The neonatologist in the future needs to have a strong clinical foundation to continue learning and to practice medicine during the exciting changes that will occur during the 21st century. Our faculty and fellows practice at different NICUs (level III/IV). Care is provided for all types of patients ranging from normal deliveries to critically ill newborns who are transferred to our hospital requiring cardiac surgery or ECMO. We believe that using Evidence-based medicine and understanding research techniques and strategies will provide tools for the candidate to understand the medical literature and to develop approaches to answer new questions to advance the care of newborns.
The fellowship training program in Neonatal-Perinatal Medicine is a three-year program accredited by the Accreditation Council for Graduate Medical Education (ACGME). There is full salary support for all three years. Dr. Vineet Bhandari is Director of the Division of Neonatology and Dr. Anja Mowes is the training Program Director. Our program accepts four first year fellows each year.
The Fellowship Program's mission is to prepare trainees for a career in academic Neonatal-Perinatal Medicine. We accomplish this goal by offering exposure to a large, diverse population of patients along with in depth training in research design, techniques, and hypothesis generated experiments. If interested, fellows are guided through the steps in preparing a grant.
Our training program consists of 12-15 months of clinical service (including 1 month of Maternal Fetal Medicine, 1 month of Cardiology/Cardiothoracic Surgery), 15- 19 months for research, and time in continuity clinic. Each year, the fellow has 4 weeks for vacation.
Our NICU at St. Christopher's Hospital (level IV) is a regional resource caring for babies referred for specialized treatment from hospitals throughout the tri-state region. All types of patients are referred including those who require management of complex medical problems, surgical intervention, cardiovascular surgery, neurosurgery, and ECMO.
Our fellows attend high risk inborn service at two different level III NICUs that provide challenges in caring for all types of sick infants. Care starts with involvement in prenatal case conferences about difficult patients and perinatal consults. The teams are available 24 hours a day for call to the delivery room. Care is provided in a Neonatal Intensive Care Unit with up to date equipment and an excellent nursing staff.
There is a strong commitment to fellow education. There are daily NICU attending teaching conferences and rounds with staff radiologists. One afternoon a week, there is dedicated time for fellow education that covers topics in clinical medicine, perinatal physiology, and research. We also hold evidence based medicine and Journal Club conferences. Monthly, there are conferences with our obstetrical colleagues. The educational experience is augmented by participation in simulations using high-fidelity mannequins that apply what is taught at other times through a structured curriculum. Similarly, material is reviewed using a Board Course format.
In addition, St. Christopher's Hospital offers a comprehensive Core Curriculum for education of the fellows. At these meetings, the Neonatal-Perinatal fellows are able to interact with their peers/fellows from all of the other disciplines. The faculty fully supports each fellow to meet all of the American Board of Pediatrics requirements for Scholarly Activity. By having joint educational meetings with fellows from other programs in Philadelphia, the fellow's experience is enriched. Fellows are encouraged to attend meetings of the Philadelphia Perinatal Society and present their research in the annual Boggs Award competition.
Ample time spread over three years is available to formulate a research project, collect data, write abstracts for national and international meetings and prepare manuscripts for publication in competitive scientific journals.
Research is important for the future to improve care of newborns and understand disease processes that affect babies. Members of our division are currently investigating:
Brain injury induced by:
- Systemic inflammation
Understanding the pathogenesis of bronchopulmonary dysplasia:
- Utilizing in vitro and in vivo hyperoxia-induced lung injury models
- Utilizing genetic gain-of-function (transgenic mice) and loss-of-function (null mutant mice; siRNA) models
- Utilizing in vitro and in vivo sepsis-induced lung injury models
Collaborative clinical projects to enhance clinical care:
- Impact of preterm formula on bone mineralization
Mechanisms of fetal programming of adult-onset diseases by investigating:
- Impact of maternal nutrition on modulating hypothalamic gene expression in offspring
- Interaction of maternal stress and diet on development of metabolic dysfunction in offspring
- Neonatal immune response to infection
- Mechanisms that the neonate uses to fight influenza virus
Simulation as an Educational Tool:
- Quantitatively Measure Critical Thinking Skills of Neonatology Fellows
This research is supported in part by grants funded by the National Institutes of Health (NIH), March of Dimes, The Hartwell Foundation, St. Christopher's Foundation for Children, and the Newborn Resuscitation Program of the American Academy of Pediatrics and industry-sponsored.
Quality Improvement in the NICU – Fellow led projects
I-Pass: Hand –off tool
Timely Administration of antibiotics in High risk admission
Accuracy of Hands-off information
Improvement of Discharge summaries
Improvement of MRI slots for NICU patients
Improve placement of umbilical catheters
Prevention of unplanned extubation events in Neonates
Improving discharge communication between well baby nursery physician and community
primary care providers
Improving adherence to AAP recommendations for the prevention of perinatal GBS
Improving physician documentation in the medical record of central line placement and removal
Vancomycin use in Neonatal patients
Newborn Resuscitation Program Compliance
Medication Reconciliation 'NPSG8'