Neonatology
Rotation Goals and Objectives
Newborn Rotation Goals and Objectives
(adapted from the AAFP recommended guidelines)
Please note that the term “manage” occurs frequently in AAFP Curriculum Guidelines. “Manage” is used in a broad sense indicating that family physicians takes responsibility for optimal and complete care of the patient. To manage does not necessarily mean that all aspects of care need to be directly delivered personally by the family physician and may include appropriate referral to other health care providers, including other specialists for evaluation and treatment.
Competencies
At the completion of the neonatology rotation, a family medicine resident should be able to:
• Demonstrate the ability to assess for appropriate development by taking an age appropriate history and performing a physical examination (Patient Care, Medical Knowledge)
• Perform health promotion (well-child care) visits at recommended ages based on nationally recognized periodicity schedules (e.g., Bright Futures, GAPS) (Patient Care, Medical Knowledge)
• Synthesize an appropriate diagnosis and treatment plan for common neonatal conditions in the inpatient settings (Patient Care, Medical Knowledge)
• Demonstrate the ability to communicate effectively with the patient’s family and caregivers, to ensure the development and clear understanding of an appropriate, acceptable evidence-based diagnosis and treatment plan (Interpersonal and Communications Skills)
• Recognize his or her own practice limitations and seek consultation with other health care professionals and resources when necessary to provide optimal patient care (Professionalism, Systems-based Practice)
• Demonstrate the ability to communicate effectively and coordinate care of the infant with families and community resources (Interpersonal and Communications Skills, Systems-based Practice)
Attitudes and Behaviors
The resident should demonstrate attitudes and behaviors that encompass:
• Empathic concern for the health of the child in the context of the family
• Importance of continuity and access to care for prevention and treatment of acute
and chronic illness, including mental health conditions
• Promotion of healthy lifestyles for children and families
• Support for parents transitioning to new roles and responsibilities as children
develop
• Awareness of unique vulnerabilities of infants and children
Before your rotation begins
1. Review the Orange schedule for your Farrell Health Center clinic days
2. Email Dr. Sibblies (cn2008@cumc.columbia.edu) and Dr. Akita (faa8@cumc.columbia.edu) with the days you will be absent/late due to Nursing Home/ IDT meetings/etc. You may be in the newborn nursery on some occasions but will start after your other activities.
3. Add the .nbhx acronym expander (see information at the bottom of the page)
4. Add the .nbplan acronym expander (see information at the bottom of the page)
5. Ask for the educational CD when you first get there. Please confirm with Dr. Garcia if this is no longer in use.
Newborn nursery (4-5891): Newborn exams, admissions/discharges
You will mostly work with Dr. Sibblies, sometimes Dr. Gupta or Dr Akita (neonatologists) if Dr. Sibblies is away.
Presentation/Note Templates
Wear burgundy scrubs if instructed to do so. You must change into these in the hospital and change out of them prior to leaving the hospital.
Dr. Sibblies will review workflow and the information below during your first day. Epic templates are constantly evolving thus you may not use all of the acronym expanders or information below.
1. Look on the whiteboard by the back of the nursery for the names of babies being discharged
2. Find ALLEN 3 RIVER WEST NEWBORN NURSERY list on Allscripts and select the babies listed on the whiteboard
3. In the hand-off, under 'hospital course' use the .nbhx acronym expander to prepare your presentations for the attending (look below for where to find the information for each line)
DOL # for this ex-_wk infant, delivered via __ to a _yo now P_ mother.
*O+/O+/C-
*GBS pos/neg
*Remainder WNL/Other relevant prenatal labs: __ >>> ex. sickle cell trait, chlamydia...
*Antepartum course notable for __ >>> if mom has PMH relevant to baby (congenital, mental, anemia, infection) include it here, from 'OB Triage' note
*Prenatal sonograms showed normal fetal anatomy >>> review these in 'OB Triage' note or in Mom's chart under OB/GYN
*ROM was _hrs prior to delivery, fluid was clear/mec >>> find this in 'Delivery Record'
*maternal fever? >>> usually noted in 'Newborn Admission' or in the handoff under patient summary
*fetal tachycardia?
*GBS positive >> PCN x_ doses >>> usually noted in 'Newborn Admission' or in the handoff under patient summary, otherwise you can go to mom's dose history
*Delivery was uncomplicated/significant for _ >>> find this in 'Delivery Note', ex. nuchal cord...
