Neonatology Fellows Research Articles

Continuous improvement of non-emergent neonatal intubations in a level IV NICU.

We sought to improve practices and outcomes related to non-emergent neonatal intubations in a level IV academic Neonatal Intensive Care Unit. A multidisciplinary team created guidelines for non-emergent neonatal intubations. In period 1, premedication practices were standardized. In period 2, paralytic use and video laryngoscope use were recommended. Premedication and video laryngoscopy practices were assessed along with number of intubation attempts and frequency of bradycardia and desaturation. 636 intubations performed by neonatology fellows and neonatal advanced practice providers were reviewed over six academic years. Two academic years were included in each of the following study periods: baseline, period 1, and period 2. In our unit, compliance with recommended premedication practices and administration of paralytic medication has increased considerably, and video laryngoscopy is now utilized in most of our procedures. The frequency of intubation success on the first attempt has increased, and the frequency of both bradycardia and desaturation during intubation has decreased. In our analysis, paralytic use (AOR 2.41, 95 CI (1.53, 3.81)) and the combination of paralytic and video laryngoscopy (AOR 4.07, 95 CI (2.09, 7.92)) are associated with increased odds of intubating successfully on the first attempt. This initiative increased the use of standardized premedication, paralytic medication and video laryngoscopy for non-emergent neonatal intubations with temporally associated improvement in patient outcomes including fewer intubation attempts and reduction in physiologic instability.

Development of a neonatal cardiac curriculum for neonatal-perinatal medicine fellowship training.

The topic of neonatal cardiovascular care in neonatal-perinatal medicine (NPM) fellowship training has continued to transform due to increased complexity of patients, development of specialized units, continued Accreditation Council for Graduate Medical Education requirements, and clinical practice variation across centers that care for neonates with congenital heart disease (CHD). We developed a neonatal cardiac curriculum comprised of eight interactive sessions with novel active learning concepts specific to our NPM fellows. A self-assessment survey in comfort in managing infants with CHD and perceived competency in neonatal cardiology topics was performed by all neonatology fellows at baseline and after completion of the curriculum. The American Board of Pediatrics Subspecialty In-training Exam (SITE) scores for fellows were compared to that of the national average. The average comfort score (0-100) of the first-year fellows increased from 33 to 76, and that of the second and third-year fellows increased from 72 to 86, and 75 to 86, respectively. The first-year fellows improved their competency score by 44 points (3 standard deviations), the second-year fellows improved their score by about 26 points (one standard deviation), and there was an overall 9-point increase in the competency score of all fellows (one standard deviation). The average local SITE score was lower than the national average before the initiation of this curriculum, became nearly equal to the national average score at the end of the first year the curriculum was implemented, and has progressively become higher since then. Due to the variable clinical exposure and differing practice models of managing CHD a neonatal cardiac curriculum may be beneficial to NPM trainees.

The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study

BackgroundIn this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates.MethodsThis study employed a qualitative study design using inductive thematic discourse analysis of ‘naturally occurring data’ in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists’ discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters.ResultsIn this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus’s presence, and (iii) fetal role in decision-making.ConclusionDiscourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM.

Umbilical Venous Catheter Position: The Value of Acquiring a Lateral in Addition to a Frontal Chest Radiograph.

Introduction Umbilical venous catheters (UVCs) are standardly used for central venous access in acutely sick neonates. Complications associated with UVCs include thrombosis, infection, diffuse intravascular coagulopathy, arrhythmia, tamponade, and liver injury, many of which are related to misplacement of the catheters. Therefore, this study aimed to institute a policy of obtaining lateral and frontal radiographs to improve the determination of the UVC position. Methods We retrospectively reviewed UVC placement from 132 radiographs. We compared interpretations by different reviewers of frontal versus frontal and lateral chest radiographs for the most accurate determination of the UVC position. The reviewers completed questionnaires indicating their assessment of the catheter tip position, as well as the appropriate catheter manipulation required for optimal positioning. Their assessment was derived from frontal chest radiographs followed by frontal plus lateral view radiographs a week later. Results The reviewers (junior neonatology fellow, senior neonatology fellow, pediatric radiology fellow, and senior pediatric radiologist) revised their assessment with regard to the UVC positioning between frontal and frontal plus lateral radiographs in 24.6%, 22.7%, 19.6%, and 15.9% of cases, respectively, and indicated that the lateral view was helpful in 18%, 13.6%, 19.6%, and 31% of the cases, respectively. UVCs were placed appropriately at the first attempt in only 13.6% of the cases. Conclusion Correct initial placement of a UVC is uncommon. A lateral radiograph is beneficial in determining the UVC position. Hence, we suggest the inclusion of a lateral view along with the frontal chest radiograph for the evaluation of the UVC position if real-time ultrasound cannot be performed before UVC usage.

