Curriculum standards: LG15: Scientific foundations of neonatal and perinatal medicine

Knowledge guides

LG15: Scientific foundations of neonatal and perinatal medicine

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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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, management and outcomes.

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Anatomy

Altered physiology states
Common congenital abnormalities identifiable in the fetus
Common maternal conditions that affect fetal growth and development
Common minor variants affecting the healthy neonate, such as:
- rashes
- skin tags
- tongue tie
Common neonatal complications associated with birth
Effects of maternal medications and substance misuse on fetuses, neonates, and growing children
Fetomaternal conditions that may influence the mode of delivery and/or resuscitation
Indications and outcome of common fetoplacental interventions
Normal fetal growth and development
Physiological changes involved in the transition to extrauterine life
Survival and long-term neurodevelopmental outcome data of extremely preterm and sick neonates by week of gestation

Epidemiology and statistics

Descriptive, qualitative, and quantitative statistics
Research methods, such as:
- audits
- cohort studies
- evidence synthesis
- quality improvement
- trial designs

Pharmacology

Assessment and management of differing pain severities associated with procedures
Dose monitoring
Drug excretion in breast milk
Drug interactions
Feeding and nutrition
Maternal medications and substance misuse on fetuses, neonates, and growing children
Pain management options:
- non-pharmacological
- pharmacological
Principles of pharmacology as applied to preterm and term neonates
Side effects
Support of parents in home administration of medications

Clinical assessment tools

Blood:
- blood counts
- interpretation of:
  - blood cultures
  - blood gasses
  - other blood tests, including inflammatory markers
- kidney and liver function tests
Developmental assessment tools, such as:
- Bayley Scales of Infant and Toddler Development
- general movements assessment
- Griffiths III
- Hammersmith Infant Neurological Examination (HINE)
Imaging and their interpretation:
- MRI
- ultrasound
- x-rays
Interpretation of monitoring:
- amplitude-integrated electroencephalography (aEEG)
- electroencephalogram (EEG)
- oximetry
- ultrasound
Other body fluids:
- biochemistry
- cultures
- interpretation of microscopy
Thermoregulatory principles in newborns, such as:
- fluid and electrolyte monitoring in sick and preterm neonates
- understanding of the thermoneutral environmen

Drains and catheters, and their insertion and removal

Endotracheal intubation
Intercostal drains
Nasogastric tube
Percutaneous:
- central venous lines
- long lines
Peripheral:
- arterial catheters
- intravenous cannulas
Umbilical catheters:
- arterial
- venous
Urinary bladder catheter

Procedures

Bladder taps
Blood cultures under aseptic techniques
Blood sampling from peripheral arterial and umbilical lines
Capillary blood sampling
Drainage of cerebrospinal fluid (CSF) reservoir
Exchange transfusions
Lumbar punctures
Paracentesis
Pericardiocentesis
Peripheral arterial punctures
Surfactant administration
Thoracocentesis

Resuscitation and stabilisation

Airway suctioning
Bag and mask ventilation
Cardiopulmonary resuscitation:
- chest compressions
Emergency thoracocentesis
Emergency umbilical venous access
Endotracheal intubation
Intraosseous needle insertion
Nasopharyngeal tube insertion
Supraglottic airway (LMA) placement
T-piece

Care of parents and neonates after birth

Anthropometry, including documentation
Bonding
Breastfeeding:
- advantages
- complications
- physiology
- practicalities
Child protection issues
Coordination of follow-up of high-risk infants and their families, including liaison with relevant community services
Current immunisation program and recommendations
Effects of maternal substance intoxication, misuse, and withdrawal, and treatment of these issues on fetuses and neonates
Factors impacting on the healthy maternal-infant dyad
Infant mental health, and recognition of the impact of hospitalisation on infants
Issues relevant to postnatal depression
Maternal postnatal care
Postnatal growth, with consideration to macro and micronutrient requirements
Routine care and assessment of a well infant through the first 12 months, including preventative advice
Safe sleeping

