DIVISION OF NEONATOLOGY

Fellowship Clinical Activities

First-Year Fellows

The main objective of the first year of fellowship is to solidify clinical skills and provide the fellow with the foundation to competently care for the majority of neonatal problems in a tertiary care NICU setting.

At University Hospital NICU, the program's primary facility for fellowship training, first-year fellows have three 4-week blocks of NICU experience and take in-hospital call on an average of every 4th night during these blocks. The remaining blocks during elective and research months, on-call averages every 7th night. During the early blocks of training, fellows progressively assume primary care of NICU patients. This opportunity allows the program director and the neonatal faculty to become acquainted with the skills and knowledge level of the trainee, allows the trainee to become familiar with the nuances of patient care in our facility, and provides time and experience for the trainee in the management of special techniques such as high frequency ventilation and inhaled nitric oxide.

As competencies are demonstrated, fellows assume an ever-increasing supervisory role at the discretion of the faculty attending. In all clinical rotations or when on-call, the fellow is expected to oversee all care provided by pediatric residents, nurse practitioners, and medical students on the intensive and intermediate care service. Fellows:

  • Assist the attending staff in providing teaching and patient care discussions. As the first year fellow demonstrates independent management and technical skills s/he will be given more responsibility to conduct teaching rounds on the NICU service.
  • Develop perioperative care skills by attending all surgical procedures performed in the NICU or operating room
  • Develop neonatal transport skills, participating in the transport process 
  • Assist in the management of all on-going clinical research studies in the NICU
  • Participate in clinical quality improvement activities

Competency with the following skills, but not limited to these, are expected in the first year of subspecialty training: techniques of neonatal resuscitation, venous and arterial access, endotracheal intubation, preoperative and post operative care of surgical patients, preparation for transport, ventilatory support, inhaled nitric oxide therapy, continuous cardiorespiratory monitoring, temperature control and intravenous/enteral nutritional support.

The first-year fellow has the option of taking the 1 week training course in extracorporeal membrane oxygenation transport (ECMO) at Wilford Hall Medical Center/Lackland AFB, whose Level III Neonatal Intensive Care Unit has a nationally recognized ECMO center and is the sole center in the United States that offers transport ECMO. Under the direction of Cody Henderson, Maj, USAF, MC, Director of ECMO and Transport, the course provides didactic lectures and laboratory experience. If the course is not taken in the first year, it must be completed successfully by the second year of training.

Fellows also attend approximately 28 to 32 high-risk follow-up clinics (PREMIEre Program) each year at the Goldsbury Outpatient Clinic/CHRISTUS Santa Rosa Children's Hospital or at the Pediatric Ouptatient facility at University Hospital. The goal of this twice-per-week clinic is to provide health care management and neurodevelopmental assessments of infants born at < 1500 grams or who were identified in the newborn period with ongoing complex medical issues. Under the direction of Rajam Ramamurthy, M.D., Medical Director, the clinic provides a transition for high-risk neonatal patients following discharge from the NICU to care in the general pediatric clinic. Fellows will become skilled in the longitudinal follow-up and evaluation of discharged infants and aware of the socioeconomic impact and psychosocial stress that such infants may place on a family. Residents are also encouraged to attend an elective summer camp for children with disabilities and/or take a course in developmental disabilities.


Second and Third-Year Fellows

The second and third-year fellows will advance and refine the skills they acquired in the first year while increasing their research activity. The clinical block responsibilities are similar in the second and third year, except that the second-year fellow is required to take one block elective at Wilford Hall Medical Center, which has both Air Force and Army neonatologists assigned to the San Antonio Military Pediatric Center. Brian H. Hall, MD, LtCol, USAF, MC, is Chief, Division of Neonatology. The NICU population is derived from a perinatal delivery base that includes 2000 deliveries at Wilford Hall Medical Center and 3000 deliveries at Darnall Army Medical Center at Ft. Hood. At Wilford Hall, the fellow is exposed to the Military Service NICU and will manage infants undergoing extracorporeal membrane oxygenation (ECMO).

The third-year fellow has a required, 4-week Pediatric PICU rotation at CHRISTUS Santa Rosa Children's Hospital which houses the largest pediatric cardiothoracic center in South Texas. During this rotation, fellows work, with pediatric intensivists, anesthesia, cardiology, and cardiothoracic surgery teaching staff in learning to diagnose and appropriately manage the care of pre- and post-operative neonates and infants with congenital heart defects. The PICU staff and Pediatric CT surgeons supervise fellows. During the third year of training, fellows have four blocks of clinical service, in addition to their continued in-hospital on-call responsibility.

Electives available during the fellowship include:

  • NICU rotations at an outside Level III or IV hospital (if the hospital is a non-academic center, fellows participate directly in patient care under the supervision of a private, community-based neonatologist)
  • Fetal Diagnostic Unit
  • Pediatric Cardiology, Academic or Office Practice
  • Clinical Statistics