Neonatologists' Perspectives on Exploring Parental Spirituality in Prenatal Consultations.

Values of religion, spirituality, and faith (RSF) are central to decision making for many parents facing extremely preterm labor or prenatal diagnoses of potentially life-limiting congenital anomalies. Neonatologists' opinions and comfort with discussing parental RSF are not well known. We sought to understand neonatologists' current practices and perceptions of exploring parental RSF in prenatal consultations. A retrospective chart review was performed at a single U.S. academic institution to evaluate the inclusion of spiritual terminology in documentation. All mothers who were admitted with anticipated extremely preterm delivery as well as those with prenatal diagnoses of potentially life-limiting congenital anomalies were included in analysis. After chart review, an anonymous survey was distributed to neonatology attendings and fellows to examine perspectives on exploring parental RSF. The chart review indicated that RSF terminology was absent from the documentation of all prenatal consultations performed by neonatology. Sixty-five percent of survey respondents considered RSF important in their personal lives and 47% considered RSF important in clinical practice. The three most significant barriers to exploring RSF were lack of training or education in spiritual care, differences between physicians' and patients' personal beliefs, and insufficient time. Our study highlights a gap between the goal for prenatal counseling in cases of extreme prematurity and potentially life-limiting congenital anomalies and current practices that frequently exclude the values most important to many parents. Lack of training in spiritual care is a significant barrier to neonatologists exploring parental RSF.

Understanding the Factors that Determine a Fellow's Choice in Neonatal-Perinatal Medicine and How They Establish Their Rank List.

Little is known about why neonatology fellows pick the fellowship program they do. Understanding why fellows choose neonatology and rank their programs would be of benefit to program leadership and to other applicants. This was a survey study sent to current neonatology fellows in the United States between September 2020 and October 2020, and were asked to rank their choices on a Likert scale. Respondents were also able to give free text responses to open-ended questions. The most important factor fellows state for choosing their program was location, with multiple reasons given. There were significant differences in how certain subgroups ranked programs. Location of the fellowship program is the most important factor for fellows. There are differences within subgroups of fellows on how they rank their fellowship program. Fellowship directors can use this information to better inform selections on who to interview and how to rank fellows. · Patient population appears to be the most important reason why fellows choose neonatology.. · Program location is the most important reason why fellows choose their specific training program.. · Fellowships can continue to highlight fellow camaraderie, scholarship, and clinical opportunities..

Evaluation of a course for neonatal fellows on providing psychosocial support to NICU families.

Families in the Neonatal Intensive Care Unit (NICU) experience significant psychological distress. Fellowship training requires education on mental health issues. No standardized program exists. We evaluated the impact of an online course, combining research with family perspectives, on neonatology fellow knowledge and self-efficacy when emotionally supporting NICU families. Fellows from 20 programs completed a course covering: (1) Parent Mental Health, (2) Infant Mental Health, (3) Communication, and (4) Comprehensive Mental Health (e.g., discharge, bereavement) with pre- and post-course knowledge and self-efficacy assessments. Fellows (n=91) completed the course and assessments. Pre-course knowledge was similar by year of training (1st: 66.9%; 2nd: 67.2%; 3rd: 67.4%). Mean knowledge and self-efficacy improved between pre- and post-course assessments regardless of training year or prior education for knowledge (d=1.2) (67.1% vs. 79.4%) and for self-efficacy (d=1.2) (4.7 vs 5.2 on 6-point Likert scale). Fellows who gained more knowledge had higher self-efficacy scores at post-test (r = .37). Current neonatal fellowship training under-educates on mental health. An online course improved fellow knowledge and self-efficacy. Our course may be an exemplar for others creating similar curricula. An online course enriched by patient perspectives is an effective method of disseminating education around mental health.

Effectiveness of Simulation Training in Acquiring Echocardiography Skills among Neonatology Care Providers.

