Neonatal-Perinatal Fellowship

Clinical Training

During their three 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); 2.5 months on elective rotations including perinatology, cardiac ICU, developmental neonatology, pediatric anesthesia, and pediatric surgery; and two weeks in one of the division's community hospital NICUs. Fellows also attend NICU follow-up clinic to learn from a variety of specialties who care for our NICU graduates. Clinical rotations are 1 to 3 weeks duration. Night call is in-house at both hospitals and averages 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 Fellowship Program offers special training in Point of Care Ultrasound (POCUS) with a multidisciplinary approach utilizing experts in Anesthesiology, Radiology, Emergency Medicine and Pediatric Intensive Care.  Training in POCUS gives our fellows the opportunity to improve their bedside diagnostic tools and their procedural success as they develop their clinical skills throughout their fellowship.  This multidisciplinary team also gives rise for the opportunity of research both within and outside of the division. POCUS machines are available at both of our academic NICUs and available for use by all fellows and faculty when needed for patient care. 

Our clinical environment focuses on the interprofessional team approach, valuing each person’s unique contributions 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:

Primary Clinical Rotations

• University of Washington Neonatal Intensive Care Unit (UWMC NICU). Fellows spend approximately half of their clinical time in the UWMC NICU, which specializes in the care of preterm infants and high-risk infants with multiple congenital anomalies. Fellows gain delivery room experience and mastery of care of preterm infants.  UWMC is the tertiary care center and preferred delivery location for high-risk infants with known severe congenital anomalies across the Pacific Northwest region due to its robust Maternal-fetal Medicine services. Fellows will gain ample experience in the delivery room care and initial stabilization of infants with abdominal wall defects, congenital heart disease, genetic syndromes, diaphragmatic hernias, and many more. Fellows meet with families and provide consults for those expecting extremely preterm deliveries or deliveries impacted by significant infant illness; they also support residents in consults for families at risk for moderately preterm delivery.  Fellows are critical leaders on rounds, in resident education, and clinical care. The UWMC NICU's "Extremely Preterm Program" is a regional initiative with a dedicated and consistent approach to the care of the highest risk patients born at 22-24 weeks' gestation. A tight-knit team of nurses, fellows, APPs, and faculty strive to provide the best possible care for these fragile infants.
• Seattle Children's Hospital Neonatal Intensive Care Unit (SCH NICU). Fellows spend approximately half of their clinical time in the SCH NICU, a quaternary referral center for a 4-state area (Washington, Alaska, Montana, and Idaho). Fellows care for newborns with respiratory failure, neurologic diseases, inborn errors of metabolism, congenital heart disease, and complex congenital anomalies, including surgical problems. Fellows round daily with the surgical team, then lead rounds for the NICU’s resident team. They perform, teach, and oversee procedures for a wide range of critically ill patients. Fellows are integral to managing the care of infants with a multi-system disease, diagnostic challenges, and prognostic uncertainty. The SCH NICU has the region’s only neonatal ECMO program and neonatal dialysis program, supplying outstanding learning opportunities for fellows pursuing careers in Level 4 NICUs. The Seattle Children’s NICU houses the Neuro-NICU program, an interdisciplinary program dedicated to optimizing outcomes for infants affected by hypoxic-ischemic encephalopathy, seizures and an array of congenital and acquired neurologic diseases.  Our Bronchopulmonary Dysplasia team provides many opportunities to improve the care for infants with severe BPD and expand our knowledge of this patient population. Fellows participate in these team meetings while on clinical service and become long-term team members when their research interests align.

Selective Rotations

• Perinatology. First-year fellows spend time with the Maternal-Fetal Medicine team at the 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 empathic prenatal counseling to families expecting infants with congenital malformations.
• Cardiac Intensive Care Unit. During their first and second years, fellows spend time on a cardiac intensive care rotation in the Cardiac ICU 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.  
• Community Neonatology: Providence Regional Medical Center Everett (PRMCE) NICU  and Valley Medical Center (VMC) NICU. Senior fellows have the opportunity to participate for two weeks in neonatal intensive care at one of the division's community sites.
• NICU Neurodevelopmental Follow-Up: The Infant Development Follow-Up Clinic (IDFC) is an interdisciplinary developmental surveillance clinic housed at the University of Washington Institute on Human Development and Disability (https://ihdd.org/services/specialty-clinics/).  First-year fellows gain an introductory experience to this clinic during their first year, learning the role and function of the various subspecialists in NICU follow-up care.  During their second year, fellows participate in a one-week developmental rotation (interdisciplinary rotation with inpatient support services, Neurology, Developmental-Behavioral Peds, Early Intervention), as well as additional time in IDFC.  The focus of the 3rd year is to learn interdisciplinary developmental assessments and treatments while practicing their skills & preparing for independence.  Interested fellows are welcome to complete additional training and clinical rotations in IDFC or participate in developmental research projects with the IDFC faculty. 

