University Hospital NICU:
The NICU is a 30,000 square foot facility located on the fifth floor of University Hospital with 28 beds for Level III care (intensive care) and 25 beds for Level II care (intermediate care). Over 3,000 newborns are admitted annually to the University Hospital, including 600 admissions to the NICU. A typical daily census in the NICU includes 16 Level III patients and 12 Level II patients. 
During the first month of training, fellows are directly involved in primary care of NICU patients at University Hospital. They also supervise members of the NICU team including pediatric and other residents, medical students and neonatal nurse practitioners. This opportunity allows the program director and other neonatal staff 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. The fellows assist in the management of patients assigned to the Attending Physician in the NICU, make daily work rounds with the NICU team, and will present and discuss patient issues (including all new admissions and updates from existing NICU patients) to the neonatal group at morning report.
Fellows assist the attending staff in providing teaching and actively assist in patient care management decisions. They provide back-up for the pediatric residents and nurse practitioners when they attend required conferences or continuity clinics and attend all surgical procedures performed in the NICU or operating room. Fellows participate in the transport process, taking initial calls, organizing the team and arranging transport as well as accompanying and leading the transport team if necessary. Fellows initially address all consultation requests by the obstetricians and referring pediatricians and neonatologists. They assist in the management of all ongoing clinical research studies in the NICU. As experience and skill levels improve, the fellow is given increasing responsibility and autonomy, including supervising morning rounds. Regardless of level of autonomy, the faculty staff is notified as quickly as possible of all Level III admissions and potential transports, or significant changes in status of NICU admitted infants. Faculty is notified of all non-urgent Level II admissions within 8 to 12 hours.
Fellows are responsible for writing Neonatal Resident admission notes, transport notes, and on-call notes for significant clinical events. In addition, they are responsible for arranging family meetings and assuring appropriate follow-up care for high-risk patients. Educational conferences (morning report, didactic lectures, journal clubs, board review conferences, discharge planning meetings) take priority over all but urgent patient care and unique training opportunities, and staff coverage is arranged to allow participation in all educational activities.
During the PGY5 and PGY 6 years, the resident will be allowed increased responsibility in patient management. They will demonstrate not only clinical skills but will be responsible for training and evaluating the pediatric residents as well. Staff backup and oversight will always be present and available. The primary goal is to ensure that the resident is a competent independent practitioner at the completion of their PGY6 year. Senior residents continue to organize and run AM report with more autonomy than per PGY 4 and 5 years.
Follow-up care of infants hospitalized at University Hospital is provided at University Hospital Pediatric Specialty Clinic and CHRISTUS Santa Rosa Children's Hospital Pediatric Clinic.
University Hospital is a component of the University Health System, a tax supported agency whose primary responsibility is to furnish medical care to indigent and needy residents of San Antonio and the surrounding Bexar County. University Hospital, a 604-bed acute care hospital, is the primary teaching facility for The University of Texas Health Science Center at San Antonio.
University Health System is one of the most prestigious health care systems in South Texas. University Health System has achieved many medical "firsts" for South Texas, including the first heart, lung and heart-lung transplants, as well as the first newborn heart transplant. University Health System is renowned for having one of the largest transplant programs in South Texas.
Wilford Hall Medical Center NICU:
Wilford Hall Medical Center/Lackland AFB has a Level III Neonatal Intensive Care Unit with ECMO capability. 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. Fellows participate in all NICU care when on service at the Wilford Hall Medical Center in a similar manner to that described for the University Hospital NICU. However, this rotation, during PGY-4 or PGY-5, offers fellows exposure to a different patient population, including extracorporeal membrane oxygen transport (ECMO) care. The fellows receive their initial training in the procedures of ECMO (if applicable). Once trained, they become the supervised team leaders when caring for patients who require ECMO.
Wilford Hall Medical Center is the US Air Force's largest medical facility, providing complete medical care to military healthcare beneficiaries in the south central United States as well as specialized care to patients referred from all over the world. Wilford Hall's patient care mission includes more than 16,000 inpatient admissions per year, and more than 700,000 clinic visits. The medical center provides the entire range of care from sick call to surgery, and serves as the national center of excellence for a number of programs. The medical center operates the only programs in the Department of Defense for allogeneic bone marrow transplantation and the military's only eye bank. The organization operates the Air Force's treatment and evaluation center for HIV. Wilford Hall OB-GYN and neonatology programs are recognized around the world. 