The objective of this study was to test the hypothesis that simulation training improves echocardiography skills. In this prospective study, 43 participants (16 neonatologists, 26 neonatology fellows, and 1 nurse practitioner) were tested on the simulator after 4 hours of didactic sessions on topographical cardiac anatomy and standard echocardiographic views. Participants were given 20 minutes to obtain and save the standard views. After the simulation hands-on training for 8 hours over 3 days, they were tested again. Each image was scored from 0 to 3 based on the image quality. Pre- and postsimulator training data were compared using both automated and visual scoring methods. After the hands-on simulator training, the automated median (interquartile) score for the quality of acquired images increased from 36 (22, 43) to 55 (48, 58), p < 0.0001. The increase was similar using visual scoring. The number of views with acceptable or good image quality (scores of 2 or 3) increased from 11 (6, 16) to 20 (17, 21), p < 0.0001. The neonatology fellows and faculty, as well as those with or without prior echocardiography experience, demonstrated significant improvement. Echocardiography simulation is an effective tool in improving echocardiography skills among neonatology care providers. · Simulation is effective in acquiring echocardiography skills among neonatology care providers.. · Simulation improves image acquisition in those with and without prior echocardiography experience.. · Effectiveness of simulation in retaining the acquired echocardiography skill should be investigated..

A National Virtual Job Search Series for Neonatal-Perinatal Medicine Fellows.

Trainees report stress and unfamiliarity with the job search and have few resources available to guide them.1 They struggle with identifying job openings, writing cover letters, identifying opportunities that align with their academic or clinical interests, and navigating specialty-specific expectations for applying, interviewing, and negotiating a job. No standard approach exists on how best to prepare trainees for finding and transitioning to their first attending jobs. To our knowledge, an attempt to provide comprehensive national education on strategies to find, obtain, and negotiate the first post-fellowship job has not been described in graduate medical education (GME) literature.We describe a virtual 7-part job search series for neonatal-perinatal medicine (NPM) fellows. The American Academy of Pediatrics' Organization of Neonatal-Perinatal Medicine Training Program Directors (ONTPD) and Trainees and Early Career Neonatologists (TECaN) co-hosted 1-hour virtual seminars (Table) on Zoom in spring and fall 2021. Sessions were advertised through social media platforms, website postings, and subspecialty listservs. Fellows registered and submitted questions for sessions via an electronic survey. Demographic information and baseline job search knowledge were collected. Sessions included didactics on the timeline and expectations of the job search, the experiences of applicants underrepresented in medicine, gender pay inequity, and job search fundamentals (eg, preparing a curriculum vitae and cover letter, contract negotiation, etc) as well as career panel discussions with moderators (Table). Trainees were given opportunities to moderate and organize these sessions to enhance their networking and academic opportunities. Questions submitted by registrants were answered by invited panelists during the live session. Written summaries and follow-up questions and answers were emailed to registrants upon session completion. Sessions were recorded and archived on the TECaN website.During the 2021-2022 academic year, 265 individuals registered for the series, with 53% (140 of 265) currently undergoing a job search. Registrants spanned 33 states and 2 countries. Seventy-eight percent (207 of 265) of registrants were female, 90% (238 of 265) were neonatology fellows, and 48% (127 of 265) were senior year fellows. A large group of registrants did not feel competent writing a cover letter (49%, 130 of 265) or marketing themselves (52%, 137 of 265). Ninety-one percent (241 of 265) lacked basic understanding of malpractice insurance. Less than 25% reported being “very knowledgeable” or “knowledgeable” of job search components, such as the general roles and responsibilities of junior faculty, the timeline of the job search, typical starting salaries in their desired locations, and contract negotiation.In post-session surveys, registrants' feelings of competence in writing a cover letter and marketing themselves increased to over 80%. More than 80% reported being “very knowledgeable” or “knowledgeable” of job search components. More than 90% reported that they would be “very likely” or “likely” to recommend the sessions to others, and more than 70% reported that they were going to change their approach to the job search because of the sessions.No funding was needed to implement the series. Organizers utilized their networking circles to identify a diverse group of recently graduated fellows and early and later career neonatologists to comprise the series' career panels. Additional time commitments included collating registrant questions for the panelists, identifying moderators, advertising the sessions, and distributing resources and post-session surveys to registrants. Ongoing analysis of survey data will help guide the development and improvement of future job search series.We identified a knowledge gap in NPM fellows' understanding of how to find their first attending job, and we describe a national structured approach to preparing trainees for the job search. We strongly believe this knowledge gap is not unique to NPM fellows and that all GME trainees would benefit from a similar, easy-to-implement, low-cost job search series.