Seminars, conferences, and courses

Fellows attend weekly core curriculum conferences, including board review, Fellow’s Conference, and twice-weekly division conferences. Fellows actively participate and lead journal clubs, M&M reviews, as well as to co-lead joint clinical conferences with 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. Education time is protected time, and fellows are encouraged to hand off clinical duties to attend conferences and seminars. For fellows who would like to build their skills in specific areas, additional training opportunities are offered by both the UW and Seattle Children’s Hospital

As all fellows need to be skilled in quality assurance and quality improvement, we collaborate with other regional fellowship programs and faculty for quarterly education on this important topic.  A quarterly Fellows’ Research Curriculum also provides core instruction relevant to fellows with a range of research interests.

Other educational support:

• Attendance costs for at least one academic conference per year are covered so that fellows can present their work and network
• Fellows receive a three years subscription to NeoReviewsPlus
• Every fellow receives a Professional Development Fund of $350 per year
• Vital Talks communication training is provided at least twice annually
• 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
• Up to six credit hours per quarter of classes at the UW are free of charge.
• Simulation training is provided to build procedural skills
• A regional boot camp for new fellows

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 is supported by a dedicated cadre of outstanding faculty from the University of Washington and Seattle Children’s Hospital. 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 five 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 inquiries and provide various options for fellows to choose from. Each track has a record of successful scholarship and productivity involving fellows. Neonatology fellows are allowed to select from any of the established tracks or pursue scholarly activity outside of a defined track in their area of interest. In addition to the tracks below, there are faculty and fellows whose scholarly passions lead them to other areas of work.

Neonatal Neuroscience

Track Director: Sandra Juul MD, PhD, Tommy Wood BM BCh, PhD
Faculty mentors: Ulrike Mietzsch MD (Co-director, Neuro-NICU), Nina Natarajan MD (Co-director, Neuro-NICU, Division of Neurology), Dennis E. Mayock, MD, Kendell German MD, Janessa Law MD, Mihai Puia-Dumitrescu MD MPH,  Ulrike
Mietzsch MD, Sarah Kolnik, MD , Sara Neches, MD

Overview: The Division of Neonatology at the University of Washington is an internationally recognized center of excellence in neonatal neuroscience scholarship. Neonatal neuroscience research projects span the disciplines of basic, translational, and clinical research. Under Sunny Juul, Tommy Wood, and other division faculty, fellows can participate in groundbreaking research focused on neonatal neuroprotection. Funded basic science, clinical and translational research projects include investigating therapeutic hypothermia, erythropoietin, azithromycin, and other therapeutic measures to treat hypoxic-ischemic injury and prematurity-associated brain injury. Additionally, fellows can be involved in the developing novel translational models of neonatal neurologic injury and/or clinical projects examining the neurodevelopmental outcomes of high-risk infants. Fellows are 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 in vivo and in vitro models
• Development of neuroprotective strategies for traumatic brain injury using ferret models
• Repurposing azithromycin for premature brain injury
• 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
• Exploring neural stem cells and extracellular vesicles as a potential therapy for perinatal hypoxic-ischemic brain injury

Clinical

• 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
• NeuroNICU guidelines and quality improvement
• Posthemorrhagic hydrocephalus protocol
• Transport cooling for HIE 
• Temperature regulation in neonates with HIE
• NIRS monitoring in extremely low-birth-weight infants
• Pharmaco-epidemiologic and drug safety studies in infants 
• In-hospital and neurodevelopmental outcomes of premature and critically ill infants
• The impact of genetic variants on neurodevelopmental disabilities
• Clinical trial evaluation of the safety and efficacy of IV iron preparations and erythropoietic stimulating agents (DIVI).

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: Sara Berkelhamer, MD, Cyril Engmann MD, Anna Hedstrom MD, Taylor Hendrixson MD, Krystle Perez, MD, Rachel Umoren, MD, MS,Gregory Valentine MD MED. 

