Neonatal-Perinatal Fellowship

Clinical Training

During their 3 years of training, fellows spend a total of 14 months on clinical service: 11.5 months on rotations split between the two teaching hospital NICUs (Seattle Children’s Hospital & University of Washington Medical Center); 2 months on rotations including perinatology, cardiac ICU, and pediatric surgery; and 2 weeks in one of the division's community hospital NICUs. Fellows also attend NICU follow-up clinic to learn from a variety of the specialties who care for our NICU graduates. Clinical rotations are generally 1 to 3 weeks duration and nearly half of these rotations are scheduled in the first year to allow for ample research time in the second and third years. Night call is in-house at both hospitals and averages approximately 50 nights per year, in line with the national median for night call.

During the first year, fellows focus on expanding their clinical knowledge base and skills. They participate as learners and teachers in procedural skills, rounds, ECMO, high risk deliveries, and family meetings. In the second year, in addition to continuing their life-long learning, fellows begin the transition from trainee to attending neonatologist, developing higher-level patient management and team leadership skills. In the third year, they complete this transition, including learning the administrative roles of the attending physician through pre-tending experiences.

Our clinical environment focuses on the interprofessional team approach, valuing the unique contributions each person brings to the patients' bedsides. Fellows are key members of our teams, working closely with attendings, residents, Advanced Practice Providers (APPs) and many others to provide the very best care for our patients.

Fellowship training in Neonatology at the University of Washington includes the following rotations:

1. University of Washington Neonatal Intensive Care Unit (UWMC NICU. Fellows spend approximately half of their NICU time in the UWMC NICU, which specializes in the care of the preterm infant, most of whom are inborn. Fellows gain delivery room experience (including the initial management of congenital anomalies such as abdominal wall defects, congenital heart disease, and diaphragmatic hernias) and mastery of care of preterm infants. They also participate in prenatal consults.
2. Seattle Children's Hospital Neonatal Intensive Care Unit (SCH NICU). Fellows spend approximately half of their NICU time in the SCH NICU, a quaternary referral center for a 4-state area (Washington, Alaska, Montana and Idaho). Fellows participate in the care of newborns with respiratory distress, neurologic diseases, inborn errors of metabolism, congenital heart disease, and complex congenital anomalies including surgical problems.
3. Perinatology. First year fellows spend time on Maternal-Fetal Medicine at University of Washington Medical Center and the Seattle Children's Prenatal Diagnosis and Treatment Program. This rotation provides exposure to the many high risk OB clinics and insight into high risk obstetrical care as well as opportunities to learn how to provide prenatal counseling to families expecting infants with congenital malformations.
4. Cardiac Intensive Care Unit.During their first and second years, fellows spend time on a cardiac intensive care rotation at SCH. The experience includes both pre and post-operative cardiac ICU care. Infants with cardiac disease complicated by prematurity or significant non-cardiac anomalies are co-managed by the CICU and NICU.  
5. Community Neonatology: Providence Regional Medical Center Everett Neonatal Intensive Care Unit (PRMCE NICU) and Valley Medical Center Neonatal Intensive Care Unit (VMC NICU). Senior fellows have the opportunity to participate for 2 weeks in neonatal intensive care at one of the division's community sites.
6. NICU Neurodevelopmental Follow-Up: [unbold] First year fellows will do 2 visits to the Infant Development Follow-up Clinic (IDFC) to understand the role and importance of Audiology, PT/OT, Psychology, Nutrition/dietary, and Social work in NICU follow up. They will have the opportunity to learn about how how each service performs their assessments. In the second year, fellows participate in a 1 week developmental rotation (interdisciplinary rotation with inpatient support services, Neuro, Developmental-Behavioral Peds, Early Intervention) as well as 2 clinical days at IDFC.  The focus of the 3rd year is to learn interdisciplinary developmental assessments and treatments while practicing your skills & preparing for independence. To meet this goal, 3rd year fellows will complete 6 days in IDFC. Interested fellows are welcome to complete additional training and clinical rotations in IDFU or participate in developmental research projects with the IDFC faculty. 

Seminars, conferences, and courses

Fellows attend weekly Core Curriculum conferences including weekly Fellow Conference, Journal Club and M & M, as well as to co-lead joint clinical conferences with pediatric surgery and perinatology. Fellows also attend courses in the Seattle Children’s Fellows’ College, which offers a core educational curriculum and career development services for postgraduate fellows in all pediatric medical and surgical programs at Seattle Children’s.

Neonatal neuroscience research projects span the disciplines of basic, translational and clinical research. Our research includes the development and use of clinically-relevant animal models to investigate new approaches to protect the brain of high-risk neonates. Research also focuses on developing and testing the efficacy of neuroprotective strategies and determining mechanisms by which they function. Additional research goals are to determine mechanisms by which neurodevelopment is impaired by stress and/or drugs used to treat stress in the neonatal period and to determine biologic correlates to MRI.

Board Pass Rate

In the past 5 years, graduates from our program have had a 100% first-take pass rate on their boards, placing our fellowship among the top programs in the country.

