Neonatology

Sleeping Baby
Draft proposed by Professor Simon Lam
Reviewed by Dr Frankie Cheng

Essential Skills

Domain 1 Professional Values & Behaviour

Domain 2 Communication

Domain 3 Procedural skills

  1. Infection control measures

  2. Aseptic technique

  3. Administration of sedation

  4. Blood-taking techniques, including heel prick

  5. Peripheral venous cannulation

  6. Umbilical venous cannulation

  7. Umbilical arterial cannulation

  8. Peripheral arterial cannulation

  9. Intraosseous needle insertion

  10. Lumbar puncture

  11. Airway management and resuscitation

    • Face-mask seal and positive pressure ventilation

    • Intubation (direct laryngoscopy)

    • Use of laryngeal mask airway

    • Use of oropharyngeal/ nasopharyngeal airway

    • Replacing tracheostomy tube

  12. Microbiological study specimen collection

  13. Bladder catheterisation

  14. Thoracocentesis and chest drain insertion

  15. Nasogastric tube insertion

  16. Exchange transfusion

  17. Skills related to cardiopulmonary resuscitation in a neonate

  18. Point-of-care ultrasound, including head ultrasound

Domain 4 Patient Management

Additional desirable skills are listed in each proposal. These recommended skills are to be acquired as opportunity arises

Basic Training

Antenatal factors related to neonatology

Understanding of fetal growth, development and physiology

Knowledge of maternal conditions and treatment affecting the newborn

Knowledge of peripartum factors affecting the newborn

Pulmonary physiology and pathophysiology

Understanding basic pulmonary physiology as related to neonatal ventilation

Interpretation of neonatal arterial and capillary blood gas results

Knowledge of common neonatal respiratory conditions:

  • Respiratory distress syndrome

  • Transient tachypnoea of the newborn

  • Neonatal pneumonia

  • Meconium aspiration syndrome

  • Pneumothorax

  • Pleural effusions

  • Apnoea of prematurity

  • Apnoea/hypopnoea in a term infant

  • Congenital pulmonary malformations

  • Congenital malformations causing airway obstruction

  • Congenital anomalies causing respiratory disorders

  • Bronchopulmonary dysplasia

Non-invasive and invasive ventilatory support

Understanding on operations of invasive and non-invasive ventilation, ventilation/oxygenation strategies

Pressure regulation/targeting

Volume regulation/targeting

Triggering (pressure/flow/Edi)

High frequency oscillatory ventilation (interpretation of frequency, tidal volume and DCO2)

Use of inhaled nitric oxide

Importance of PEEP and its relation with functional residual capacity and compliance

Interpretation of trends of ventilator parameters

Indications for surfactant therapy

 

Cardiovascular physiology and pathophysiology

Understanding of transition from fetal to neonatal physiology

Knowledge of congenital cyanotic heart disease

Understanding of how structural heart problems may lead to heart failure

Knowledge of persistent pulmonary hypertension of the newborn

Understanding of principles of management of hypotension in newborn infants

Neonatal neurology

Knowledge of hypoxic-ischaemic encephalopathy and hypothermic therapy

Recognize common clinical manifestations of neonatal seizure

Understanding of acute in-hospital seizure management (identify possible underlying cause and use of anticonvulsants (benzodiazepines/phenobarbitone)

Understanding of long-term neurodevelopmental outcomes of newborns with prematurity and/or brain injury

Knowledge of retinopathy of prematurity

Neonatal nutrition

Understanding of importance of breastfeeding to:

  • Normal infants

  • Infants with medical problems

Enteral nutrition

Parenteral nutrition

Neonatal sepsis

Early onset sepsis and late onset sepsis:

  • Risk factors

  • Monitoring and screening of high-risk infants

  • Sepsis evaluation

  • Early recognition of sepsis and/or septic shock

  • Treatment of the septic infant

  • Appropriate use of antibiotics

Common neonatal problems

Management of neonatal jaundice

Management of neonatal hypoglycaemia

Management of infants with common congenital abnormalities, e.g., urinary tract dilatation

Common surgical emergencies

Recognition and initial stabilisation of neonates with surgical emergencies

Management of newborn infants with intestinal obstruction, e.g., volvulus

Knowledge of congenital gastrointestinal abnormalities, e.g., omphalocoele, congenital diaphragmatic hernia

Management of necrotising enterocolitis

Ethical issues in neonatology

Understanding of ethical issues related to borderline viability

Understanding of ethical issues related to redirection of care in a neonate

Apparently well baby examination

Red reflex examination

Examination for cleft palate and lips

Hip examination

Detection of heart murmur

Fracture of clavicles

Mandatory skills specific to neonatology:

  1. Basic skills of surfactant delivery

  2. Clinical assessment of newborn maturity (new Ballard score)[SL(1] 

Desirable skills 

  1. Injection of hyaluronidase to treat vascular extravasations

  2. Neonatal transport: intra-hospital transportation

Higher Training

Non-invasive and invasive ventilatory support

Understanding of advanced modes of ventilatory support

  • HFOV with volume targeting

  • NAVA

  • NIV NAVA

Cardiovascular physiology

Understanding of haemodynamic assessments and management of the sick neonate

Common surgical emergencies

Knowledge of perioperative management of neonates with surgical emergencies 

Neonatal neurology

Understanding of the use of second line anticonvulsants (e.g., levetiracetam, topiramate)

Use of anaesthetic agents for seizure control

Interpretation of aEEG

 

 

Desirable skills 

  1. Airway management: intubation by video laryngoscopy

  2. Delivery of surfactant: delivery by thin catheter techniques

  3. Intravenous access

    1. Insertion of percutaneously inserted central venous catheter

    2. Ultrasound-guided intravenous access

  4. Arterial access: ultrasound-guided arterial access

  5. Neonatal audit: involvement in neonatal audit projects

  6. Neonatal transport: inter-hospital transportation

  7. Advanced procedures:

    • Chest physiotherapy for collapsed lung

    • Ascitic tap

    • Haemodynamic monitoring devices:

      • ICON

      • USCOM

      • NIRS

  8. Advanced communication skills - counselling for poor prognosis, borderline viability, end-of-life care, complaints

  9. Multidisciplinary discharge planning for NICU graduates with chronic medical problems