Curriculum and Scholarly Activities

There are regularly scheduled weekly and monthly conferences as presented in the following table.

Sample Conference Schedule

Congenital Anomalies Conference

Collaboration between Maternal Fetal Medicine (MFM) and Neonatology is critical to providing the highest quality care for our tiniest patients. This monthly conference is fellow-led and is a combined meeting between Neonatology and MFM. Pending cases or recent deliveries of infants with congenital abnormalities are discussed. One of the MFM fellows reviews the prenatal course and management while the NICU fellow discusses the delivery or delivery plan and management of the infant after birth. Additionally, there is a brief review of relevant embryology and genetics discussion pertaining to the anomalies. 

ECMO Case Conference

Kentucky Children's Hospital (KCH) maintains an active Extracorporeal Membrane Oxygenation (ECMO) Program and is an Extracorporeal Life Support Organization (ELSO) Center of Excellence. Fellows have the opportunity to participate in the management of neonates requiring ECMO. Each neonatal patient who undergoes ECMO at KCH will have their hospital course reviewed by the ECMO team. These cases are presented by Neonatal Fellows and the patient presentation, events leading up to cannulation, EMCO course, and post-ECMO course are reviewed and discussed. 

Fetal Infant Mortality Review

Fetal and infant deaths are reviewed by the division monthly. These conferences are presented by the neonatal fellows and advanced practice providers (APPs). During this time the patient’s prenatal, delivery, and ICU course is discussed and reviewed. Additionally, relevant literature is incorporated into the discussion to identify potential practice and quality improvements.  

Journal Review

Neonatal fellows are responsible for presenting journal reviews annually during their fellowship. Fellows choose a topic of interest and meet with a faculty mentor to prepare a presentation that reviews the current relevant literature. Fellows analyze the strength of the studies in regards to design, methods, statistical analysis, and conclusions. The fellow also facilitates in-depth discussion with faculty members to improve existing practice standards.

Discharge Planning Meeting

While on service, the fellows covering the APP team, resident team, and delivery/step down team attend a multidisciplinary meeting to discuss all the hospitalized infants and plan for their discharge. Key team members include: discharge planning nurses, social workers, speech therapists, physical and occupational therapists, and NICU Graduate Clinic staff. The meeting is designed to ensure all infants being discharged receive all services and equipment necessary to thrive in their home environment. 

Maternal Fetal Medicine – Neonatology – Pathology Joint Conference

Interdisciplinary collaboration is a key component of modern medical practice; as such each month Maternal Fetal Medicine, Neonatology, and Pathology hold a joint conference to discuss interesting or unusual cases seen at Kentucky Children’s Hospital in the past few months. The conference is jointly presented by MFM fellows, Neonatology fellows, and Pathology residents. This allows faculty, fellows, and residents to follow a patient’s course prenatally, through delivery and throughout NICU management and ultimately to a pathologic diagnosis. These presentations illustrate the complex interaction between clinical presentations and cellular pathology. 

Neonatal Grand Rounds

Each month either a neonatal faculty member or a speaker from another division at Kentucky Children’s Hospital will present a topic of their choosing to the division. Topics are all relevant to neonatology and range from Radiology, Cardiology and Infectious Disease, to Ethics and Palliative Care. A selection of recent topics is listed below:

• “ECMO Consultation Criteria and Implementation”
• “The Challenge of Discussing Goals of Care”
• “Vasopressors and Inotropes in the Neonate”
• “Resistant Bacterial Infections in the NICU”
• “Postnatal Hypotension in Extreme Prematurity”
• “Neonatal Nutrition”
• “Appropriate Positioning of Lines and Tubes on X-ray”

Neonatal Fellow Board Review

In addition to clinical training during fellowship, emphasis is placed on preparing for the American Board of Pediatrics Subspecialty Exam in Neonatal and Perinatal Medicine. We incorporate a three year rotating curriculum board review into our conference schedule two to three times per month. Each meeting occurs on a Wednesday morning and is attended by all fellows and our program director, Henrietta Bada, MD, MPH. Assigned readings come from either NeoReviews or Fanaroff and Martin’s Neonatal-Perinatal Medicine: Disease of the Fetus and Infant. Additional resources are incorporated as needed. Prior to each meeting, fellows are expected to read the assigned literature and take a practice test. Topics and questions are then discussed as a group under the guidance of our program director. 