The Hidden Impact of Neonatology Boot Camp: A Qualitative Study.

Simulation-based boot camps have been evaluated by fellows as an effective way to learn, to improve self-confidence, and to prepare for new responsibilities. However, existing studies do not explore how boot camps may contribute to other critical aspects of trainee development. Our objective was to use qualitative research methodology to characterize trainees' experiences of boot camp and its impact on their professional development. This study used a phenomenological framework to explore fellows' experience of boot camp. Semistructured phone interviews were conducted with first-year neonatology fellows after attending the Regional Neonatology Boot Camp. Interviews were transcribed and coded for themes. The authors continually evaluated the coding categories in an iterative process until consensus was reached. Seventy-seven first-year neonatal-perinatal medicine fellows representing 16 fellowship programs participated in the Regional Neonatology Boot Camp in 2016 and 2017. Fifteen fellows from 10 institutions were interviewed before reaching thematic saturation. Five themes were identified: introspection about starting fellowship, learning to lead and communicate, gaining reassurance from the shared experience, understanding the fellow role, and developing future identity as a neonatologist. Participation in boot camp enhances fellows' professional identity formation (PIF) by incorporating key aspects of socialization, including role models and mentors, a variety of experiential learning, and opportunities for conscious self-reflection. In designing future boot camp experiences, educators should integrate these elements into the curriculum to support PIF and explicitly state PIF as a learning objective.

Framework for Considering Abnormal Heart Rate Characteristics and Other Signs of Sepsis in Very Low Birth Weight Infants.

A heart rate characteristics index (HeRO score), incorporating low variability and superimposed decelerations, was developed as a sepsis risk indicator for preterm infants in the neonatal intensive care unit (NICU). A rise in the risk score should prompt consideration of other clinical changes that may be signs of sepsis to decide whether a workup and antibiotics are needed. We aimed to develop a framework to systematically consider signs potentially indicating sepsis in very low birth weight (VLBW) infants. We developed easy-recall acronyms for 10 signs of sepsis in VLBW infants. Over 12 months in a level IV NICU, neonatology fellows completed a brief survey after each shift to document changes prompting sepsis workups. We analyzed associations between survey data, hourly heart rate characteristic data, and the diagnosis of the workup, grouped as culture-positive sepsis (CXSEP, positive blood or urine culture), clinical sepsis (CLINSEP, negative cultures treated with antibiotics ≥5 days), or sepsis ruled out (SRO, negative cultures and <3 days antibiotics). We analyzed 93 sepsis workups in 48 VLBW infants (35 CXSEP, 20 CLINSEP, and 38 SRO). The most frequently cited changes prompting the workups were heart rate patterns and respiratory deterioration, which were common in all three categories. Low blood pressure and poor perfusion were uncommonly cited but were more likely to be associated with CXSEP than the other signs. A rise in the HeRO score ≥1 from 0 to 12 hours before compared with 12to 72 hours prior the blood culture occurred in 31% of workups diagnosed as CXSEP, 16% CLINSEP, and 31% SRO. The HeRO score can alert clinicians to VLBW infants at high or increasing risk of a sepsis-like illness, but heart rate characteristic patterns are highly variable in individual babies. The easy-recall NeoSEP-10 framework can assist clinicians in considering other clinical changes when making decisions about sepsis workups and the duration of antibiotics. · Abnormal heart rate characteristics can indicate sepsis or other pathologies in preterm infants.. · We developed a simple bedside tool to consider clinical signs potentially associated with sepsis.. · Considering vital sign trends together with clinical changes is a key to right-timing antibiotics..

Provider concordance regarding elements of goals-of-care discussions in neonatal intensive care.