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 Health and the Department of Global Health neonatal fellows can participate in meaningful scholarly activity in Neonatal Global Health, and forge viable career paths in this burgeoning area. Alignment of Division Faculty with PATH, an international, nonprofit global health organization based in Seattle, and the Bill and Melinda Gates Foundation allows for further potential opportunities for neonatal fellows. Within the division a career development and mentoring group entitled ALIGN: Advancing Learning and Innovation in Global Newborn Health, provides novel ideas and guidance on projects focused on improving neonatal care in low-resourced settings globally.

Current projects

Track opportunities

• Graduate-level course in public health, epidemiology, and global health 
• Opportunity for a neonatal global health rotation elective abroad 
• Global Health Training Certificate for Residents & Fellows, Department of Global Health 

Neonatal Education and Simulation-based Training

Track Co-Directors: Megan Gray MD, Dr. Rachel Umoren 
Faculty mentors: Tom Strandjord MD, Taylor Sawyer DO, MEd, Zeenia Billimoria MD, Sara Berkelheimer 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 interested in pursuing a career as a clinician-educator to gain a strong foundation with educational research. This track is well suited for fellows interested in pursuing leadership positions in graduate medical education, including training program directorship. The Division of Neonatology has established the Neonatal Education and Simulation-based Training (NEST) Program to support academic scholarship and simulation-based research

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 and communication 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 Course through the Seattle Children's Simulation Program
• Simulation Fellowship through the International Pediatric Simulation Society
• Involvement in the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE)
• Research into intubation practices and outcomes via the NEAR4Neos Intubation Database

Neonatal Quality Improvement and Patient Safety

Track Director: Elizabeth Jacobson MD

Faculty Mentors: Christina Long, DO, Toby Cohen MD, Michael Neufeld MD MPH, Kirti Upadhyay, MD

Overview: Involvement in quality improvement (QI) is a requirement for maintenance of certification by the American Board of Pediatrics and is also a recognized area of scholarly activity. The goal of the QI component of the fellowship program is to ensure that fellows acquire the knowledge and skills required to improve their own and system’s practice continually. 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. Active engagement in these programs builds fellow’s knowledge and skills. In year one, fellows learn the variety of quality matrices used in the NICU; during years two and three, they lead their own QI initiative with the help of multi-disciplinary teams.

Current projects

• Pneumothorax Prevention Project across Regional NICU network
• 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
• Join a Children’s Hospital Neonatal Consortium (CHNC) work group

Neonatal Bioethics

Track Director: Elliott Weiss, MD, MSME 
Faculty Mentors: 

Douglas J Opel, MD, MPH (Division of General Pediatrics) 
Malia Fullerton, DPhil (UW Bioethics and Humanities) 
Jori F Bogetz, MD (Division of Bioethics and Palliative Care) 
Benjamin Wilfond, MD (Division of Pulmonology) 
J. Craig Jackson, MD, MHA 
Josie H. Amory, MD (Neonatal/Perinatal Palliative Care) 
Jenn Kett, MD, MA  (Seattle Children’s Palliative Care)

Overview:  The Division of Neonatology has been highly active in bioethics scholarship through division members and through collaborations with scholars from the University of Washington Department of Bioethics and Humanities and Seattle Children’s Hospital Treuman Katz Center for Pediatric 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. Research methodologies include qualitative interviews, quantitative surveys, case studies, and conceptual work.  Fellows may apply for the Treuman Katz Bioethics Fellowship, a unique opportunity which includes mentored scholarship, education, and ethics consultation experience, as well as formal coursework towards a Master’s in Bioethics. This will prepare them well for a career in academic neonatal bioethics. 

Current projects

• Parental decision-making in the NICU
• Research participation in the NICU 
• Use of biases and heuristics in medical decision-making 
• Models of shared decision-making  
• Neuroethics, including caring for infants with severe neurological impairment 
• Ethics of perinatal consultation

Track opportunities

• Concurrent Clinical Bioethics Fellowship through the Treuman Katz Center for Pediatric Bioethics  
• Attendance at the Annual Pediatric Bioethics Conference 
• Graduate level coursework in bioethics 
• Clinical ethics consultation experience 
• Research ethics consultation experience 
• Hospital ethics committee involvement 
• Participation in combined Neonatal-Obstetric ethics conferences 

Scholarly Activity Timeline

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 various fellowship program's track directors and selected division and non-division faculty members to discuss potential projects. Once fellows 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 forming 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. Fellows are encouraged to collaborate and contribute to other scholarly activities as bandwidth and interest allow. During their research time, fellows learn to critically evaluate the relevant literature and 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.

Roadmaps to Clinical Research, Basic Science Research, and QI Research