Respiratory Physiology and Mechanical Ventilation Seminar

At the start of each academic year, all fellows attend a detailed lecture series that discusses pulmonary physiology and mechanical ventilation. This seminar occurs on Wednesday mornings. This lecture series is presented by M. Douglas Cunningham MD, Professor of Pediatrics and founder of Kentucky Children's Hospital NICU. Dr. Cunningham has over forty years of experience caring for critically ill neonates and is an expert in mechanical ventilation and lung development. These are didactic, interactive case-based lectures that discuss key components of ventilation. Topics include:

• Volume Targeted Ventilation
• Lung Mechanics and Pulmonary Functions
• Non-invasive Positive Pressure Ventilation
• Indications for Mechanical Ventilation
• Time Constants and Related Case Studies
• Pressure Volume and Flow Volume Loops
• Weaning from Conventional Ventilation
• High Frequency Oscillatory Ventilation

Research Methods Seminar

During the first half of the academic year, NICU fellows attend a seminar on Wednesday mornings that provides an orientation and detailed discussion of research methods and techniques. While basic science research is not a requirement of the fellowship, an understanding of basic science techniques is important for a neonatologist career. Additionally, if fellows desire a career in basic science research, this serves as an excellent primer. This seminar is given by Mandar Joshi PhD, Associate Professor of Pediatrics, who has an extensive background in pharmacology and laboratory research. Topics include:

• Immunohistochemistry
• Microscopy and Imaging
• Flow Cytometry
• Molecular Methods
• Pharmacological Research Techniques
• Research Presentations

Pediatric Grand Rounds

Our weekly lecture series is presented to the entire Department of Pediatrics. Topics are incorporated from all specialties of pediatrics. The meeting is held in our department office building at 138 Leader Avenue and is live-streamed over the intranet so that faculty and residents on service in the hospital can view the presentation as well. The conference is attended by: faculty, fellows, Pediatric residents, Internal Medicine-Pediatric residents, Pediatric neurology residents, and Triple Board (Pediatrics – Psychiatry – Child Psychiatry) residents. Relevant and meaningful discussion is an important component of these lectures. 

Ethics Conference

Each month Rebecca Yarrison PhD, Assistant Professor in the University of Kentucky’s Program for Bioethics, and Nirmala Desai MD, Professor of Pediatrics and Senior Faculty in the Division of Neonatology, hold a conference with fellows and faculty to discuss ethical and moral issues faced during caring for infants in the NICU. The issues and cases discussed are designed to challenge providers’ moral and ethical ideals, and in the process, to work through the difficult issues faced in the modern practice of neonatology. Additionally, fellows are encouraged to attend Schwartz Center Rounds at Kentucky Children’s Hospital where ethical issues that affect the whole of Pediatrics are discussed. Schwartz rounds are conducted six times per year. 

Scholar Activities 

In addition to attendance to above conferences, fellows are expected to engage in scholarly activities to meet the requirements for certification by the Neonatal Perinatal Sub-Board of the American Board of Pediatrics. As part of the scholarly activities, fellows are required to complete the following:

• Scholarly Work Product (basic, clinical, or translational research with a first authored manuscript submitted for publication)
• Graduate Level Course in Physiology
• Graduate Certificate in Clinical Research Skills or Graduate Certificate in Clinical and Translational Science

For those interested, there is an option to enroll in the Master of Science in Medical Science (Clinical & Translational Science Pathway) program. Completion of this program will fulfill the graduate certificate requirement of the fellowship.