Clinical activities are based in the University of Vermont Children’s Hospital NICU, a busy 20 bed Level III service with an 8 bed transitions suite and almost 650 admissions annually. Approximately 75% of our admissions are born at the adjacent birthing center, with nearly 2,250 babies delivered in the past year. The remaining infants admitted are transported from a wide referral region including Vermont, northern New York and New Hampshire. We have an active transport team staffed by the NNP/PA service. Fellows are provided with the opportunity to participate in transport. Incoming transports are solely by ground ambulance. The population includes all socioeconomic groups and serves a diverse range of medical conditions. We provide all aspects of neonatal intensive care except cardiac surgery and ECMO.
As a regional intensive care unit (and the sole or predominant provider in the state of certain medical and surgical subspecialty services), the NICU provides fellows with numerous opportunities under faculty supervision to observe, conduct, and supervise the care of newborns with a wide variety of diseases, and to stabilize and medically manage our nurse practitioner team transports of sick newborns from outlying hospitals.
Close mentoring with attending physicians and the advanced practice service allows for an emphasis on high-quality, evidence-based healthcare. Our adjacent labor and delivery suite is managed by community and UVMCOM obstetricians, perinatologists, and nurse-midwives. We work very closely with our Maternal Fetal Medicine colleagues, meeting regularly to review past and anticipated cases. Our newborn nursery service is managed by both the pediatric hospitalists and private general pediatrics and family medicine practices.
In addition to managing infants in our NICU, our fellows have an external clinical rotation at the Cardiac Intensive Care Unit (CICU) at Boston Children’s Hospital. Fellows experience neonatal follow-up outpatient clinical care in our Neonatal Medical Follow-up clinics during their off service months.
The Neonatal Medical Follow-up Clinic (NeoMed) allows fellows to participate in a clinic designed to identify, follow, and assist in the fulfillment of the long-term medical and social needs of high-risk infants and their families.
Responsibilities are graded as the fellow advances through the program. First year fellows will increasingly conduct work rounds during those months when they are on the NICU clinical service; the attending physician will still examine and evaluate each patient in parallel and will provide suggestions, queries, and feedback as the final step of work rounds on each patient for inclusion in the daily plan. This will allow the fellow increased opportunity to consider and discuss diagnostic and therapeutic plans, while still assuring an appropriate “safety net” of faculty supervision. It is also expected that fellows will assume progressively more responsibility for requested consultations and management of patients as the fellow progresses from the first through the third year of the program; during the third year the fellow is expected to function fully as an attending neonatologist.