CHRISTUS Santa Rosa Children's Hospital PICU:
The main purpose of this rotation during PGY-6 is for senior fellows to further their understanding of both the diagnosis and management of congenital heart disease (CHD) in neonates. Fellows are directly supervised by the pediatric intensive care faculty at CHRISTUS Santa Rosa Children's Hospital, and have multidisciplinary interaction with pediatric cardiology, cardiothoracic surgery, and anesthesia staff. Fellows primarily follow and make decisions on all neonatal and infant patients with CHD admitted to the unit for surgical repair of their disease. Didactic teaching is given during daily rounds with the PICU and cardiology faculty, as well as weekly grand rounds with pediatric cardiothoracic surgery. Fellows participate in any procedures required for their patients both pre- and post-operatively while in the PICU, and directly observe operative management by CT surgery and anesthesia in the operating room. They also participate in diagnostic management of patients with cardiology to include involvement with pre-operative echocardiograms and cardiac catheterizations, as well as through attendance of a weekly cardiac care conference. Additionally, fellows present their patients to the neonatal staff and other fellows weekly during their rotation and present one didactic lecture related to CHD during the rotation.
CSRCH pediatric housestaff provide care for children on two general pediatric ward services, an inpatient pediatric hematology/oncology service, a pediatric intensive care unit, and the children's emergency center. There are 2,600 admissions annually to the general pediatric ward services, 600 admissions to the hematology/oncology service, and 1,400 admissions to the 29 bed PICU. Patients admitted to the Children's Hospital come not only from the immediate San Antonio metropolitan area but also from west and deep South Texas. More than 400 patients per year are admitted after land or air transport by the Children's Hospital's highly skilled physician/nurse transport team. There are 56,000 annual visits to the dedicated Children's Hospital emergency center.
PREMIEre Clinic
The PREMIEre Clinic meets at two locations. On Tuesdays at the Goldsbury Center for Children and Families, Christus Santa Rosa Children's Pavilion and on Wednesdays at the Children's specialty clinic in the University Hospital. The clinic provides developmental assessment and intervention planning for very low birth weight premature infants and infants with complicated NICU course who are referred by the primary care physician from any NICU in South Texas.
Research
A variety of research facilities are available to the fellows:
- 1100 square feet of laboratory space equipped for molecular biology and cellular physiology investigation;
- Separate laboratory for small animal ventilation; equipped with a computer-monitored premature rabbit ventilator system (capable of ventilating 20 premature rabbits simultaneously);
- Animal care and laboratory facilities for neonatal specialty resident's bench research projects in UTHSCSA facilities;
- Access to the Southwest Foundation for Biomedical Research, a facility housing the largest primate research colony in the United States, for projects by the neonatal faculty and residents.
Resources for clinical research include the University Hospital NICU, a 30,000 square foot facility with 28 beds for Level III care and 25 for Level II care. Within the perimeter of the NICU clinical research is facilitated by:
- a clinical laboratory staffed by 24 hours/day technicians to perform blood gas, glucose, bilirubin, hematocrit, and electrolyte analyses;
- a pharmacy staffed 54 hours/week and equipped with controlled temperature refrigerator and freezer;
- a 250-square foot research laboratory;
- dedicated equipment for performing and imaging digital radiographs;
- dedicated supply and respiratory therapy facilities;
- a dedicated "bay" for surgery or isolation;
- separate office facilities for neonatal faculty and residents equipped with separate desktop computers and Internet access;
- conference rooms and parent education rooms;
- a dedicated elevator connecting the NICU to labor and delivery one floor below; and
- electronic bedside medical charting. The focus of many of the clinical research programs are investigation of new or untested therapeutic interventions in the critically ill and very low birth weight neonates.
UTHSCSA Library
The mission of the UTHSCSA Library is to advance the teaching, research, patient care, and service programs of The University of Texas Health Science Center at San Antonio and the health care programs of South Texas by providing library services and access to biomedical information fundamental to maintaining health and treating and preventing disease.
There are 21 librarians and 36 support staff who provide library services for the system which is comprised of: the Dolph Briscoe, Jr. Library; the Brady Green Library at the University Health Center-Downtown; the library at the Regional Academic Health Center in Harlingen; the library at the Regional Academic Health Center in Laredo; and the Circuit Librarian Health Information Network (CLHIN), which provides information services to hospitals in the border region of South Texas.
The Library offers a variety of education opportunities on a regular schedule and by special request. Scheduled classes, such as searching the web for biomedical information, using web-based bibliographic tools, and searching OVID and other databases, are announced in the monthly Library News, on the Library web site, and through posted flyers.
The Dolph Briscoe, Jr. Library, on the UTHSCSA Main Campus, was constructed to serve as the library for the five schools--Medical, Dental, Nursing, Allied Health, and Graduate--of the university. The Library building has more than 75,000 square feet of public space with a comprehensive collection of resources, e.g. 221, 927 book and journal volumes, 2,867 print and electronic journals in the health sciences, 4,532 print and electronic journals in all subjects. There are also interlibrary loan and desktop delivery services.
