collaboration from pediatric neurology, pediatric neurosurgery and pediatric radiology.

Clinical experience is augmented by a number of formal lectures and conferences. These include a weekly fellow-focused didactic lecture series with the curriculum reviewing neonatal physiology, pathophysiology, pharmacology and diagnosis and management of common and rare conditions. Additional regularly scheduled conferences include case management and code reviews, journal club, mortality and morbidity, quality improvement, NICN clinical conference, and joint conferences with pediatric surgery, as well as with maternal-fetal medicine and fetal therapy that provide ample exposure to interpretation of prenatal imaging. Simulation exercises in our state-of-the-art simulation center as well as ad hoc simulations in the NICU are incorporated into the curriculum on a quarterly basis.

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