The NICU Team 1 rotation is a 1 month rotation at CMHH NICU. Fellows are supervised by Neonatology faculty of the Division of Neonatal-Perinatal Medicine.

Fellows participate in a month’s clinical rotation during their PGY-5 and PGY-6 year. During this rotation, fellows are exposed to neonatal patients with varying complex conditions such as, congenital anomalies, complex surgical conditions, extreme prematurity, hypoxic ischemic encephalopathy, primary pulmonary hypertension and nonsurgical cardiac conditions. The CMHH NICU Team 1 is comprised of a neonatology faculty, at least one fellow and two neonatal nurse practitioners (NNP). The NNPs on this rotation provide direct care to 8-10 assigned patients. The purpose of this rotation is to expose the fellow to supervisory role on an advanced nurse practitioner service. Fellows’ exposure to this type of team composition is similar to academic and private practice settings. Fellows’ develop and refine supervisory “acting attending” skills with a greater complexity of patients than cared for on the resident services (Team 3 and LBJ). Fellows’ require adaptation of their teaching skills to certified neonatal nurse practitioners and neonatal nurse practitioner students.

The NICU Team 4 rotation is a 1 month rotation at CMHH's NICU. This rotation occurs in the PGY-4 and PGY-5 years as a core rotation. The PGY-6 fellow rotates on this service as a part of weekend coverage approximately once every other month. Fellows are supervised by Neonatology faculty of the Division of Neonatal-Perinatal Medicine.

During this rotation, fellows are exposed to neonatal patients with varying complex conditions such as congenital heart disease, congenital anomalies, complex surgical conditions, extreme prematurity, hypoxic ischemic encephalopathy, primary pulmonary hypertension and those who require ECMO. Fellows are assigned 8 to 10 patients for whom they provide direct patient care and management with direct faculty supervision.

The NICU Team 3 (resident team) rotation is a 1 month rotation at the CMHH NICU. Fellows rotate four times on this rotation over the three years of training. Fellows are supervised by Neonatology faculty of the Division of Neonatal-Perinatal Medicine.

During this rotation, fellows are exposed to varying neonatal patients such as pediatric surgical patients (i.e. gastroschisis, omphalocoele, myelomeningocoele), premature infants >26 weeks, late preterm infant,term infants with congenital anomalies, neonates with respiratory illnesses (i.e. transient tachypnea of thenewborn, respiratory distress syndrome, bronchopulmonary dysplasia), and mild perinatal depression.

These are examples of various patient diagnoses but not a complete list. Fellows’ role on this resident service is to supervisor the clinical care provided by the residents and to develop teaching skills at the bedside, in group discussions and through formal presentations.

The NICU Transport rotation is a 2 week experience during the first months of the first year fellowship at CMHH NICU. Fellows are supervised by and Neonatal Transport Nurses or Neonatal Nurse Practitioners under indirect supervision with direct supervision immediately available by Neonatology faculty of the Division of Neonatal-Perinatal Medicine.

During this clinical experience the PGY-4 fellow is exposed to varying types of neonatal patients including those with complex health issues such as congenital heart disease, congenital anomalies, complex surgical conditions, extreme prematurity, hypoxic ischemic encephalopathy, primary pulmonary hypertension and extreme prematurity. The patients will require stabilization in the delivery suite or NICU, transport to the NICU or other intra-hospital locations (i.e. operating room, cardiac catheterization lab, diagnostic radiology). Fellows are rotate with the team, composed of neonatal transport nurses that are NRP and stable instructors and respiratory therapist. The fellow participates as team member and leader in delivery resuscitation, and performs procedures (endotracheal intubation, umbilical line placement, thoracentesis) in the care, resuscitation, and stabilization of neonatal patients with varying problems. Stabilization understanding includes but not limited to thermoregulation, airway stabilization, assessment and awareness of neonatal transition. Fellows are introduced to the basics in altitude physiology and considerations during transport. Fellows are certified providers in Neonatal Resuscitation (NRP) prior to the start of this rotation.

The Neonatal High Risk Clinic rotation is a 1 month rotation with daily half clinic visits conducted at UTPB Kid’s Place. Fellows are supervised by Neonatology and Pediatric Faculty from the Division of Neonatal-Perinatal Medicine.

