Curriculum standards

Knowledge guides

LG16: Neonatal and perinatal medicine

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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Presentations

Antenatally diagnosed conditions
Billious vomiting
Cardiac murmurs
Collapsed neonate
Cyanosis
Dysmorphic features
Floppy infant
Hypoglycaemia
Hypothermia
Jaundice
Large for gestational age
Neonatal resuscitation
Poor feeding
Preterm neonates
Respiratory distress
Seizures
Slow growth
Small for gestational age
Vomiting

Conditions

Air leak syndromes:
- pneumomediastinum
- pneumothorax
Anaemia
Apnoea
Birth trauma:
- brachial plexus palsy
- cephalhaematoma
- clavicular fracture
- subgaleal haemorrhage
Bronchopulmonary dysplasia
Congenital anomalies of the kidney and urinary tract
Congenital heart disease, including duct-dependent circulation
Congenital malformations:
- cleft lip or palate
- digit / limb abnormalities
- Pierre Robin sequence
- sacral dimples
- single umbilical artery
Congenital pneumonia
Developmental dysplasia of the hips
Electrolyte abnormalities
Gastro-oesophegeal reflux
Group B strep sepsis screening and management
Head moulding
Hypoglycaemia
Hypoxic ischaemic encephalopathy
Infant of diabetic mother
Intracranial or intraventricular haemorrhage
Intrauterine growth restriction
Lung disease, chronic
Meconium aspiration syndrome
Meningitis and encephalitis
Nasolacrimal duct obstruction
Necrotising enterocolitis
Neonatal abstinence syndrome
Neonatal asphyxia
Neonatal infection
Persistent pulmonary hypertension
Plagiocephaly
Polycythemia
Respiratory distress syndrome
Retinopathy of prematurity
Sepsis
Shock
Skin conditions
Small for gestational age
Transient tachypnoea of the newborn

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, pathophysiology, and clinical science
take a relevant clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigation
consider the impact of illness and disease on patients and families, and their quality of life

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Conditions

Ambiguous genitalia
Choanal atresia
Chromosomal and genetic conditions
Congenital adrenal hyperplasia
Congenital and perinatal infections
Congenital brain abnormalities
Congenital diaphragmatic hernia
Congenital eye abnormalities
Congenital lung abnormalities
Congenital skin disorders, such as ichthyosis and epidermolysis
Disseminated intravascular coagulation (DIC)
Extreme prematurity
G6PD deficiency
Gastrointestinal emergencies
Haematological conditions:
- acute bleeding disorders:
  - lymphopenia
  - neutropenia
  - thrombocytopenia
  - vitamin K-deficient bleeding
- haemolytic disease of the newborn
Hereditary spherocytosis
Herpes simplex virus – approach to infants at risk or with suspected infection
Hyperthyrodism
Hypothyroidism
Larygneal lesions
Metabolic disorders
Neonatal encephalopathy
Neural tube defect
Perinatal stroke
Periventricular leukomalacia
Pulmonary interstitial emphysema
Respiratory failure
Stridor
Supraventricular tachycardia

Surgical problems in the neonate

Abdominal wall defects
Atresia:
- anal
- duodenal
- oesophageal
Hirschprung disease
Hypospadias
Inguinal hernia
Intestinal malrotation, with or without volvulus
Meconium ileus
Trachea-oesophageal fistula
Undescended testes

Synthesise

recognise the clinical presentation
identify relevant epidemiology, pathophysiology, and clinical science
take a relevant clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigation
consider the impact of illness and disease on patients and families, and their quality of life

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Anatomy, neurodevelopment, and physiology aspects of feeding and gut maturation in term and pre-term infants
Drug metabolism in the neonate and breastfeeding mother, and appropriate and safe prescribing
Effects of intrauterine and perinatal events on outcome
Pathophysiology of common and uncommon neonatal conditions
Physiology of extra-uterine adaptation, including initiation of feeding, and changes to cardiac and respiratory physiology

