While on service in the NICU, fellows oversee the team and provide teaching for the residents, either formally or at bedside when possible. This team oversight may involve interacting with one of the many subspecialty services Children’s Hospital has to offer, as the NICU team rounds daily with both Cardiology and Pediatric Surgery.
The variety of patients admitted to CHW provides an unrivaled opportunity to master procedural skills. First year fellows are preferentially given procedural opportunities during the first six months of fellowship, and nearly all have become phenomenally competent during that time.
In addition to direct patient care of infants in the NICU, fellows attend deliveries and perform prenatal consults. Children’s Hospital of Wisconsin is affiliated with Froedtert Hospital (FH). FH has over 3,000 deliveries annually and is home to an expanding Maternal Fetal Medicine and High Risk OB program. CHW is recognized as both the top Children’s Hospital in the state, and also one of the most prestigious hospitals in the nation. Expecting parents are referred to CHW for many reasons, including prematurity, high-risk deliveries, and congenital anomalies. Our pediatric surgeons and MFM physicians have successfully conducted many fetal procedures, including meningomyelocele (MMC) repairs, bladder outlet obstructions, and fetal hydrops. These unique opportunities ensure that fellows will become skilled at not only typical neonatal resuscitations, but also in the delivery room management of complex congenital anomalies. The Labor and Delivery unit is conveniently located within the east tower of the Children’s Hospital building and is a short walk from the NICU.
Neonatal Developmental Follow-Up Clinic
All fellows will participate in the Neonatal Developmental Follow-up Clinic, which is run by our developmental pediatrician and follows NICU graduates up to age three. Fellows will attend clinic twice per month when not on service. This experience provides fellows with an opportunity to see the outcomes of our smallest and sickest patients, and provide fellows experience with the developmental assessment tools.
Newborn Nursery Rotation
During the first year, fellows will rotate through the newborn nursery for 2 weeks. During the rotation, fellows manage the resident team and are responsible for running rounds and staffing patients in the afternoon. The Newborn Nursery actually functions as a Level II NICU, and often has late premature infants and those requiring moderate intervention. Fellows will become familiar with the protocols and abilities of the Level II newborn nursery within Froedtert Hospital.
Maternal Fetal Medicine Clinic
During their second year, fellows rotate for two weeks in the maternal fetal medicine clinic. Fellows follow MFM providers to learn about the obstetrical management of our potential patients. Fellows attend prenatal consults with Neonatology faculty and pediatric subspecialists and observe fetal surgery if possible.
Second year fellows will also rotate for two weeks with the pediatric anesthesia department. CHW has a robust surgery service and a Pediatric Anesthesia service that provides exceptional care for neonatal patients. Fellows will learn more about the intraoperative management of neonatal patients, and observe the operative course for common NICU procedures. Fellows additionally have the opportunity for procedures such as intubations and IV insertions.
Cardiac ICU Rotation
During the third year of fellowship, fellows will rotate for two weeks in the cardiac ICU. While there, fellows will gain experience with the post-operative management cardiac conditions and ECMO. NICU fellow rotating through the CICU will provide care for post-operative neonates only.
Depending on the individual fellow's needs and desires, elective rotations will be designed throughout the fellowship for additional exposure to areas of particular clinical interest to the fellow (e.g. cardiology rotation with focus on neonatal echocardiography, radiology rotation with emphasis on neonatal ultrasounds and special procedures). Each elective is done for a period of one month and no more than one elective month may be requested for each subspecialty area.
The Neonatal-Perinatal Medicine Fellowship Referrer's Evaluation Form (PDF) must be attached with each of your LOR’s and uploaded in ERAS with your application.
For more information on how to apply for our program please go to the ERAS website.
If a physician is needed to go on a transport during the day, the fellow on the admitting team will go with the transport team. On nights and weekends, this responsibility is for the on-call fellow. Exceptions to this are if the fellow is unable to go on transports (pregnancy, illness, or other circumstances). The attending acting as medical control makes the final decision about who goes on transport after assessing the unit’s needs and acuity. On transport, the fellow is the “eyes and ears” for the faculty at CHW. They will perform procedural expertise as needed, and will provide medical care in coordination with the transport nurse and respiratory therapist. In addition, the fellow is the representative of CHW, and is responsible for communicating with the patient’s family members. Senior fellows also have the opportunity to serve as the “Junior Medical Control” by communicating with the referring physician and transport team in conjunction with the staff neonatologist.
In order to be eligible for transports, you will complete a short orientation to get familiar with the equipment used and review safety information for the helicopters. Fellows are required to document care provided during the transport.
The Division of Neonatology holds many academic conferences throughout the year to enhance fellow’s learning. Some of these conferences occur on a weekly basis, while others are monthly to bimonthly. Fellows are expected to participate in these conferences, and the level of responsibility is graduated based on fellowship level.
View list of conferences and didactic sessions (PDF)
Progression in Responsibilities
For each year of your fellowship, you will be given more responsibility in direct patient care and leading the care team. We expect that by the end of your third year, you will be functioning at the level of an attending and we will work with you to help you get there! Because of this graded responsibility, each year of your fellowship will look a little different.
- Develop clinical competence (5 months in the NICU and ½ month in the Newborn Nursery). You will master the procedural skills during the first 6 months by preferentially giving procedures to first-year fellows during this time.
- Attend the Neonatal Developmental Follow-up Clinic.
- Present two basic physiology conferences, one journal club, and at least one patient oriented conference during your service months.
- Attend the Joint Fellowship Curriculum of the Department of Pediatrics.
- Initiate research: Identify project, mentor, and Scholarly Oversight Committee (SOC). You will have two SOC meetings to evaluate your progress and provide guidance (see Research).
Fellows will gain procedural competence through time spent on service and on call in the NICU, in the delivery room, and through various clinical rotations during their fellowship. We feel that competence in the following procedures is necessary prior to completion of training:
- Needle aspiration of the chest and chest tube insertion
- Delivery room resuscitation
- Lumbar puncture
- PICC line insertion
- Peripheral arterial puncture and line insertion
- Umbilical line placement (both arterial and venous)
- Continue to develop clinical competence (3 months in NICU) but focus more on teaching residents and junior fellows. Two service months will be on resident teams (A or B) while one month will be on C team, staffed by one faculty members and 2-3 Neonatal Nurse Practitioners (NNP’s). During your C team month, you will have more opportunity to round independently, and gain the experience in providing care with nurse practitioners.
- Continue to attend the Neonatal Developmental Follow-up Clinic.
- Present three basic physiology conferences, one journal club, and at least one patient oriented conference while on service.
- Work on research project. We encourage fellows to write a first author abstract that will be submitted by the fall of the third year.
- Participate in the Joint Fellowship Curriculum
- Continue to develop clinical competence and teaching skills by serving approximately 3 months (including at least 1 month as a Junior Attending in the NICU).
- Continue to attend the Neonatal Developmental Follow-up Clinic.
- Present three basic physiology conferences (one of which is a presentation of your research), one journal club, and at least one patient-oriented conference while on service.
- Complete research project and write manuscript for submission by end of third year.
- Present your completed research project at a major conference (usually PAS/SPR).