Introduction
Critical care for neonates with brain injury and neonates at risk for brain injury (e.g. extremely premature neonates) is a growing subspecialty within child neurology. Similarly, advances in fetal imaging and genetic testing have propelled fetal neurology into the forefront. Child neurologists are increasingly expected to manage neurocritical care issue in neonates and provide prognostication for families whose fetus’ may have been found to have imaging abnormalities in utero. This elective rotation allows for an immersive experience in the neonatal ICUs at UW with an emphasis on the evidence based neuroprotective strategies employed in that setting as well as the techniques used for advanced neuroprognostication for neonates and fetuses with known brain injury or neurologic disease.
Schedule
The schedule for this week-long inpatient elective will be determined in accordance with Dr. Carrasco McCaul in the weeks preceding the elective. Please email her to determine the details of scheduling. This elective must land on a week that Dr. Carrasco McCaul is scheduled on the NeuroNICU service. Clinical activity will consist of initial consultations for acutely ill patients in the AFCH and Meriter NICUs and follow up visits for both acutely active NICU patients as well as neuroprognostication visits on patients at risk for neurodevelopmental impairment.
Patient Care
Goals
Residents must demonstrate the ability to provide family centered patient care that is developmentally and age appropriate, compassionate, and effective for treatment of neurological problems and the promotion of health of neonatal patients.
Objectives
Demonstrate proficiency in gathering a history and physical on patients with neurologic disorders in the NICU.
Apply relevant clinical pathways to the care delivery in patients in the NICU (e.g. therapeutic hypothermia, neonatal status epilepticus).
Recognize the continuum of care between fetal consult and NICU stay in patients with predetermined neurologic disease and appropriate apply plans made for those patients.
Medical knowledge
Goals
Residents will know, critically evaluate and use current medical information and scientific evidence for patient care.
Objectives
Describe the pathologic basis of fundamental disorders of neonatal neurology including (but not limited to) hypoxic ischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia.
Summarize neuroprotective strategies for neonatal patients with brain injury and those at risk for brain injury.
Gain familiarity with treatment approaches for the common diagnoses encountered in the NICU including neonatal seizures, HIE, neonatal hypotonia/neuromuscular disease, etc.
Use continuous EEG and amplitude integrated EEG to support decision making in the NICU.
Review neuroimaging techniques specific to the NICU (MRI, MR spectroscopy, head ultrasound, etc.)
Interpersonal Communication
Goals
Demonstrate excellent communication skills by partnering with the multidisciplinary neuro NICU team aiming to provide timely patient care with complete and prompt documentation.
Demonstrate active listening as well as empathetic and comprehensive counseling to families of patients in the NICU.
Objectives
Effectively communicate with patient’s families regarding relevant clinical information and deliver prognoses in a compassionate manor.
Interface with the multidisciplinary team by disseminating the neurology team’s assessment and plan in a timely and effective manor.
Maintain comprehensive, accurate and timely medical records.
Practice-Based Learning and Improvement
Goals
Identify opportunities for improvement in the delivery of quality of patient care
Objectives
Integrate feedback from supervising faculty and other teams into practice.
Reference to the literature about evidence-based practice pertinent to neonatal patients with neurologic issues.
Professionalism
Goals
Residents will demonstrate ongoing self-education and habits of life-long learning.
Objectives
Residents will maintain the highest standards of professionalism, especially in interactions with patients and NICU faculty and staff. The resident will be responsible for tracking duty hours and reporting them to the supervisory attending.
Systems-Based Practice
Goals
Residents will recognize that they are part of a multidisciplinary team and the complexity required to coordinate care across multiple subspecialties.
Objectives
Demonstrate ability to deliver thoughtful, and quality base care by considering cost and allocation of resources in the NICU.
Recognize barriers to care for patients following discharge and leverage resources to improve likelihood of appropriate follow up.
