Neonatal-Perinatal Fellowship
Curriculum

Clinical Training

During their 3 years of training, fellows spend a total of 56 weeks on clinical service: 46 weeks on rotations in the two teaching hospital NICUs (Seattle Children's Hospital & University of Washington Medical Center); 8 weeks on clinical services including perinatology, cardiac ICU, and pediatric surgery; and 2 weeks in one of the division's community hospital NICUs. Fellows also attend NICU follow-up clinic 8 half days each year. Clinical rotations are generally 2 to 4 weeks duration and nearly half of these rotations (24 weeks) are scheduled in the first year. Night call is in-house at both hospitals and averages approximately 50 nights per year. During the first year, fellows focus on expanding their clinical knowledge base and skills. They participate as learners and then teachers in procedural skills labs, and they are required to take an ECMO training course. In the second year, in addition to continuing their life-long learning, fellows begin the transition from trainee to attending neonatologist, developing higher-level patient management and team leadership skills. In the third year, they complete this transition, including learning the administrative roles of the attending physician through "subattending" experiences. All fellows are expected to complete a quality improvement project and a project which requires them to use our clinical database. They also participate in the development of clinical care guidelines and are expected to "own" one set of guidelines during their training.

Fellowship training in at University of Washington includes the following rotations:

  1. University of Washington Neonatal Intensive Care Unit (UWMC NICU). Fellows spend approximately half of their NICU time in the UWMC NICU, which specializes in the care of the preterm infant, most of whom are inborn. Fellows gain delivery room experience (including the initial management of congenital anomalies such as abdominal wall defects, congenital heart disease, and diaphragmatic hernias) and mastery of care of preterm infants. They also participate in prenatal consults.
  2. Seattle Children's Hospital Neonatal Intensive Care Unit (SCH NICU). Fellows spend approximately half of their NICU time in the SCH NICU, a quaternary referral center for a 4-state area (Washington, Alaska, Montana and Idaho). Fellows participate in the care of newborns with respiratory distress, neurologic diseases, inborn errors of metabolism, congenital heart disease, and complex congenital anomalies including surgical problems.
  3. Perinatology. First year fellows spend two weeks on Maternal-Fetal Medicine at University of Washington Medical Center. This rotation provides exposure to the many high risk OB clinics and insight into high risk obstetrical care.
  4. Pediatric Surgery. During their first or second year, fellows rotate for two weeks with the Pediatric Surgery team at SCH. This rotation provides insight into pre and post-operative care of neonatal surgical disease.
  5. Cardiac Intensive Care Unit. During either their second or third year, fellows spend 4 weeks on a cardiac intensive care rotation at SCH. The experience includes both pre and post-operative cardiac ICU care.
  6. Providence Regional Medical Center Everett Neonatal Intensive Care Unit (PRMCE NICU). Senior fellows have the opportunity to participate for 2 weeks in neonatal intensive care at one of the division's community sites for both exposure and a "subattending" experience.
  7. Follow-Up Clinic. Follow-up clinic designed specifically for NICU graduates is scheduled one day per week. Fellows participate in 8 half-day clinics per year. Time is spent participating in the medical, OT/PT, and psychological assessment of these infants at the corrected ages of 4 months, 8 months, 1 year, 2 years, 4.5 year, and 7 years old, with the goal of following longitudinally patients cared for in the NICU.

SAMPLE CLINICAL SCHEDULE

Year NICU Selectives Call Vacation
First 24 weeks
(12 at UW, 12 at SCH)
2 weeks perinatology 54 nights
(22 at UW, 32 at SCH)
3 weeks
Second 10 weeks
(6 at UW, 4 at SCH)
4 weeks CICU

2 weeks peds surgery
50 nights
(20 at UW, 30 at SCH)
3 weeks
Third 12 weeks
(6 at UW, 6 at SCH)
2 weeks PRMCE 46 nights
(18 at UW, 28 at SCH)
3 weeks
Total 46 weeks
(24 at UW, 22 at SCH)
10 weeks 150 nights
(60 at UW, 90 at SCH)
9 weeks

Seminars, conferences, and courses

Fellows attend weekly Core Curriculum conferences including weekly Fellow Conference, Journal Club and M & M, as well as to co-lead joint clinical conferences with pediatric surgery and perinatology. Fellows also attend courses in the Seattle Children’s Fellows’ College, which offers a core educational curriculum and career development services for postgraduate fellows in all pediatric medical and surgical programs at Seattle Children’s.

