What factors to consider when deciding to pursue Neonatology?

[Zora98]

Hello! I wanted to know what should I be paying attention to and how I should prepare for my upcoming NICU rotation. I'm currently a PGY2 and am interested in neonatology. I don't have much experience in this field apart from doing a newborn nursery rotation and attending to deliveries, which piqued my interest in the first place. In addition, my institution's NICU gets referrals from other places, so we don't have deliveries, and most (if not all of the patients) are already stabilized from a procedure standpoint by the time they reach our hospital. I do have a family member who specializes in neonatology, and she works in settings with very few resources in Nigeria (where my family is from), which has the #2 newborn death rate worldwide. I'd love to help in some capacity to provide services/skills/teaching in a global health fashion as a long-term career goal regardless of what I eventually end up doing after residency, and I felt that neonatology would be of a great benefit back in my country.

With that in mind, what other factors should I be looking at to make a more informed decision, given that I won't have the typical NICU experience? Any other advice is appreciated. Thanks!

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[Oso]

Some things to consider:
babies - you have to like the newborn population enough and feel like you won't miss interacting with older kids who can actually talk to you

systems - do you like taking care of the 'whole' patient (ie. all the different organ systems, w/ help from consultants of course) vs would you rather focus on one particular system/pathology

setting - this is a hospital based specialty - are you okay mostly working inpatient (w/ some exceptions for follow up clinic) and all that it entails - ie. working weekends, nights, holidays, etc?

acuity - there's variation in acuity based on what level NICU you end up working in (II-IV), but for training you will be working at a level IV taking care of critically ill patients on different types of vents, placing ETT's and lines, starting ECMO, etc. Unfortunately some babies will not have good outcomes

procedures - have to enjoy (or at least tolerate) doing procedures, especially during fellowship


It's unfortunate you won't have any true delivery/resuscitation experience. If you're still thinking about NICU and can somehow do an away at a place where you could get some deliveries in, that could be helpful (though don't know how feasible this would be in the time of COVID)