*Apgars 9/9 >>> find this in 'Delivery Record'
Birth weight _g >> _g on DOL #_ >>> find birth weight in 'Delivery Record' and discharge weight is written on white board
HC_, Length _ >>> press F6, 1, 3
*Tolerating breast/formula feeding, stooling and voiding appropriately >>> see flowsheets. Make sure 1 void by 24hrs, 2 by 2 days, 3 by 3 days; At least 3-4 urine and stools recommended prior to discharge
*Vitals stable >>> see flowsheets
O2 sats: pre-ductal _%, post-ductal _% >>> see flowsheets (a difference of >3 is c/f coarctation!)
TC bili _ @ _hrs >> low risk >>> see flowsheets (if not done, inform RN)
other labs/imaging >>> see results tab
*Physical exam WNL/significant for _
*Passed Newborn Hearing screen >>> see note 'Infant Hearing Screening'
*Vitamin K and erythromycin ointment administered in delivery room >>> see dose history
*Hep B vaccine given >>> see dose history, (if not done, go consent the patient, and then place order)
*SW cleared mother for d/c >>> see SW note - look for 'no further SW needs' in the note
Newborn clinic/PMD appt____ >>> under pt appointments -> if pt has outside pediatrician or DID NOT GET PRENATAL CARE through NYP, they cannot be seen at VC10 clinic
4. Perform newborn physical exam (tips below)
5. Start discharge note: "Newborn Discharge Note' -> flowsheet is inside this, insert the completed .nbhx in the 'assessment' box, click in their appointment, and use .nbplan in 'plan' box
6. If the mom has a private pediatrician/family doctor -> also complete the "newborn hospital summary course" by copy-forwarding in the information from 'newborn discharge note,' nursing delivery note, and newborn admission note.
7. Discharge patient - order is 'newborn discharge set' -> click in 'home' and under hep B vaccine, click in that 'hep B vaccine has been given prior to discharge' (unless mom has refused)
*** co-sign all notes to attending for review***
Neonatal Resuscitations and Education Time: On L&D
Usually with Dr. Akita or Dr. Gupta.
When in the newborn nursery in the morning, you may get called down to the OR for C-Section neonatal resuscitations. Go as soon as you are called down and present to the L&D ORs. Don't forget to grab a patient sticker to log this procedure in Medhub. You may spend educational time in the call room to be on call for neonatal resuscitations in the OR or vaginal deliveries.
Acronym expanders:
.nbhx
DOL # for this ex-_wk infant, delivered via __ to a _yo now P_ mother.
*O+/O+/C-
*GBS pos/neg
*Remainder WNL/Other relevant prenatal labs: __
*Antepartum course notable for __
*Prenatal sonograms showed normal fetal anatomy
*ROM was _hrs prior to delivery, fluid was clear/mec
*maternal fever?
*fetal tachycardia?
*GBS positive >> PCN x_ doses
*Delivery was uncomplicated/significant for _
*Apgars 9/9
Birth weight _g >> _g on DOL #_
HC_, Length _
*Tolerating breast/formula feeding, stooling and voiding appropriately
*Vitals stable
O2 sats: pre-ductal _%, post-ductal _%
TC bili _ @ _hrs >> low risk
other labs/imaging
*Physical exam WNL/significant for _
*Passed Newborn Hearing screen
*Vitamin K and erythromycin ointment administered in delivery room
*Hep B vaccine given
*SW cleared mother for d/c
Newborn clinic/PMD appt____
.nbplan
Anticipatory guidance discussed including the following: Seek immediate medical care at 168th St and Broadway or closest emergency room if baby has fever >100.4, persistent vomiting,breathing problems,lethargy, increasing jaundice or feeding problems. Read all the written material given to you about baby care. Continue breastfeeding, provide formula only if necessary. Make sure baby has at least 6-8 wet diapers a day. Use a car seat and ensure the home is safe for baby. Place baby on BACK to sleep. Sponge-bathe baby until the umbilical cord falls off. Never leave baby unattended.
Rotation Evaluation
i. Please message Dr. Garcia ASAP if any concerns and or changes in the rotation.
ii. Residents are expected to complete rotation evaluations sent by Diana Suarez on Medhub which are anonymous and will be reviewed every 6 months.