Neonatology education for general pediatrician

[bks524]

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I am interested in understanding how I can better educate residents and students that may not become neonatologists. What do you feel like are the best topics to cover in neonatology for the general pediatrician? I just don't think another lecture on ROP is all that helpful for the residents 🙂. Any thoughts would be helpful.

 

[oldbearprofessor]

I am interested in understanding how I can better educate residents and students that may not become neonatologists. What do you feel like are the best topics to cover in neonatology for the general pediatrician? I just don't think another lecture on ROP is all that helpful for the residents 🙂. Any thoughts would be helpful.

Good question.

Suggestions:

- post-discharge nutritional management (how long do we keep them on higher calorie feeds?)
- Management of the near-term infant (34-36 weeks)
- Management of apnea of prematurity (a perennial favorite)
- Neonatal seizures

There are others, but this is a short-list of some of the ones I think are helpful for general pedi resident groups.

 

[bks524]

One of my favorites is the near term infant. We try so hard to make these kids term and then we disappoint the parents (and ourselves) when they don't act like a term kid. Notoriously don't feed well, may have temp instability, apnea occassionaly, they all seem to have desats and tachypnea etc etc. They drive the gen pediatrician crazy - and me sometimes. Right now we have this IDM that is 34 weeks and 3800 grams. Looks term, but totally acts preterm. I think we kid ourselves when we just look at these kids.

As far as apnea of prematurity, I wonder if that is a gen ped problem. I guess if you are "isolated" then you may end up dealing with these kids, but I would think true apnea would send most pedis to transfer these kids to the local NICU.

likewise neonatal seizures. I just feel like most of the time, they will get admitted and someone else figures them out. Still doesn't mean that we shouldn't educate on these things-what do you guys think

 

[zoondel]

Having spent my first month as an intern in the NICU, here's what I would have loved:

-Bilirubin in premies vs. full-term
-the overall goals/approaches to hydration and nutrition in the NICU
-the psychology of mothers of premies (not medical, but I felt often completely ignored by us docs)

 

[waldenwoods]

-What parents can expect after their babies are discharged in terms of their child's health, i.e., anticipatory guidance for parents who are taking kids home who had pulmonary problems, apneas, feeding intolerance, ROP, IVH and other issues. Also would be helpful to know this stuff just for day-to-day conversations with parents during NICU rotations.

 

[waldenwoods]

-the psychology of mothers of premies (not medical, but I felt often completely ignored by us docs)

Fathers too

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Shaw, Richard J., Bernard, Rebecca S., DeBlois, Thomas, Ikuta, Linda M., Ginzburg, Karni, Koopman, Cheryl. The Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder in the Neonatal Intensive Care Unit. Psychosomatics 2009 50: 131-137

BACKGROUND: Having an infant hospitalized in the neonatal intensive care unit (NICU) is a highly stressful event for parents. Researchers have proposed posttraumatic stress disorder (PTSD) as a model to explain the psychological reaction of parents to their NICU experience. OBJECTIVE: The authors sought to examine the prevalence of PTSD in parents 4 months after the birth of their premature or sick infants and the relationship of PTSD and symptoms of acute stress disorder (ASD) immediately after their infant’s birth. METHOD: Eighteen parents completed a self-report measure of ASD at baseline in addition to self-report measures of PTSD and depression at a 4-month follow-up assessment. RESULTS: In the sample, 33% of fathers and 9% of mothers met criteria for PTSD. ASD symptoms were significantly correlated with both PTSD and depression. Fathers showed a more delayed onset in their PTSD symptoms, but, by 4 months, were at even greater risk than mothers. DISCUSSION: The relatively high levels of psychological distress experienced by parents coupled with the potential negative outcomes on the parent and infant suggest that it is important to try to prepare parents for the expected psychological reactions that may occur in the event of a NICU hospitalization and also to support parents during the transition to home care.