Acta PaediatricaVolume 111, Issue 4 p. 776-778 BRIEF REPORT Provider concordance regarding elements of goals-of-care discussions in neonatal intensive care Katherine Guttmann, Corresponding Author Katherine Guttmann katherine.guttmann@mssm.edu orcid.org/0000-0001-6136-4834 Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York City, New York, USA Correspondence Katherine Guttmann, Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY 10029, USA. Email: katherine.guttmann@mssm.eduSearch for more papers by this authorBian Liu, Bian Liu Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorAmy Kelley, Amy Kelley Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this author Katherine Guttmann, Corresponding Author Katherine Guttmann katherine.guttmann@mssm.edu orcid.org/0000-0001-6136-4834 Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York City, New York, USA Correspondence Katherine Guttmann, Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY 10029, USA. Email: katherine.guttmann@mssm.eduSearch for more papers by this authorBian Liu, Bian Liu Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorAmy Kelley, Amy Kelley Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this author First published: 22 December 2021 https://doi.org/10.1111/apa.16235 Funding information: Dr. Kelley's work was funded by NIA K24AG062785. This work was funded by the Children's Hospital of Philadelphia Division of Neonatology fellow's research fund. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume111, Issue4April 2022Pages 776-778 RelatedInformation

Developing a digitally innovative ethics and professionalism curriculum for neonatal-perinatal medicine fellows: a 3-year multicenter pilot study.

The purpose of this study was to develop and regionally pilot a digitally innovative curriculum in ethics and professionalism in neonatology and study the effects on trainee knowledge and confidence. We developed 13 modules in ethics for neonatology fellows and piloted them at three academic institutions utilizing a flipped-classroom approach. Baseline surveys in ethics knowledge and confidence in approaching ethical dilemmas were compared with repeat surveys after curriculum completion. Pre- and post-tests were also administered for all 13 modules. Forty-four of 49 eligible fellows participated (90% response rate). Pre/post comparisons demonstrated significant improvements in overall knowledge and in 8/13 modules, as well as improvement in overall confidence and individually when navigating 16/22 ethical dilemmas. After completing this curriculum, participants' knowledge scores and reported confidence in approaching ethical challenges significantly improved. Future steps include assessing the effects of this innovative curriculum via an ongoing international pilot.

Knowledge, Attitudes, and Perceptions about Antibiotic Stewardship Programs among Neonatology Trainees.

Antibiotic stewardship should be an essential component of neonatology training as neonatal intensive care units (NICU) have unique stewardship needs. Our aim was to assess neonatology fellowship trainees' knowledge, attitudes, and perceptions about antibiotic stewardship to inform sustainable curriculum development. We distributed an electronic survey to neonatology fellows in the United States over 4 months (January-April 2018) via Accreditation Council for Graduate Medical Education program directors. Of 99 programs in the United States with an estimated 700 fellows, 159 (23%) fellows from 52 training programs (53%) responded to the survey and 139 (87%) provided analyzed responses. Majority of respondents were training in southern (59; 42%) and northeastern (43; 31%) regions and were equally spread across all 3 years of training. One hundred (72%) respondents reported an antibiotic stewardship program (ASP) in their institution. While 86% (120/139) were able to identify the components of an ASP, 59% (82/139) either did not or were unsure if they had received antibiotic stewardship training during fellowship.Furthermore, while answering case studies, 124 (89%) respondents identified the optimal antibiotic for methicillin susceptible Staphylococcus aureus (MSSA) infection and 69 (50%) respondents chose appropriate empiric antibiotics for neonatal meningitis. Notably, fellowship training year was not significantly related to the proportion of incorrect knowledge responses (p = 0.40). Most survey respondents (81; 59%) identified small group sessions as the most useful teaching format, while others chose audit and feedback of individual prescribing behavior (52; 38%) and didactic lectures (52; 38%). Finally, ninety-five (69%) respondents preferred trainee-led ASP interventions targeting focal areas such as antifungal and surgical prophylaxis. Antibiotic stewardship is a critical part of neonatology training. Neonatology fellows report variation in access to ASP during their training. Fellows prefer dedicated trainee-led interventions and stewardship curriculum taught within small group settings to promote targeted NICU ASP. · Most neonatology programs expose trainees to internal or external antibiotic stewardship programs.. · Over half of fellow trainees are unsure about receiving targeted antibiotic stewardship training.. · Most neonatology fellows prefer a trainee-led antibiotic stewardship intervention..

Pivot and Persist: A Technical Report on Adapting an Existing Multi-Institutional Bootcamp to a Hybrid Platform.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted most in-person simulation training, including established simulation-based medical bootcamps. These sessions are important for the preparation of new trainees to think critically about common clinical scenarios, practice technical skills, and optimize leadership, teamwork, and communication. Having the opportunity to hone these skills in a safe environment is instrumental for the development of trainees’ confidence and professional identity formation, and may contribute to patient safety.When the annual New England/Mid-Atlantic regional first-year neonatology fellows’ bootcamp was jeopardized by COVID restrictions, we implemented a novel approach to adapt the existing in-person format and curriculum for large-scale hybrid delivery. The resultant two-day session was well-received by both participants and facilitators. Important lessons from this experience, including adaptions to the curriculum, schedule, simulation interface and hybrid platform, are relevant to educators seeking to conduct large-scale virtual simulation-based educational sessions.