Clinical assessment tools

Neonatal growth charts (Fenton)
Newborn hearing screening
Postnatal assessment of gestestional age (Ballard / Dubowitz)

Investigations

Blood tests:
- bacterial and viral PCR
- biochemistry
- blood gas
- endocrinological
- genetic investigations
- haematological
- inflammatory markers
- metabolic screening tests
- microscopy:
  - culture and antimicrobial sensitivity
- newborn screening
Cardiac studies:
- echocardiography
- electrocardiography (ECG)
Electroencephalography (EEG)
Other pathology:
- cerebral spinal fluid microscopy:
  - culture and antimicrobial sensitivity
- swabs from sterile and non-sterile sites
- urine microscopy:
  - biochemistry
  - culture and antimicrobial sensitivity
  - metabolic screening
- viral PCR
Radiology:
- MRI
- plain x-rays
- ultrasound
- upper gastrointestinal contrast study

Procedures

Awareness of role of adjuncts to diagnostic assessment and procedures, such as:
- point of care ultrasound (POCUS)
- transcutaneous bilirubinometer
- transilluminator
Intramuscular injections:
- vaccinations
- vitamin K injection
Intubation
Lumbar puncture
Needle thoracostomy and intercostal drain insertion
Nasogastric (N-G) tube placement
Peripheral intravenous (IV) access, including knowledge of:
- mid lines
- peripherally inserted central catheters (PICC)
Suprapubic aspirate
Surfactant administration
Transfusion of blood and blood products
Umbilical venous and arterial catheterisation
Urinary catheter insertion

Administration of maternal medications such as magnesium sulfate, steroids, and tocolytics for prevention of premature birth, prevention of perinatal morbidity, and neuroprotection
Antenatal screening
Antenatally diagnosed conditions, such as:
- cerebral ventricular dilatation
- choroid plexus cysts
- congenital heart disease
- dilated kidney system
Breastfeeding difficulties and support
Congenital conditions associated with maternal conditions, such as:
- maternal infections
- maternal medical diseases
- maternal substance use / misuse
- teratogens
Continuous positive airway pressure (CPAP) and humidified high-flow oxygenation
Developmental care for neonates
Early intervention services
Extreme prematurity – decision making, along with obsteric collegues, regarding:
- immediate care of the neonate
- limits of viability
- managing labour
Feeding difficulties
Growth patterns in newborn period
Immunisation of term and preterm infants
Implications and considerations in the redirection of care and palliative care
Implications of congenital abnormalities for continuation of pregnancy and method of delivery
Implications of congenital abnormalities for development, physical, and psychological function during childhood and adolescence
Implications of congenital abnormalities for genetic counselling
Infant care, feeding, and sleep
Infant caregiver relationship
Local resources available to ensure monitoring of growth and development in the newborn
Manual and mechanical ventilation, including bag mask and T-piece
Multiple pregnancies and complications
Neonatal fluid management, including intravenous fluid prescription
Neonatal resuscitation
Neurodevelopmental outcomes and follow-up
Normal growth and development in neonates
Normal neurodevelopmental milestones in preterm infants
Nutritional requirements of term and preterm infants:
- enteral feeding and parenteral nutrition
Parental counselling
Perinatal epidemiology
Postnatal depression
Preterm neonate complications, such as:
- anaemia
- chronic neonatal lung disease
- electrolyte disturbances
- intraventricular haemorrhage
- long-term neurodevelopmental disability
- metabolic bone disease
- necrotising enterocolitis and spontaneous intestinal perforation
- nosocomial infection
- patent ductus arteriosus
- retinopathy of prematurity
Prevention of perinatal mortality and low birth weight
Principles of stabilisation and management of neonate prior to and during transport
Procedural pain management, including sucrose and non-pharmacological supports
Risk factors for neonatal sepsis and neonatal sepsis calculators
Transport and retrieval issues
Transport and retrieval services
Vitamin, probiotic, and mineral supplementation and fortification options in premature infants