Resident Education in the Division of Neonatal/Perinatal Medicine

Click Here   for the Neonatal-Perinatal NICU Resident Orientation Handbook (The "Blue Book")

1st Year Resident (PL-1) Activities:

The first year Pediatric Resident will typically spend one month in the Newborn Nursery (NBN) and 1-2 months in the Neonatal Intensive Care Unit at Parkland Memorial Hospital (PMH).  PMH is physically connected by hallways to Children's Medical Center.

NBN Rotation

The PL-1 spends one month in the Newborn Nursery, which has over 14,500 admissions each year.  Since over 75% of these babies are cared for by experienced pediatric nurse practitioners, the PL-1 may focus on a small number of patients, yet learn from a large clinical service. 

NICU Rotation

The PL-1 will spend 1-2 months in the neonatal intensive care unit (NICU).  The NICU experience involves care of the premature and term neonates who require a higher level of care than would be found in the Newborn Nursery.  
 
The NICU is subdivided into:

• Intensive Care Nursery (ICN) - for neonates who require the highest level of care (e.g. ventilation, pre and post-op surgery, pressor support, etc.)
• Acute Care Nursery (ACN) - for neonates who are less acutely ill, but require continuous monitoring
• Continuing Care Nursery (CCN) - those post-ICN/ACN babies who are stable, growing, and do not require continuous monitoring
  

2nd Year Resident Activities:

NBN Rotation

Although the PL-2 does not have a formal rotation through the NBN, s/he is sometimes scheduled to provide night-call coverage.  This is an opportunity to refine delivery room skills and newborn assessments.

NICU Rotation

The PL-2 spends one month in the NICU and experiences these activities:

• Maintains a patient care assignment, and is given more responsibility for ICN patients
• Takes call every 4th night as the "Senior Resident" who leads the Resuscitation Team when called to high-risk deliveries
• Opportunities exist to perform procedures (umbilical vessel catheter placement, intubation, and thoracenteses). 
• Provides antenatal consultations to Obstetricians in the Labor and Delivery area
• Serves as a resource for other Pediatric Residents
  

3rd Year Resident Activities:

NBN Rotation

The PL-3 spends two weeks in the NBN, and primarily functions as a teacher and supervisor of the 3rd year medical students who rotate weekly.  The PL-3 takes every 4th night call in the NICU and provides delivery room coverage during the day.  The PL-3 also has the option of learning the technique of Gomco circumcision during this rotation.

NICU Rotation

The PL-3 spends two weeks in the NICU.

Elective Rotations for CMC Pediatric Residents

Low Birth Weight Rotation at Children’s Medical Center 

The Low-Birth-Weight Follow-Up Clinic is run by Dr. Roy Heyne

• Provides primary care to 90% of extremely low birth weight infants born at Parkland Memorial Hospital up to 3 years as needed.
• Is involved routinely with national studies regarding premature infants and their future development.
• A unique clinic in the state that provides comprehensive primary care specifically to very low birth weight infants.
• Provides formalized developmental testing as part of a patient’s treatment plan.

The goals and objectives of this rotation include the following:

• Learn how impact of neonatal morbidities and interventions is tracked over time from clinical and research perspectives
• Become familiar with spectrum of evolving variations from normal development in high-risk infants and with the tools used to assess/diagnose such; develop understanding of issues/controversies in administering, interpreting, reporting
• Acquire appreciation of ongoing growth, nutritional, and feeding issues of ELBW infants, including social FTT, oral aversion, GERD, short bowel.
• Observe course/management of chronic lung disease (BPD)
• Gain insight into psychosocial impact of prematurity, emerging morbidities, chronic illness on families, as well as impact of psychosocial and environmental factors on child's course/outcome.
• Learn how a multidisciplinary team interacts internally and interfaces externally with community services to address medical, developmental, and psychosocial issues/needs

Outline of the Rotation (allowing for extension into other weeks according to availability of illustrative patient cases):

• First two days: Introduction/Orientation
• First week: Development Screening/Assessment
• Second week:  Neuromotor Assessment
• Third Week: Psychosocial Assessment
• Fourth Week: Chronic Diseases & Growth/Nutrition 

The Newborn Nursery (NBN) at Parkland Memorial Hospital 

The Newborn Nursery offers a 2-4 week elective for Residents who have completed their required month in the NBN [link].  This elective may be tailored to the Resident’s needs, and may include any of the following:

• Complete care of the term and near-term newborn from delivery through discharge, including anticipatory guidance for the parent
• Assessment and management of the breastfeeding couplet
• Early follow-up care of the infant with common problems such as weight loss, jaundice, and breastfeeding issues
• Care of Level 2 patients (those with pneumonia and other transient respiratory problems, illicit drug exposure, hypoglycemia)
• Neonatal resuscitation experience in the Delivery Room
• Interactive teaching of the 3^rd year medical students
• The complete circumcision process
• Option to combine this rotation with an outpatient experience (e.g., Genetics Clinic, Low Birth Weight Clinic, etc.)

Elective Rotations for Pediatric Residents from outside the University of Texas Southwestern Medical Center/Children’s Medical Center

The Division offers four elective rotations to residents from other programs:

1. Neonatal Intensive Care Unit (NICU) Rotation at Parkland Memorial Hospital with one afternoon a week of observership at the Low Birth Weight Clinic at Children’s Medical Center [link]. The overall goal and objective of the rotations for the pediatric residents in the NICU is to gain extensive experience in the recognition and care of the high-risk, low-birth-weight, preterm (<2200gm or <34wks) and term neonate who requires intensive or intermediate care, surgery, or evaluation by other pediatric specialists.
2. Labor and Delivery Rotation at Parkland Memorial Hospital, offered to PGY-3 residents. The primary objective of the PGY-3 L&D rotation is to solidify and enhance skills in effective newborn resuscitation as well as appropriate triage of the high risk newborn. Myra Wyckoff, M.D., an internationally acclaimed physician in neonatal resuscitation research, directs a very unique resuscitation rotation, which includes exposure to a computerized patient simulator, NRP certification and training, participation in resuscitation research, review of the literature, attendance at high-risk deliveries, and transfer to and admission of high-risk infants to the NICU.
3. Newborn Nursery Rotation at Parkland Memorial Hospital – see Elective Rotations for CMC Pediatric Residents, above
4. Low Birth Weight Rotation at Children’s Medical Center – see Elective Rotations for CMC Pediatric Residents, above

These away rotations may be of interest to Residents from other Training Programs interested in a Fellowship in Neonatal-Perinatal Medicine. If you are interested in any of these rotations please contact Ms. Dawn Baye, Residency Program coordinator, dawn.baye@utsouthwestern.edu or 214-456-1867. Note:  You will need to apply for credentialing either at Children’s Medical Center or Parkland Memorial Hospital; this process typically takes three months.