Türkiye’deki Yenidoğan Hekimlerinin Klinik Ultrasonografi Kullanımı ve Bakışının Değerlendirildiği Ulusal Anket Çalışması

Introduction: There is no information about the clinical ultrasonography (US) use, opinion and experiences in neonatal physicians in Turkey. The aim of our study is to evaluate the attitudes, preferences, frequency of use and perspectives of neonatal physicians in our country regarding clinical use of US. Materials and Methods: The study was conducted through a survey with the participation of neonatal physicians in Turkey with electronically between 1 February to 1 March 2020. The information about participants’ age, gender, type of institution, experience period in neonatal intensive care and academic title were recorded. The participants were asked questions such as whether they use US in the clinic, if they are using, which part of body and for which intervention, and whether they received training for this purpose. The attitudes about Clinical US were evaluated using a 5-point Likert scale. Results: 120 neonatal physicians participated in the study. The average age of the participants was determined as 40.38 ± 5.24 years. While 90% (n=108) of the participants had US devices in their clinics, the use of frequency of US among the participants was found as 69.1% (n=83). There was no difference between groups in the answers according to academic title about US device availability in the clinic, use of, participation in clinical US training, pediatric radiology rotation in the neonatal fellow education program,use of US for cranial US, abdominal US and central vein catheterization (p>0,05). Lung US use was found at a significantly higher rate in the neonatology fellows group (86.7%) compared to other academic titles (p<0.05). Conclusions: The study is the first national study in its field. It has been determined that US, which has an important role in the diagnosis, monitoring and treatment of the critically ill group in Turkey, is not used effectively by neonatal physicians.

Neonatal Cardiac Emergencies: A Multidisciplinary Simulation Curriculum for Neonatology and Pediatric Cardiology Fellows.

IntroductionAlthough care for neonates with cardiac disease is frequently provided by neonatologists and pediatric cardiologists, training in the multidisciplinary management of neonatal cardiac emergencies is not often included in fellowship training. We created a multidisciplinary simulation curriculum to address the skills needed for neonatal cardiac care.MethodsNeonatology and pediatric cardiology fellows participated in 1-hour simulations on 3 different days. They managed a neonate with: (1) cyanosis, (2) cardiogenic shock, and (3) an unstable arrhythmia. Using both remote consultation and bedside evaluation, the participants diagnosed and jointly established a management plan for the infant. During the debrief, facilitators reviewed the clinical decisions and multidisciplinary management skills of the participants. Participants completed pre- and postparticipation surveys to evaluate the curriculum's effect on their confidence in the management of neonatal cardiac disease.ResultsThirty-three paired survey responses from 20 participants (11 neonatology and 9 pediatric cardiology) reported a mean overall satisfaction score of 4.6 (SD = 0.7) based on a 5-point Likert scale. Postparticipation confidence scores improved significantly in: (1) the recognition of the signs of congenital heart disease (pre = 4.1, post = 4.5, p = .01), (2) differentiation of cardiac cyanosis from noncardiac cyanosis (pre = 3.9, post = 4.2, p = .05), and (3) confidence in discussing cardiac concerns with consultants (pre = 3.3, post = 4.1, p = .02).DiscussionThis multidisciplinary simulation improved fellows’ confidence in the management of neonates with cardiac disease and provided an opportunity to practice team work, remote consultation, and cross-disciplinary communication.