During this rotation, fellows are exposed to preterm infants of varying socioeconomic and psychosocial environments that may impact overall neurodevelopment. The patients include graduates from the Children’s Memorial Hermann Hospital neonatal intensive care unit with varying conditions such as extremely low birth weight infants, hypoxic ischemic encephalopathy, intraventricular hemorrhage, bronchopulmonary dysplasia, apnea, gastroesophageal reflux, retinopathy of prematurity. This is not the complete list of types of infants’ health concerns that will be seen in the clinic. Fellows’ expectations in direct clinical care and patient education role progressives based upon advancement in level of post-graduate level training. Fellows are expected to attend a minimum of 11 clinics per rotation period. Fellows are to inform the coordinator of the clinic and program the clinic days attended.

The PCVS rotation is a 1 month rotation conducted at Children’s Memorial Hermann Hospital Pediatric Intensive Care Unit during the PGY-6 year. The fellow is supervised by Pediatric Cardiovascular Surgery Faculty.

During this rotation, the fellow is exposed to children with varying congenital heart defects and acquired cardiac conditions requiring pre-operative and post-operative care. The patients are either direct admissions or transfers to Children’s Memorial Hermann Hospital. The cardiac conditions cared for include right and left outflow obstruction defects, conotruncal defects, congenital and acquired cardiomyopathies, atrioventricular valve anomalies, semi-lunar valve anomalies, ventricular septal and atrial septal defects, congenital heart defects, cardiac arrhythmias. This is not a complete list of all types of neonatal, infant or pediatric cardiac conditions on this rotation. The fellow’s function in clinical care and teaching role in goals and objectives is based upon post-graduate level at the time of the rotation.

The LBJ (intern and resident team) rotation is a 1 month rotation at a community hospital that provides care for an underserved diverse patient population in Houston with limited health care resources. Fellows participate in this clinical rotation at least one month in each year of training. Fellows are supervised by Neonatology faculty of the Division of Neonatal-Perinatal Medicine.

During this rotation, fellows are exposed to varying neonatal patients such as pediatric surgical patients (i.e. gastroschisis, omphalocoele, myelomeningocoele), extremely premature infants, term infants with congenital anomalies, neonates with respiratory illnesses (i.e. transient tachypnea of the newborn, respiratory distress syndrome, bronchopulmonary dysplasia), hypoxic ischemic encephalopathy, mild perinatal depression, preterm and term infants with pulmonary hypertension. Fellows’ role on this resident service is to supervisor the clinical care provided by the residents and to develop teaching skills at the bedside, in group discussions and through formal presentations.

The University of Texas Health Science Center at Houston NPM Fellowship provides a minimum of 21 months of “research” rotations throughout the three year fellowship. The fellow is expected to identify, participate and complete a scholarly activity as described by the American Board of Pediatrics.

The ABP has expanded the options for projects but did not dilute the rigor expected. Scholarly activity can include, but is not limited to, clinical research, basic science research, meta-analysis, Cochrane review, Quality improvement project, educational curriculum design, and Master’s level program with a thesis.

Rotations are provided in monthly time periods with increasing numbers of months as the fellow advances in training. Oversight of all scholarly activity is provided by Divisional Scholarship Oversight Committee (SOC).

• Neonatal-Perinatal Medicine (NPM) Fellows’ Lecture Series

• Joint Maternal Fetal Medicine/Neonatal Perinatal Medicine Conference (MFM/NPM)

• Multidisciplinary Fetal Center Conference

• Morbidity and Mortality Conference (M&M)

• Case Conference

• Radiology

• Simulation Sessions

• Center of Clinical Research Courses

• Departmental Fellows’ Core Curriculum

• Journal Club, Literature Appraisal

The Goal of the MFM/NPM, Multidisciplinary Fetal Center Conference, M&M, Case Conference and NPM Fellows’ Lecture Series is to provide a formal and an informal educational venue, respectively, to develop knowledge and understanding in physiology and endocrinology of pregnancy, the placenta, the fetus and the neonate including but not limited to:

• Maternal adaptation

• Fetal development

• Placental function

• Parturition

• Neonatal adaptation to extrauterine life

• Medical and surgical neonatal conditions

• Genetic disorders