Discipline of Paediatrics & Child Health

Neonatology

Introduction

The Neonatal Fellowship Training Programme at the University of KZN-Natal is a 2 year training programme that provides the necessary education and experience for eligibility to sit for the Sub-specialty Certificate in Neonatology in South Africa {Cert Neonatology (SA)}. This Programme is accredited by The College of Pediatricians of South Africa and was started in 2000. 3 pediatricians have successfully achieved sub-specialty certification and currently 2 pediatricians are in training.


Overview and Mission

The mission of the Programme is:

  • To achieve professional competence in the clinical care of critically ill newborns
  • To develop outstanding clinicians with knowledge of physiology, pathophysiology, and evidence-based practices in Neonatal Medicine
  • To develop skills in the management and administration of a Health System caring for Newborns
  • To develop excellence in the teaching of Neonatal Medicine
  • To develop research experience through mentorship and research projects
  • This is accomplished through comprehensive training at the NICU at Inkosi Albert Luthuli Hospital and King Edward VIII Hospital, Durban KZN-Natal. The sites of training will be further expanded to Level 2/3 hospitals NICUs staffed by Neonatal Consultants.

The programme includes:

  • A structured curriculum for continuous education in fetal and neonatal physiology and pathophysiology, evidence-based practices and academic career development
  • A mentored research experience and an opportunity for structured research in neonatology
  • Introduction to Neonatal Follow-Up and Neonatal Outreach Programmes


Curriculum

The clinical curriculum consists of practical clinical experience and seminars that supplement bedside teaching by neonatal consultants

The programme is structured to give maximum clinical exposure in a supervised neonatal intensive care setting in the first year with more specialized training and exposure to HFOV, NO, Neonatal Bronchoscopy and Amplitude Integrated EEG Monitoring in the second year. The second year also embraces experience in follow-up and outreach together with administrative experience in the NICU and Paediatric Registrar Programme

Year 1 Objectives

Patient Care

  • Practice in a Neonatal Intensive Care Unit under the guidance of a certified Neonatologist
  • Application of expert knowledge and skills in the management of critically ill neonates
  • Logbook of supervised management of clinical cases (minimum 12) and technical and procedure skills
  • Family centered patient care and counseling
  • Diagnosis and management of problems seen in the continuum of fetal and neonatal development ( including neonatal follow-up)
  • Techniques of Neonatal Resuscitation

Medical Knowledge

  • Appropriate knowledge of embryology, physiology and pathophysiology in the fetus and the neonate
  • Principles of evidence based medicine in Neonatology
  • Respiratory care and ventilator management
  • Preparation and stabilization of neonate for transport
  • Diagnosis and management of surgical problem such as diaphragmatic hernia, gastrochisis and omphalocoele
  • Preoperative management of neonates with cardiac anomalies

Practice-Based Learning and Improvement

  • Active participation in ward rounds, seminars and bedside teaching under the supervision of certified Neonatologist
  • Development of a research interest and /or protocol under mentorship
  • Ability to critically review and interpret current literature through clinical presentations and peer-reviewed journal articles
  • Development of teaching skills in and preparation of teaching materials for Undergraduate and Postgraduate programs in pediatrics and neonatology

Interpersonal and Communication Skills

  • Develop effective skills in communication with family counseling and professional associates
  • Develop interpersonal skills with other health care professionals and hospital administration

Professionalism

  • Commitment to being a patient advocate in the health care system
  • Carrying out professional responsibilities with adherence to ethical principles and sensitivity to cultural diversity

Administration

  • Organization of Level 2 neonatal unit
  • Clinical governance and clinical audit
  • Collection and analysis of neonatal data and statistics

Year 2 Objectives

All above with further emphasis on:


Neonatal Intensive Care

  • HFOV
  • NO Administration
  • Neonatal Bronchoscopy – indication and value
  • Amplitude Integrated Continuous Cerebral Monitoring – clinical application
  • Neonatal Cranial Ultrasound – technique and value
  • Post-operative care of neonates with surgical and cardiac anomalies

Feto-Maternal Medicine

  • Principles of management of high-risk pregnancies
  • Evaluation of fetal well-being and fetal distress
  • Ante-natal ultrasound- uses and limitations
  • Ante-natal counseling of high-risk pregnancies
  • Ethical considerations in the termination of pregnancies

Teaching and Clinical Presentations

  • Develop as effective teachers in Neonatal Medicine to Year 1 Fellows, Paediatric Registrars, Nursing and Paramedic health professionals and medical students

Neonatal Follow-up Clinic and Neonatal Outreach

  • Follow-up experience of NICU patients
  • Review of Neonatal Follow-up Literature
  • Participation in the Neonatal Outreach Programme with on-site visits to clinics and Level 1 health facilities

Administration Skills for the NICU

  • Supervision of Pediatric Registrars and Neonatal nursing staff
  • Preparation of Policies and Protocols for a NICU
  • Appropriate data acquisition and analysis
  • Clinical Audit and Systems Management
  • Quality Improvement Strategies in Clinical Practice
  • Iatrogenic Reporting
  • Medico-legal aspects of Neonatal Practice

Neonatal Transport

  • Effective stabilization of sick newborns in field conditions
  • Protocols for stabilization and transport of sick outborn neonates

Research Targets

  • Participation in a course in biostatistics and epidemiology is encouraged
  • Research projects are tailored according to the individual needs and preferences of the Fellows. Mentorship is available according to the research project
  • At the end of the 2nd year there has to be evidence of a completed or an ongoing research project duly signed by the research supervisor

The Logbook

A logbook with appropriate signatures by the supervising Neonatologist should completed by the end of Year 2 as part of the necessary requirements to complete the training programme. At the completion of Year 1 training, an interim assessment of the logbook will be duly signed by the supervising neonatal consultant

Components of the Logbook

  • A list of scholarly activities e.g. talks, presentation etc
  • Written summaries of 12 cases in neonatal medicine in which the trainee has participated in medical management with follow-up and counseling. Each of these cases must be signed by the supervising Neonatologist.
  • The cases must embrace all aspects of neonatal medicine with at least one case involving ethical issues
  • A list of techniques and practical procedures in neonatology. Each supervised and or countersigned by supervising Neonatologist
  • Neonatal Follow-up activities
  • Neonatal Outreach Activities
  • Research activities and research protocols
  • A total of four 6 monthly reports on performance duly signed by supervising Neonatologist

The Logbook will be approved and signed by the Neonatal Programme Director at the end of Year 2 and be submitted as part of the college requirements for

Sub-specialty certification in Neonatology

Training sites for Training Programme in Neonatology (2009)

Neonatal ICU, Inkosi Albert Luthuli Hospital, Cato Manor
Neonatal Nursery, King Edward VIII Hospital, Umbilo, Durban

References

The College of Paediatricians of South Africa : Regulations for admission to the exmanination for the post-specialisation : Subspeciality Certificate in Neonatology
ACGME Program Requirements for Fellowship Education in Neonatal-Perinatal Medicine, USA