Scholarly Activity

Fellows choose their scholarly focus and type of scholarship (e.g. neonatal neuroscience, global health, clinical research, ethics, public health, education, etc.) early in their first year. To choose an area of scholarship, fellows spend their non-clinical time meeting with the fellowship program's Research Director and with selected division and non-division faculty members to discuss potential projects. By October, fellows should have identified their scholarly focus and mentor(s). This will determine the composition of their Scholarship Oversight Committee (SOC) and will shape the content and direction of their 2nd and 3rd years of training. Scholarly activity generally includes the formation of a hypothesis-driven research question, planning and execution of the project including IRB or IACUC submission as appropriate, data analysis, and publication of the work. During their research time, fellows learn to critically evaluate the relevant literature and can take relevant coursework, including biostatistics. For fellows choosing a basic science or clinical research focus, grant preparation will be emphasized in the 2nd and 3rd year so that funding is likely to be available for an optional 4th year. For fellows choosing a global health, education, or ethics scholarly focus, there is an opportunity to incorporate a Master’s degree at University of Washington during training. To do so, fellows are strongly encouraged to take an additional year to complete all their requirements. Fellows present their scholarly work at regional and national research conferences, such as the District VIII section on Perinatal Pediatrics meeting and Pediatric Academic Societies (PAS) meeting.

Scholarly Activity Areas of Concentration

Neonatal Neuroscience

Faculty Mentors: Sandra Juul, MD, PhD; Colin Studholme, PhD; Christopher Traudt, MD; Ryan McAdams, MD.
Collaborators: Robert Synovec, PhD; Todd Richards, PhD; Kathleen J. Millen, PhD; Patrick Heagerty, PhD; Thomas Burbacher, PhD; , Theo Bammler, PhD
Affiliations: Center for Integrated Brain Research (CIBR), Center on Human Development and Disability (CHDD), Neurodevelopmental Disorders Research Consortium, Washington National Primate Research Center (WaPRC), Institute of Translational Health Sciences (ITHS), Center for Ecogenetics and Environmental Health (CEEH).

Neonatal neuroscience research projects span the disciplines of basic, translational and clinical research. Our research includes the development and use of clinically-relevant animal models to investigate new approaches to protect the brain of high-risk neonates. Research also focuses on developing and testing the efficacy of neuroprotective strategies and determining mechanisms by which they function. Additional research goals are to determine mechanisms by which neurodevelopment is impaired by stress and/or drugs used to treat stress in the neonatal period and to determine biologic correlates to MRI.

Funded basic and translational studies:

  • Biomarkers of Neonatal Encephalopathy in a Nonhuman Primate Model (R01)
  • Mapping Patterns of Brain Tissue Growth in Premature Neonates-(R01)
  • Motion Robust Mapping of Human Brain Functional Connectivity Changes In-Utero (FUN) (R01)
  • Motion Robust Mapping of Human Brain Microstructure and Macrostructure In-Utero (MIC)
  • Cerebellar Development Disruption After Perinatal Brain Injury (K12)
  • New Zealand White Kit Developmental Atlas of MRI and Histology.
  • Are the Neurodevelopmental effects of neonatal stress and morphine regulated by miRNAs? Academic Enrichment Fund
  • Is Prolonged Exposure to Dexmedetomidine Safe for Neonates? Pediatric Pilot Fund Program, Center for Clinical and Translational Research, Seattle Children’s Research Institute

Clinical Research

Faculty Mentors: Sandra Juul, MD, PhD; Christine Gleason, MD; Dennis Mayock, MD; Shilpi Chabra, MD

Our division has a long history of participation in both multi-center and single center clinical research trials. Areas of particular interest for this Division have included research on neuroprotective strategies, lung disorders (surfactant trials, high frequency oscillation trials, prevention of bronchopulmonary dysplasia trials), as well as studies having to do with erythropoietin and iron balance.

