Neonatology Fellowship Program | Loyola Medicine

Neonatology Fellowship Program

Program Overview

We have a staff of 12 attending neonatologists, 5 perinatologists, 4 neonatal nurse practictioners and 6 neonatal-perinatal fellows. Our neonatal attendings (without assistance from fellows) also service three other community hospital special care nurseries. We admit 350-400 patients per year to the Loyola neonatal intensive care unit (NICU), with an average daily census of 27-30. About 15% of our admissions are <28 weeks gestation, and about 40% are term giving the fellows a wide range of clinical exposure. About 15% of admissions are outborn transfers.

Our program is supported by the following Pediatric subspecialists:

Cardiology, Dermatology, Endocrinology, Gastroenterology, Genetics, Hematology-Oncology, Infectious Disease, Nephrology, Neurology, Nutrition, Ophthalmology, Pulmonology, and Palliative Care.

We also consult with Pediatric Surgery and the  surgical subspecialists including Cardiovascular Surgery, ENT, Orthopedics, Neurosurgery, Plastics, Urology and Hand Surgery. We have a strong working relationship with the Maternal-Fetal Medicine Section and the Department of Obstetrics and Gynecology. A Doctor of Pharmacy and Neonatal Nutritionists help manage our patients. Occupational Therapy/Physical Therapy, Speech Therapy, Audiology, Social Work and Spiritual Care actively involved in educational program as well as in the daily care of our patients.

As part of our active Quality Improvement activities, we are part of the Vermont-Oxford Network. As well, we review quarterly neonatal and maternal morbidity and mortality issues for our Regional Perinatal Network as well as help initiate and implement both the regional and state of Illinois ongoing quality projects.

Another resource is the Neiswanger Institute of Ethics located here on campus, with a full range of ethics offerings in academics, lectures, consultation and research.

Follow-Up Clinic

We have an excellent High-Risk Newborn Follow-Up Clinic which meets one half days a week. Fellows participate approximately 1-2 times per month in these clinics. The clinic is supported by a neonatal nurse practitioner and OT/PT trained in early intervention.

On-call Schedule

On-call responsibilities are consistent through all three years, averaging six in house calls per month. Attending coverage is provided concurrently; attendings and fellows share weekend NICU team rounds. Fellows are responsible for primary critical decision-making and provide ongoing reports to the attending.

Fellowship Training

Fellowship training at Loyola includes:

  • 12 months of clinical neonatology
  • One-month rotations in Cardiology
  • 2-4 months of electives such as ID, Neo Pharmacology, Radiology
  • 16-18 months of research
  • Three months of vacation/meeting

Other electives may be accommodated.

Our 40 bed NICU is divided into two clinical teams each consisting of one attending neonatologist, one fellow, Pediatric and Med-Peds residents, nurse practitioners and 4th year medical students.  The fellows act as team leader with support from the attending. Medical rounds are in the morning. We huddle twice a day with OB staff to keep apprised of Labor & Delivery, ante-partum and post-partum.

Fellows are trained in procedures such as endotracheal intubation, umbilical catherization, peripheral arterial lines, PICC placement, chest tubes, paracentesis, and exchange transfusion.

Research/Scholarly Activity

The fellowship requires research/scholarly activity following the guidelines outlined by the American Board of Pediatrics’ scholarly activity requirement. An individualized Scholarly Oversight Committee for each fellow is formed and will mentor each fellow through his/her scholarly activity.  Research Conferences presented by fellows and attendings are designed to present results of current projects, discuss new protocols and critique proposed research design.  Fellows are expected to present their research at a regional and national research meeting such as the Society for Pediatric Research meeting or an appropriate subspecialty society research meeting. A manuscript submitted to a peer-reviewed journal is expected for completion of the Scholarly Activity. The design, implementation and completion of a fellow CQI project is expected prior to program completion.

The fellow with the guidance of an attending neonatologist, will also design and implement a Quality Improvement project, usually through several cycles. These are often presented at regional and national Quality Congresses, such as VON Annual Conference and Illinois Perinatal Quality Collaborative Conference.

Scholarly Activity (snapshot);

Astrug, L and Claud, E(2020). Necrotizing Enterocolitis. In R Polin and  M Yoder (Ed.) Workbook in Practical Neonatology (6th edition, pp. 330), Philadelphia, PA.

 

Astrug L, Claud E (2018). 'Necrotizing Enterocolitis: Neonatology Questions and Controversies' in Neu J, Poindexter B, Polin R (editor). Neonatology Questions and Controversies. Philadelphia, PA: Elsevier, pp 87-98.

 

Astrug L, Lu L, Lu J, Yu Y, Claud E (2017). 'Prenatal Probiotics Enhance Neonatal Gut Immunity.' Pediatric Academic Societies Conference. San Francisco, California.

 

Astrug L, Christine L, Ochieng J, Hornig J, Jaleel M (2015). Decreasing Blood Culture Contamination with Coagulase-Negative Staphylococcus (CoNS) in the NICU: A Quality Improvement Project. Pediatric Academic Societies Conference. San Diego, Ca.

 

Astrug L (2014). "Neonatal Aortic Thrombosis Case Report." Southern Regional Conference: American Federation of Medical Research. New Orleans, LA.

 

Astrug L, Thinman D, Baldovsky M (2014). 'Constipation and Abdominal Pain in a 2 year old girl.' Consultant for Pediatrics. V13:I9.

Feltman DM, Weiss MG, Nicoski P, Sinacore J.  Rocuronium for non-emergent intubation of term and preterm infants. Journal of  Perinatology 2011; 31: 38-43.   PMID: 20539274

Katebian R, Festle L, Herring B, Nickoski P, Bennett LN. Obtaining Admission Blood Work from the Umbilical Cord and Improving Average time to First Dose of /Antibiotic and Intravenous (IV) Dextrose.

 

Ngan M, Durazo-Arvizu R, Weiss MG, Kramer H.  Nutrient-Enriched Infant Formula Is Associated With Higher Weight Gain for Low Birth Weight Infants.  J Pediatr Gastroenterol Nutr. 2017 Jun;64(6):975-978. PMID: 28541261

 

Poster Presentations:

Vermont Oxford Network (VON) Improvement Science Expo, Chicago, IL October 2-6, 2019.

St. Albert's Day LUMC Research Conference, Maywood, IL October 24, 2019.

Conferences

Our weekly and monthly conferences provide an ample and varied educational experience including: three year cycled Neonatal Didactic Lecture Series, Pediatric Grand Rounds, Perinatal M&M case review and M&M teaching conferences, Neonatal Ethics, Neonatal Journal Club, Neonatal Physiology Seminar, Case Management and Neo Board Review.  The Neonatal Didactic Lecture Series provides a thorough review of various neonatal topics reflecting the ABP Neonatal Perinatal content outline presented by neonatologist, fellows and Pediatric subspecialist.Pediatric Grand Rounds provides updates of various pertinent pediatric subjects. Attendings and fellows present critical reviews of recent articles in our monthly Journal Club. Case Management and Ethics Conferences offer the opportunity to discuss and review interesting problem cases.