Neonatology

The Neonatal Intensive Care Unit (NICU) at the Janet Weis Children’s Hospital of Geisinger is a 38-bed unit that provides comprehensive medical and surgical care to critically ill infants. It is staffed by board certified neonatologists, pediatric residents and neonatal nurse practitioners. The NICU also oversees an active neonatal transport team.

The NICU cares for a wide range of clinical conditions commonly observed in the neonatal period. Conditions that the rotating medical student will encounter include:

• Prematurity including very low birth weight infants (VLBWs)
• Neonatal sepsis/infections
• Shock
• Neonatal seizure
• Hyperbilirubinemia
• Congenital heart disease
• Inborn errors of metabolism
• Congenital malformations
• Genetic conditions

The neonatologists in conjunction with pediatric surgical subspecialties care for conditions requiring multidisciplinary care such as gastroschesis, intestinal atresia, myelomenigocele and congenital heart disease. The maternal fetal medicine service works closely with neonatology in the identification and management of the high-risk obstetrics patient.

The fourth-year medical student is completely and actively integrated into the NICU medical team. Due to the complexity of most NICU patients, the fourth-year medical student (with resident supervision) follows two to three patients at any one time. Students may have NICU patients in any part of the continuum of care (critically ill to convalescence).

Goals & objectives

Professional conduct
A commitment to excellence in medical practice as well as service in the interest and welfare of assigned patients will be requisite of all students. Students are expected to exhibit a respectful approach toward patients and their families, members of the medical team, nursing and ancillary staff. Compassion toward patients and their families is a critical competency required in the NICU. The recognition of one’s limitations is a valuable requirement for students rotating in the NICU. The neonatology staff will be available to the rotating students at all times to discuss patient care and assure a quality educational experience.

General goals

• Effectively analyze maternal history and identify risk factors for preterm birth   
• Understand the steps in resuscitation/stabilization of critically ill neonates   
• Actively participate in the care of critically ill and convalescent neonates   
• Formulate a case appropriate general differential diagnosis and assessment   
• Initiate basic treatment plans for critically ill and convalescing neonates   
• Understand the complexities associated with discharge planning for the recovering neonate   

Specific educational objectives

• The student will gain functional efficiency and effectiveness in neonatology via a “systems based” approach.
• The student will acquire an understanding of current medical management of the ill neonate using evidence-based practice.
• At the completion of the rotation the student should have a fundamental knowledge of the following processes:
  • Fetal growth and maturation
  • Normal newborn examination
  • Prematurity
  • Birth injuries
  • Transient tachypnea of the newborn
  • Meconium aspiration
  • Respiratory distress syndrome
  • Sepsis and infections in the neonatal period
  • Anemia in the neonatal period
  • Apnea
  • Hyperbilirubinemia
  • Hypoglycemia
  • Neonatal seizures

Patient care objectives

• Pre-rounding and data collection on assigned patients
• Formal presentation of patients on bedside rounds
• Assisting or performing (under direct supervision) invasive procedures
• Writing of daily notes with resident and attending attestations
• Follow up on all ordered diagnostics (i.e. imaging, laboratory results)
• Participating in supervised call (every five evenings until midnight)
• Reviewing the medical literature pertinent to their patients
• Attend and participate in delivery room stabilization/resuscitation
• Providing a short oral presentation (15 minutes) to the NICU team on a neonatal topic of their choosing