Added Benefits

• Fellows receive a 3 years subscription to NeoReviewsPlus
• Every fellow receives a Professional Development Fund of $350 per year
• Fellows are reimbursed for state medical license fees, and required certifications
• Every fellow receives a home call stipend and a transportation allowance
• Fellows have the opportunity to moonlight in the NICU during their 2nd and 3rd years of training

Fellowship Tracks

What is a fellowship track?

We define a ‘track’ as a consolidation of resources and opportunities in an area of scholarly focus. Each of our tracks are supported by a dedicated cadre of outstanding faculty from the University of Washington/Seattle Children’s Hospital Division of Neonatology. These recognized experts provide fellows with mentorship in their chosen field of scholarly inquiry. Additional faculty mentors, and resources, are available at the University of Washington and/or Seattle Children’s Research Institute. Track opportunities include graduate-level courses, the potential for elective clinical rotations and matriculation in various certificate programs. Selected fellows may also have the opportunity to pursue a master’s degree, with prior arrangements with the Fellowship Director and the Neonatal Division Head.

What tracks are available?

Our fellowship tracks align with 5 major areas of interest and expertise within the University of Washington/Seattle Children’s Hospital Division of Neonatology. Our tracks cover a diverse range of scholarly inquiry and provide a variety of options for fellows to choose form. Each track has a record of successful scholarship and productivity involving fellows. Neonatology fellows are given the option of choosing from any of the established tracks, or pursuing scholarly activity outside of a defined track in their individual area of interest. Our current fellowship tracks include the following:

Neonatal Neuroscience

Track Director: Sandra Juul MD, PhD
Faculty mentors: Nina Natarajan MD (Division of Neurology), Dennis E. Mayock, MD, Kendell German MD, Janessa Law MD, Mihai Puia-Dumitrescu MD MPH, Ulrike Mietzsch MD

Overview: The Division of Neonatology at the University of Washington is an internationally recognized center of excellence in neonatal neuroscience scholarship. Under the direction of Sunny Juul, and other division faculty, fellows have the ability to participate in ground breaking research focused on neonatal neuroprotection. Funded basic science and translational research projects include the use of therapeutic hypothermia, erythropoietin, and other therapeutic measures in the treatment hypoxic ischemic injury and prematurity-associated brain injury. Additionally, fellows can be involved in the development of novel translational models of neonatal neurologic injury, and/or clinical projects examining the neurodevelopmental outcomes of high risk infants. Fellows are also welcome to join the BRAIN Team; a research and education-focused group aimed at improving neurodevelopmental outcomes through neuroprotection-focused research and clinical application. 

Current projects:

Bench/Translational

• Development of neuroprotective strategies for encephalopathy of prematurity using ferret models
• Fatty acid intake and lipid-based mediators of developmental brain injury
• Effects of premature birth on the hallmarks of aging
• Mechanisms of susceptibility and resilience to developmental brain injury
• Biological markers for neonatal brain injury in nonhuman primates

Clinical

• Therapeutic hypothermia and erythropoietin in the treatment of hypoxic-ischemic injury
• Effects of Reach Out and Read on home literacy and language development in the NICU and follow-up clinics
• Curriculum development and NICU follow-up training for Neonatal and Developmental and Behavioral Pediatrics fellows
• Database development to follow neurodevelopmental outcomes of critically ill neonates
• Evaluation of an IVH prevention bundle
• NeuroICU guidelines and quality improvement
• Posthemorrhagic hydrocephalus protocol
• Transport cooling for HIE 
• Pharmaco-epidemiologic and drug safety studies in infants 
• Clinical trials: HEAL, PENUT, AEROFACT 2B
• In-hospital and neuro-developmental outcomes of premature and critically ill infants (BRAIN program)

Track opportunities:

• Graduate-level course in neurology, neurobiology and neuropathology
• Neonatal Neurology rotation elective at the University of Washington and Seattle Children’s Hospital

Neonatal Global Health

Track Director:Maneesh Batra MD, MPH
Faculty mentors:Anna Hedstrom MD, Cyril Engmann MD, Krystle Perez, MD, Rachel Umoren, MD, MS

Overview: Neonatal global health has been an area of interest within the UW Division of Neonatology for over a decade. With close alignment, and collaboration, with the University of Washington School of Public Healthand the Department of Global Health, neonatal fellows can participate in meaningful scholarly activity in Neonatal Global Health, and forged viable career paths in this burgeoning area. Recent alignment of Division Faculty with PATH, an international, nonprofit global health organization based in Seattle, with 1200+ employees in more than 30 offices around the world, allows new opportunities for neonatal fellows to get involved with neonatal global health.