Funded clinical studies:

  • Preterm Epo Neuroprotection (PENUT) Trial (UW is the lead site for NINDS funded U01 Phase III trial of Preterm Erythropoietin Neuroprotection)
  • The Neonatal Erythropoietin in Asphyxiated Term Infants Trial-O. The NEAT Trial-Outcomes. UCSF subcontract (Thrasher Foundation)
  • Darbepoietin administration in newborns undergoing cooling for encephalopathy (DANCE Study), University of Utah subcontract (Thrasher Foundation)

Global Health

Faculty Mentors: W. Alan Hodson, MD; Maneesh Batra, MD, MPH; Anna Hedstrom, MD; Ryan McAdams, MD

Affiliations: Child Health Epidemiology Reference Group (CHERG), UW Kenya Research Program, Global Alliance for the Prevention of Prematurity and Stillbirth (GAPPS)

Ongoing scholarly projects include the establishment of essential neonatal care guidelines for referral-level neonatal care in developing country settings, the development of educational programs in global health to address the unmet need in the global health workforce, and the assessment of long-term neurodevelopmental outcomes in developing country community-based settings.

Additional studies being conducted:

  • Kenya: Examination of the impact of maternal immune status and prematurity on transplacental transfer of antibodies to respiratory pathogens and clinical correlates.
  • Mongolia: Joint research with local neonatologists is being done to better understand healthcare provider attitudes regarding antenatal counseling and neonatal resuscitation-related practices in Mongolia.
  • Multinational: Measuring the main components of global neonatal disease as a part of the Institute for Health Metrics and Evaluation (IHME) publication on the Global Burden of Disease.
  • Uganda: Implementation of Continuous Positive Airway Pressure (CPAP) in a rural Ugandan NICU as well as the design of a novel data collection system and analysis of a database containing demographics, clinical characteristics and outcome information.

If appropriate, trainees may enroll in the UW Masters of Public Health (MPH) program.

Funded clinical studies:

  • Impact of Preterm Birth on Immunity to Hib and Pneumococcal Infection (Academic Enrichment Fund, Seattle Children’s Hospital)

Education

Faculty Mentors: Taylor Sawyer, DO, MEd; Thomas Strandjord, MD; Craig Jackson, MD, MHA; Isabella Knox, MD; David Loren, MD

Ongoing medical education research projects include: 1) simulation as an educational tool in neonatal resuscitation training; and 2) evaluation of a web-based training and simulation program to improve pediatric trainee error disclosure proficiency.

Biomedical Ethics

Faculty Mentors: David Woodrum, MD; Paul Mann MD; Ben Wilfond, MD

There are opportunities for scholarly activity with a focus on such issues as the limits of parental autonomy or factors involved in clinical decision making. Fellows emphasizing biomedical ethics would be involved in the activities of the Pediatric Bioethics Center, institutional ethics committee activities, ethics consultations, teaching rounds, a targeted reading program, ethics/philosophy course work and, if appropriate, enrollment in the UW Masters of Ethics program.

Health Services and Quality Improvement

Faculty Mentors: Linda Wallen, MD; Elizabeth Jacobson-Misbe, MD; Thomas Strandjord, MD; Taylor Sawyer, DO, MEd; Shilpi Chabra MD

The division is involved in scholarly work focused on improving the quality of care delivered in neonatal intensive care units and on medical education of care providers for newborn infants. Recent quality improvement projects include: 1) collaboration with the Vermont Oxford Network of neonatal intensive care units to reduce nosocomial infections; and 2) ongoing review of video-recorded neonatal resuscitations for quality improvement and education. Continuing work includes the implementation of clinical standard work for care of the fetus and neonate with gastroschisis; developing multidisciplinary guidelines for managing complex neonatal problems; and work with simulation and debriefing to enhance team communication, leadership skills and competency at procedural skills.

Biomedical and Health Informatics

Faculty Mentors: Peter Tarczy-Hornoch, MD

Dr. Peter Tarczy-Hornoch serves as Head of the Division of Biomedical and Health Informatics in the Department of Biomedical Informatics and Medical Education. Dr. Tarczy-Hornoch's NIH and NSF funded research has included: a) real time biomedical instrumentation control systems, b) bench research and mathematical modeling of liquid ventilation, c) clinical information systems, and d) electronic clinical knowledge resources. His current research on methods and models (in collaboration with computer scientists) focuses on data integration of biomedical and health data including looking at ways of handling semi-structured data, representing uncertainty at various levels in the system, and doing computerized reasoning over integrated data.