Clinical Documentation Improvement: Transitioning to Neonatologist Driven Progress Notes

Clinical Documentation Improvement: Transitioning to Neonatologist Driven Progress Notes Purpose: Our purpose was to implement a consistent documentation standard for a neonatology provider group including neonatal advanced practice providers (APP), neonatology fellows and neonatologists serving at a level four tertiary care Neonatal Intensive Care Unit (NICU). Primary outcomes included consistent note content, timeliness of note completion, and overall provider time spent in documentation. Secondary objectives included clinician satisfaction with the new standard and usefulness of the daily note to consulting services and other clinical team members Methods: …

A National Survey on Physician Trainee Participation in Pediatric Interfacility Transport*

To ascertain the national experience regarding which physician trainees are allowed to participate in pediatric interfacility transports and what is considered adequate education and training for physician trainees prior to participating in the transport of children. Self-administered electronic survey. Pediatric transport teams listed with the American Academy of Pediatrics Section on Transport Medicine. Leaders of U.S. pediatric transport teams. None. Forty-four of the 90 U.S. teams surveyed (49%) responded. Thirty-nine (89%) were university hospital-affiliated. Most programs (26/43, 60%) allowed trainees to participate in pediatric transport in some capacity. Mandatory transport rotations were reported for pediatric critical care (PICU) fellows (9/42, 21%), neonatology (neonatal ICU) fellows (6/42, 14%), pediatric emergency medicine fellows (4/41, 10%), emergency medicine residents (3/43, 7%), and pediatric residents (2/43, 5%). Fellow participation was reported by 19 of 28 programs (68%) with PICU fellowships, 12 of 25 programs (48%) with pediatric emergency medicine fellowships, and 10 of 34 programs (29%) with neonatal ICU fellowships. Transport programs with greater than or equal to 1,000 annual incoming transports were more likely to include PICU and pediatric emergency medicine fellows as providers (p = 0.04; 95% CI, 1.04-25.71 and p = 0.02; 95% CI, 1.31-53.75). Most commonly, trainees functioned as medical control physicians (86%), provided minute-to-minute medical direction for critically ill patients (62%), performed intubations (52%), and were code leaders for patients undergoing cardiopulmonary resuscitation during transport (52%). Most transport programs required pediatric residents, PICU, and pediatric emergency medicine fellows to complete a PICU rotation prior to participating in pediatric transports. The majority of transport programs did not use any metrics to determine airway proficiency of physician trainees. There is heterogeneity with regard to the types of physician trainees allowed to participate in pediatric interfacility transports, the roles played by physician trainees during pediatric transport, and the training (or lack thereof) provided to physician trainees prior to their participating in pediatric transports.

Standardizing the approach to late onset sepsis in neonates through antimicrobial stewardship: a quality improvement initiative.

Antibiotics are the most prescribed medication in the neonatal intensive care unit (NICU) and there is marked variation in their use. While they are vital for treatment of infections, they put infants at risk for infections with drug resistant organisms, alteration in their microbiome and several other morbidities. Specific guidelines for neonates are often lacking and our NICU is not compliant with late onset sepsis (LOS) guidelines. By January 2019, there will be >75% compliance with our LOS bundle for any infant admitted to Tampa General Hospital's (TGH) NICU undergoing a LOS evaluation at >72 h of life. The bundle includes documented reason for LOS evaluation, appropriate initial antibiotic selection, appropriate initial evaluation considered, and appropriate de-escalation of antibiotics. The project was implemented in the NICU at TGH, the academic medical center affiliated with the University of South Florida in Tampa, FL. The multidisciplinary antimicrobial stewardship (ASP) team responsible for the project consists of a neonatology attending, three neonatology fellows, a pediatric infectious disease attending, and two NICU pharmacists. The project was started in January 2017 and all data were collected prospectively. We implemented multiple Plan-Do-Study-Act cycles in a stepwise manner; outcome measures included compliance with the LOS bundle and ASP team recommendations. Our process measures were the documented reason for sepsis evaluation, appropriate initial evaluation considered, appropriate antibiotic selection and appropriate antibiotic de-escalation. Patient length of stay was the balancing measure studied. During this 20-month initiative, there were 232 infants who underwent LOS evaluation and there were 98 true positive cultures from blood (28%), urine (35%), and cerebrospinal fluid (3%). Commonly documented rationales for treatment of culture negative sepsis were clinical pneumonia (38%) and necrotizing enterocolitis (38%). Common indications for LOS evaluations were increased respiratory support (51%) and abdominal distension (17%). There was improvement in appropriate initial antibiotic selection (70% vs. 94%); appropriate consideration of initial evaluation (63% vs. 94%, respectively); appropriate de-escalation of antibiotics (86% vs. 100%, respectively) and increase in LOS bundle compliance (44% vs. 87%, respectively). The overall antibiotic utilization rate and length of treatment did not change significantly. Developing and engaging a NICU ASP team improves compliance with late onset sepsis guidelines through the implementation of a LOS bundle of care.