BRONX-LEBANON HOSPITAL CENTER

Jing Ya Yoon, M.D.

The  Neonatal  Intensive  Care  Unit is staffed by 5 neonatologists who supervise the activities of the residents and the nurses. It manages a wide variety of ailments that  newborns face. These include medical and surgical conditions, like prematurity, respiratory distress syndrome, cardiac conditions, and post-surgical patients.

Through the course of their three-year program, residents will spend four one-month rotations in the NICU. These rotations offer residents the opportunity to manage critically ill newborns.

To provide basic knowledge for the diagnosis and therapy of general neonatal problems.

To promote proficiency in emergency resuscitative and supportive skills

To train the resident in neonatal resuscitation and intubation.

To train the resident in appropriate newborn management in the delivery room.

To train the resident in basic care of infants with cyanosis, apnea, hyperbilirubinemia, low birth weight, asphyxia, respiratory distress, anemia, polycythemia, infection, drug withdrawal, congenital malformations and metabolic disorders.

To help the resident in organizing his/her thoughts in shifting emphasis from acute to chronic care.

To provide an adequate environment to test and further develop these acquired skills.

Primary Goals for this Rotation

Perinatal Prevention

Understand the pediatrician's role in and become an active advocate for programs to reduce morbidity and mortality from high risk pregnancies.

Identify and describe strategies to reduce fetal and neonatal mortality, including use of group B strep prophylaxis, perinatal steroids.

Resuscitation and Stabilization (NICU). Assess, resuscitate and stabilize critically ill neonates.

Explain and perform steps in resuscitation and stabilization, particularly airway management, vascular access, volume resuscitation, indications for and techniques of chest compressions, resuscitative pharmacology, and management of meconium deliveries.

Common Signs and Symptoms

Evaluate and manage, under the supervision of a neonatologist, common signs and symptoms of disease in premature and ill newborns.

Under supervision, evaluate and manage patients with the signs and symptoms that present commonly in the NICU (examples below):

feeding problems, history of maternal infection or exposure, hyperthermia, hypothermia, intrauterine growth failure, irritability, jitteriness, large for gestational age, lethargy, poor post-natal weight gain, prematurity (various gestational ages).

Cardiorespiratory: Apnea, bradycardia, cyanosis, dehydration, heart murmur, hypertension, hypotension, hypovolemia, poor pulses, respiratory distress (flaring, grunting, tachypnea), shock.

Dermatologic: Birthmarks, common skin rashes/conditions, discharge and/or inflammation of the umbilicus, hyper- and hypopigmented lesions, proper skin care for extreme prematures.

GI/surgical: abdominal mass, bloody stools, diarrhea, distended abdomen, failure to pass stool, gastric retention or reflux, hepatosplenomegaly, vomiting.

Genetic/metabolic: Apparent congenital defect or dysmorphic syndrome, metabolic derangements (glucose, calcium, acid-base, urea, amino acids, etc.).

Hematologic: Abnormal bleeding, anemia, jaundice in a premature or seriously ill neonate, neutropenia, petechiae, polycythemia, thrombocytopenia.

Musculoskeletal: Birth defects and deformities, birth trauma and related fractures and soft tissue injuries, dislocations.

Neurologic: Birth trauma related nerve damage, early signs of neurologic impairment, hypotonia, macrocephaly, microcephaly, seizures, spina bifida.

Common Conditions

Recognize and manage, under the supervision of a neonatologist, the following common conditions in patients encountered in the NICU.

Diagnostic Testing

Under the supervision of a neonatologist, order, and understand the indications for, limitations of, and interpretation of laboratory and imaging studies unique to the NICU setting.

Demonstrate understanding of common diagnostic tests and imaging studies used in the NICU.

Monitoring and Therapeutic Modalities

Understand how to use the physiologic monitoring, special technology and therapeutic modalities used commonly in the care of the fetus and newborn.

Demonstrate understanding of the monitoring techniques and special treatments commonly used in the NICU by being able to:

1.       Discuss the indications, contraindications and complications.

2.       Describe the general technique for use in infants.

3.       Interpret the results of monitoring.

Use appropriately the following monitoring and therapeutic techniques in NICU.

1.       Physiologic monitoring of temperature, pulse, respiration, blood pressure.

2.       Pulse oximetry.

3.       Neonatal pain and drug withdrawal scales.