NICU Sub-I...anything I should know?

[skeletor06]

I'm a rising 4th year DO student, and I'm applying to pediatrics next year. I'm starting 4th year with a NICU sub-I rotation at my home institution, which is a level 4 with ~40-50 beds. Anything I should know off the bat to make a good impression, things I should read up on, etc?

I'm also doing an away rotation in outpatient peds in a few months that is at a program I REALLY would like to go to, so anything I should know for that would also be super helpful. I just want to hit the ground running, since my board scores were super low and I want to shine on 4th year rotations. Thanks!

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[applicant2016]

Rule number one in NICU... every sick baby has sepsis until proven otherwise,, literally, sepsis will never be the wrong answer to any NICU question..

Rule number two, this baby is intubated on %100 O2 and still desats .. what should we do??? ECHO?....... wrong!!!!!! go back to rule number one, and then maybe consider echo..

Read about
RDS\TTN
ROP
NEC
Severe hyperbili
and other common premature problems ... if you are going to deliverers, glance over the NRP guidelines for resuscitation,,, and if you happen to have time, go over some ventilation topics (they are complicated to read, so you can always make it a topic to talk about during rounds, NICU attending and fellows LOVE to talk about ventilation)..

Finally, remember that premie babies and newborns have different physiology from infants and older kids, for example, it is normal to have RVH (since the right side of the heart is doing all the work in the womb) in a newborn... bone fractures from delivered heals very quickly.. bilirubin of 12 is completely normal for 5 days old full term newborn.

good luck.

 

[mvenus929]

For NICU, review on how to calculate numbers--ml/kg, kcal/kg, etc. That's half the prerounding.

For gen peds clinic, review milestones and vaccine schedules.

 

[Capote1]

I'm a rising 4th year DO student, and I'm applying to pediatrics next year. I'm starting 4th year with a NICU sub-I rotation at my home institution, which is a level 4 with ~40-50 beds. Anything I should know off the bat to make a good impression, things I should read up on, etc?

I'm also doing an away rotation in outpatient peds in a few months that is at a program I REALLY would like to go to, so anything I should know for that would also be super helpful. I just want to hit the ground running, since my board scores were super low and I want to shine on 4th year rotations. Thanks!

All the above is good advice. I goggled NICU manuals and found a couple of good ones. I was going to post a link but it didn’t let me.UCSF has a good one.
Remember every NICU varies slightly, but reading one of the resident manuals will give you a good foundation to begin with.

 

[SurfingDoctor]

Make nice with the nurses...

 

[NurWollen]

Make nice with the nurses...

This is the most important thing for a med student, IMHO. The NICU has a different culture than the floor, etc. The nurse is the boss. DO NOT, I repeat, DO NOT, go to examine a baby until you have checked with that baby's nurse to find when/if you can examine them.

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[oldbearprofessor]

I'm a rising 4th year DO student, and I'm applying to pediatrics next year. I'm starting 4th year with a NICU sub-I rotation at my home institution, which is a level 4 with ~40-50 beds. Anything I should know off the bat to make a good impression, things I should read up on, etc?

I'm also doing an away rotation in outpatient peds in a few months that is at a program I REALLY would like to go to, so anything I should know for that would also be super helpful. I just want to hit the ground running, since my board scores were super low and I want to shine on 4th year rotations. Thanks!

Know each patient's labs and meds and route of delivery. Nothing is worse than hearing on rounds about the patient's IV furosemide and then seeing it was switched to oral the day before. Same for the nutrition stuff. Learn the basics of TPN from the nearest dietitian, NP or resident ASAP on starting the rotation. Know how and why human milk gets fortified and how to assess growth in a preterm. For quick topic reviews, go to UpToDate and then you can actually search for references if really needed. And of course NEVER wake (non-emergently of course...) a sleeping baby unless you plan to spend the next hour at its bedside!

 

[oldbearprofessor]

This is the most important thing for a med student, IMHO. The NICU has a different culture than the floor, etc. The nurse is the boss. DO NOT, I repeat, DO NOT, go to examine a baby until you have checked with that baby's nurse to find when/if you can examine them.

And ask in the format "Is now a good time to examine baby .....? If not, when will you be waking him or working with him so I can do a quick exam?"

 

[Perrotfish]

I'm a rising 4th year DO student, and I'm applying to pediatrics next year. I'm starting 4th year with a NICU sub-I rotation at my home institution, which is a level 4 with ~40-50 beds. Anything I should know off the bat to make a good impression, things I should read up on, etc?

I'm also doing an away rotation in outpatient peds in a few months that is at a program I REALLY would like to go to, so anything I should know for that would also be super helpful. I just want to hit the ground running, since my board scores were super low and I want to shine on 4th year rotations. Thanks!

What to read

NICU: I always recommend working through Polin and Yoder's practical neonatology. Its a case files book for the NICU. HARD read, but if you get through it you'll be a rock star.

Outpatient Peds: Your best bet for looking better than your peers is to focus on baby and toddler trivia that isn't pathology. Pathology is the most important thing but chances are you already know most of what you need from your third year rotation and reading, beyond reading on your patients, isn't going to move the needle a lot. I recommend reading Baby 411 and Toddler 411, which are guides for new parents and answer all the common questions parents ask in clinic. You should be able to read through each one in a weekend. Also drill down on the vaccine schedule. The CDC has several self paced web modules that are excellent practice: Vaccine Courses, Broadcasts, Webcasts and Self Study Training | CDC. Hopefully you already know developmental milestones but if you haven't made flashcards yet now is the time.

 

[skeletor06]

Thanks for the replies and advice, everyone!