The primary site for clinical training for the Neonatal-Perinatal (NPM) Fellows is the Doernbecher Neonatal Intensive Care Unit at Oregon Health & Science University (OHSU).. The fellows do at least 12 months of clinical rotations, evenly divided between daytime 12 hour shifts, and nighttime 12 hour shifts, over the three year fellowship (typically done in 1 week periods at a time). The remaining two years are dedicated to scholarly activityThe program is front loaded, with approximately 50% of the service time in the first year of the training, and 25% for each year thereafter.
Neonatal Perinatal Medicine (NPM) fellows are involved in the entire course of the NICU patient experience at OHSU, from antenatal consultation, delivery room resuscitation, admission and care in the NICU and if needed, PICU, to outpatient clinic appointments with our neurodevelopment specialists. The clinical curriculum ensures that our fellows are well-versed in managing the complexities of inpatient neonatal medicine and exposes them to the intricacies of neonatal outcome after discharge from the NICU.
The Doernbecher Neonatal Intensive Care Unit at OHSU is the only academic center in Oregon and is a primary referral center for Oregon and Southwest Washington, as well as receiving patients from Alaska, Hawaii, Idaho, and Northern California. The majority of infant patients cared for in this 46-bed quaternary care (Level IV) NICU have complex pathophysiology and/or surgical (cardiac and pediatric) diagnoses. The NICU admits approximately 650 Newborns per year, about 75% of whom are born in the University Hospital, with the remaining 25% transported from outside. OHSU is one of only two NPM fellowship programs in the Pacific Northwest. The clinical education includes experience with patients requiring extracorporeal membrane oxygenation (ECMO), most frequently due to congenital diaphragmatic hernia (CDH) or severe respiratory failure.
There are multiple opportunities for elective rotations for the NPM fellows, including Cardiology, Maternal-Fetal Medicine, Critical Care Transport, among others. The electives can be developed on an individual basis to help meet the fellow's experience and goals. Starting in 2019-2020 academic year, all second year fellows will do a two week elective with our Pediatric Palliative Care Team.
Transport and telemedicine
OHSU Neonatal-Perinatal Medicine Fellowship Program trainees gain transport experience directly by receiving and directing all transport calls initially received by OHSU. Transports for OHSU/Doernbecher are performed by the PANDA transport team. Fellows also serve as the medical control physician for any neonatal transport that is conducted by PANDA. There are approximately 200 neonatal transports per year, not including back transports.
OHSU also provides neonatal telemedicine services for 7 hospitals in Oregon and Southwest Washington. Network hospitals call for telemedicine support during resuscitations, stabilizations, and prior to and during transport. Telemedicine calls are almost exclusively directed by fellows, providing an invaluable experience with remote virtual direction of the care of critically ill patients.
NICU follow-up experience
The OHSU Neonatal-Perinatal Medicine fellowship has several aspects of the infant follow up program, including the Developmental Evaluation Clinic (DEC) (traditional neonatal follow up program for NICU graduates), Down Syndrome Program, and Neurodevelopmental clinic that is particularly focused on neonates with neurologic issues during their NICU stay. Additional experiences are available through the Spina Bifida Program and Feeding Clinic for NICU graduates.