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 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. We have an active transport team staffed primarily by the NNP/PA service, and infants are transported from a wide referral region including Vermont, northern New York and New Hampshire. Fellows are provided with the opportunity to participate in transport. Incoming transports are solely by ground ambulance. Our patients come from diverse socioeconomic groups, and we manage all aspects of neonatal intensive care except for cardiac surgery and ECMO, for which patients are typically are referred to quaternary centers in NY or MA.
As a regional intensive care unit (and the sole provider in the state of many 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, fellows rotate through the Cardiac Intensive Care Unit (CICU) at Boston Children's Hospital to gain experience with post-operative management of congenital heart disease and ECMO. Fellows attend neonatal follow-up outpatient clinical care in our Neonatal Medical Follow-up clinics during their off-service months where they identify, follow, and assist in 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 lead work rounds during months when they are on the NICU clinical service with the attending physician providing suggestions, queries, and feedback as needed. This allows the fellow increased opportunities 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 as they advance through the program; during the third-year fellows are expected to function fully as an attending neonatologist.