Current projects:

• Neonatal respiratory care in low resource areas
• Neonatal health metrics
• Maternal and child health and nutrition

Track opportunities:

• Graduate-level course in public health, epidemiology and global health
• Neonatal Global Health rotation elective abroad*
• Global Health Training Certificate for Residents & Fellows, Department of Global Health
• Elective rotation at PATH
• Master’s degree in Public Health

Neonatal Education and Simulation-based Training

Track Director:Rachel Umoren MD, MS,
Faculty mentors: Tom Strandjord MD, Megan Gray MD, Taylor Sawyer DO, MEd, Sarah J. Handley MD, Zeenia Billimoria MD

Overview: Educational scholarship is a well-recognized area of academic focus for neonatologists on a clinician-educator career path. The use of simulation methodology to facilitate educational research has seen an exponential rise over the past few years. The Neonatal Education and Simulation-based Training Track provides an opportunity for Fellows with an interest in pursuing a career as a clinician educator to gain a strong foundation with educational research. This track is well suited for fellows with an interest in pursuing leadership positions in graduate medical education, including training program directorship. To support educational scholarship, and simulation-based research, the Division of Neonatology has established the Neonatal Education and Simulation-based Training (NEST) Program.

Current projects:

• Procedural skills training and competency assessment
• Neonatal resuscitation training
• Neonatal airway management
• Virtual reality teamwork training
• Prenatal counseling milestones and training 
• Transport and telemedicine systems simulations
• National Neonatology Curriculum
• E-learning
• Disaster training in the virtual environment
• Patient safety curriculum

Track opportunities:

• Graduate-level course in education
• Academic Pediatric Association Educational Scholars Program
• Participation in the University of Washington Center for Leadership and Innovation in Medical Education (CLIME) Program
• Simulation elective with Seattle Children’s Hospital Learning and Simulation Center
• Simulation Fellowship through the International Pediatric Simulation Society
• Involvement in the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE)

Neonatal Quality Improvement and Patient Safety

Track Director: Elizabeth Jacobson MD
Faculty Mentors: Davia Loren MD, Linda Wallen MD, Christina Long, DO, Toby Cohen MD, Michael Neufeld MD MPH, Kirti Upadhyay, MD

Overview: Involvement in quality improvement is a requirement for maintenance of certification by the American Board of Pediatrics, and is also a recognized area of scholarly activity. The Neonatal Quality Improvement and Patient Safety Track allows fellows to learn the intricacies of conducting quality improvement research. Through involvement with the Vermont Oxford Network (VON) and the Children’s Hospital Neonatal Consortium (CHNC) fellows will learn the power of utilizing a neonatal database for quality improvement efforts.

Current Projects:

• Optimizing teamwork in the NICU & Delivery Room
• Bronchopulmonary dysplasia prevention
• Probiotic use for the prevention of necrotizing enterocolitis
• Gastroschisis care
• Temperature management in the golden hour
• Regional QI Educational Collaborative

Track Opportunities:

• Seattle Fellow’s College courses in quality improvement
• Participation in the UW Perinatal Continuous Quality Improvement Team
• Institute for Healthcare Improvement coursework
• Participation in Vermont Oxford Network Annual Quality Congress
• Certificate Program in Patient Safety and Quality, UW Medicine and Seattle Children’s Hospital

Neonatal Bioethics

Track Director: Elliott Weiss, MD, MSME 
Faculty Mentors: Benjamin Wilfond MD (Division of Pulmonology), J. Craig Jackson, MD, MHA

Overview: The Division of Neonatology, in conjunction with the University of Washington Department of Bioethics and Humanities and the Seattle Children’s Hospital Treuman Katz Center for Pediatric Bioethics, has been highly involved in the area of neonatal bioethics. Fellows participating in the Neonatal Bioethics Track will have the opportunity to conduct research in bioethics related to neonatal care and will be able to take advantage of the outstanding bioethical resources at the University of Washington and Seattle Children’s Hospital. The Trueman Katz Bioethics Fellowship is truly a unique opportunity, allowing fellows to complete a prestigious Ethics fellowship and earn a Masters in Bioethics which will prepare them well for a career in academic neonatal bioethics..

Current Projects:

• Parental decision-making in the NICU
• Ethics of research consent and enrollment processes
• Use of biases and heuristics in medical decision-making
• Models of shared decision-making 
• Neuroethics, including ethical implication of neuroimaging in neonates
• Perinatal consultation

Track Opportunities:

• Graduate-level course in bioethics
• Hospital Ethics Committee involvement
• Participation in combined Neonatal-Obstetric Ethics conferences
• Attendance of the Annual Pediatric Bioethics Conference
• Concurrent Clinical Bioethics Fellowship through the Treuman Katz Center for Pediatric Bioethics

Scholarly Activity

Fellows choose their scholarly focus and type of scholarship (e.g. neonatal neuroscience, global health, clinical research, ethics, public health, education, etc.) early in their first year. To choose an area of scholarship, fellows spend their non-clinical time meeting with the fellowship program's Research Director and with selected division and non-division faculty members to discuss potential projects. By October, fellows should have identified their scholarly focus and mentor(s). This will determine the composition of their Scholarship Oversight Committee (SOC) and will shape the content and direction of their 2nd and 3rd years of training. Scholarly activity generally includes the formation of a hypothesis-driven research question, planning and execution of the project including IRB or IACUC submission as appropriate, data analysis, and publication of the work. During their research time, fellows learn to critically evaluate the relevant literature and can take relevant coursework, including biostatistics. For fellows choosing a basic science or clinical research focus, grant preparation will be emphasized in the 2nd and 3rd year so that funding is likely to be available for an optional 4th year.