Clinical training in neonatology takes place in the
William H. Tooley Intensive Care Nursery (ICN). It has a licensed
capacity of 51 beds and is located on the 15th floor of the Moffitt-Long
Hospitals at the
UCSF
Medical Center.
Obstetrics/Gynecology
On the same floor as the ICN, the
Department of Obstetrics and Gynecology has a delivery service with 2000
births per year. This is a very high risk service and 25% of inborn
patients are admitted to the ICN. The Neonatology Faculty and Fellows work
closely with the Obstetrical staff, including daily meetings to discuss prenatal
management of high risk patients. The Neonatology Fellow meets with
ante partum,
high risk mothers to discuss the expected neonatal care and long term outcome.
High Risk Preganancies
These obstetrical patients include a large proportion of high risk pregnancies
due to the large number of pregnant women referred to UCSF for very early
preterm labor and those referred to the Fetal
Treatment Program at UCSF because of prenatally diagnosed fetal
anomalies. These referrals result in a unique population of infants
delivered at UCSF which include 2% weighing <1000 grams, 6% weighing <1500 grams
and 5% with severe congenital anomalies. All of these are 5 to 6 times the
national average. The more common congenital anomalies among the inborn
population of infants include congenital diaphragmatic hernia, congenital heart
disease, neural tube defects, abdominal wall defects and cystic adenomatoid
malformation of the lung.
Neonatal Resuscitation
A
Neonatal
Resuscitation Room is located within the Obstetrical suite and
is used for intensive resuscitation of high risk infants. Depending on the
prenatal diagnosis of the infant, the resuscitation team may include all of the
following: Pediatric Residents, Neonatology Fellow, Neonatology Faculty, ICN
Nurses, Respiratory Therapists and a Blood Gas Technician.
Intensive Care Nursery - Clinical Neonatology Service
The
Clinical Neonatology Service is divided into two teams (Blue and
Gold), each with a Faculty Attending Physician. Depending on the type and
acuity of the patients, a team may also include a Neonatology Fellow, Pediatric
Residents and Neonatal Nurse Practitioners. Patients on the Blue team are
those with surgical conditions and congenital heart disease as well as those who
are on ECMO. Patients on the Gold team are those with medical diseases.
- Approximately 1,000 infants are admitted to the UCSF ICN each year
- ~50% are delivered at UCSF and the rest are referred from other hospitals
- The UCSF ICN
patient population includes the whole range of medical and surgical
diseases that affect newborn infants:
- 30% have congenital cardiac disease
- 27%
weigh less than 1500 grams
- 12% weigh less than 1000 grams
- 10% have a primary surgical
diagnosis
- All modalities for treatment are available including high
frequency ventilation, nitric oxide and ECMO.
Intradisciplinary ICN Team
Pediatric Medical services
that consult in the ICN include Cardiology, Endocrinology, Gastroenterology,
Genetics and Dysmorphology, Hematology, Immunology, Infectious Disease,
Nephrology, Neurology, Oncology, Pulmonology, Radiology, and Bioethics.
Pediatric Surgical services that consult in the ICN include Pediatric General
Surgery, Cardio-Thoracic Surgery, Neurosurgery, Ophthalmology, Orthopedics,
Otolaryngology, Plastic Surgery and Urology. The ICN has a Nursing staff
of 140 nurses. Four social workers attend to the needs of patients and
their families in the ICN. All patients in the ICN are under the care of
the Neonatology service; patients with consulting physicians (e.g.,
Pediatric Surgery, Cardiology) are managed jointly. There is excellent
rapport among all of the ICN staff, including the Neonatology service,
consulting Medical and Surgical services and the Nursing staff.
Neonatal Clinical Physiological Laboratory
The
Neonatal Clinical Physiological Laboratory, located in the ICN,
provides point of care measurements of pH and blood gas tensions, electrolytes
and hematocrit. The laboratory staff also performs measurements of
pulmonary function in newborn infants. These are interpreted by the Fellow
on clinical service in the ICN under the supervision of an Attending
Neonatologist. The staff members of this laboratory also perform hearing
screening of all newborns and they maintain the extensive
Neonatal
and Obstetrical databases, which are available for clinical
research. Through the database, the ICN participates in the
Vermont-Oxford Neonatal data program and the
California Perinatal Quality Control
Cooperative.
Neonatal
Follow-Up Program
The
Neonatal
Follow-Up Program, under the direction of Dr. Robert Piecuch,
provides comprehensive long term evaluation of infants weighing less than 1500
grams at birth, those who have undergone fetal surgical procedures, ECMO
patients and other selected high-risk groups. The Follow-Up clinics are
conducted both at UCSF and at various outreach sites in Northern California.
Fellows rotate through this clinic on a regularly scheduled basis.
Fetal Treatment Center
A unique aspect of the UCSF Campus is the Fetal Treatment Center directed by Dr. Michael Harrison, Professor of
Pediatric Surgery. This multidisciplinary group provides comprehensive
diagnostic and consultative services and prenatal, intrapartum and postnatal
care of patients with certain prenatally diagnosed congenital abnormalities.
The Fetal Treatment Center team includes Pediatric Surgeons, Radiologists (ultrasound
and MRI), Perinatologists, Neonatologists, Pediatric Cardiologists and Social
Workers. Patients are discussed at the weekly multidisciplinary Fetal Therapy
Conference.
Many of the ICN patients who have congenital anomalies have been
referred to UCSF through the Fetal Treatment Center. The more common conditions referred to the
Fetal Treatment Center include:
Fetal Treatment Research
The Fetal Treatment Center recently concluded an NIH-sponsored, randomized,
controlled trial of fetal tracheal occlusion for severe congenital diaphragmatic
hernia. An NIH-sponsored controlled trial of fetal surgical correction of
meningomyelocele is currently in progress. Also, a new investigation of prenatal steroids for treatment of prenatally diagnosed CCAMs is currently underway.