Chronic conditions of neonates

Chronic respiratory disease
Hearing impairment
Long-term mental health issues, neurodisability, and neurodiversity
Severe retinopathy of prematurity (ROP) and visual impairment
Short gut syndrome, malnutrition / poor growth, and chronic feeding issues

Considerations when undertaking neonatal retrievals

Airway management and monitoring:
- chest drain insertion and management
- emergency intubation
- endotracheal tube (ETT) suction
- nitric oxide administration
- options for non-invasive respiratory support
- surfactant administration
Cardiovascular support:
- inotropic support:
  - dosing calculations
  - drug selection
  - infusion preparation
  - threshold for prostaglandin administration
  - titration protocols
Effects of transport on neonatal physiology:
- impact of adverse physical environment on neonates, including acceleration / deceleration forces, light, noise, temperature, and vibration on:
  - cerebral circulation
  - endotracheal tube position and securement
  - equipment stability
  - fluid dynamics
  - monitoring:
    - accuracy
    - methods
  - neonatal eye protection
  - neonate securement
  - noise stress prevention
  - temperature regulation
  - vascular catheter security
- physiological effects of air transport on pregnancy / fetus or neonate
Infection:
- investigation and treatment of bacterial and viral infections
Neurological support:
- fluid management:
  - choice of fluids
  - prevent and manage hypoglycaemia
  - rate determination
  - response assessment
  - volume calculation
- management of gastric and Replogle tubes where indicated
- methods of achieving therapeutic hypothermia:
  - fluids and nutrition
  - management of seizures
  - neuroprotective care
  - sedation and analgesia
Risk mitigation:
- alternative routes
- backup planning
- communication protocols and equipment
- equipment redundancy
Use of equipment specific to retrieval, such as:
- stretchers
- transport:
  - incubators
  - ventilators

Ethical and legal considerations

Ethical considerations for the care of sick neonates, families, and the clinical community
Ethical issues, such as:
- borderline viability – awareness of attitudes
- congenital malformations
- discontinuation of life support measures
- non-initiation of resuscitation
Ethics of providing support for sick neonates within the wider society, such as:
- at the limits of gestational viability
- for culturally and linguistically diverse families and communities
- for infants anticipated to have poor outcomes
Issues relating to end-of-life care, such as:
- family (including sibling) emotional and behavioural issues
- medicolegal issues
- palliative care
- role and importance of autopsy
- role of cognitive, cultural, emotional, and spiritual factors in end-of-life decisions
Legal responsibility for documentation
Long-term outcome of infants of borderline viability and infants with major medical problems
Medicolegal knowledge:
- zone of parental discretion – the right to refuse / redirect care

Management of neonatal retrievals

Appropriateness and availability of receiving unit
Assessment of risks of fetal and neonatal transport
Assessment of urgency of response and transfer, and consideration of alternatives
Communication of patient clinical status, needs, and retrieval plan with retrieval coordinator and receiving unit, as appropriate
Equipment and asset requirements, such as:
- anticipated need for inhaled nitric oxide
- multiple infusion pumps
- phototherapy
- therapeutic hypothermia
Equipment considerations, including battery life, management, and alarm settings
Factors that may extend transit time, such as weather and traffic conditions
Indications and limitations of different transport modalities, such as:
- fixed wing
- road
- rotor craft
Maternal conditions requiring in utero transfer
Neonatal conditions requiring transport, including critically unwell infants and those with special conditions, such as:
- cardiac
- congenital anomalies
- hypoxic ischemic encephalopathy (HIE)
- surgical
Plan for transport / retrieval, and in the event of major deterioration
Principles of management of neonates during transport
Referral, stabilisation, transfer, and receipt of transported patients
Resuscitation, stabilisation, and management of critically ill neonates in a non-critical care environment
Situations / Conditions where speed of transit to receiving unit is prioritised over intervention at referring unit
Team:
- composition
- responsibilities
- roles
- skill mix
Use of the transport equipment