The training provided should equip the doctor with the necessary knowledge, skills and attitudes required to practice high quality neonatal medicine.

The trainee Neonatologist should acquire detailed knowledge of:

Epidemiology: Mortality and morbidity rates in the perinatal period and factors which influence mortality and morbidity. Methods of data collection at national and local level, including birth and death notification systems and audits aimed at quality assessment.

Pathophysiology of the fetus: Fetal growth and development and the means of its assessment. Impact of the major diseases of pregnancy on the fetus, e.g. hypertensive disease, maternal medical conditions, ante partum haemorrhage, and preterm labour. Detection of fetal anomaly and collaborative prenatal counselling.

Physiology of postnatal adaptation: Respiratory, cardiovascular and other physiological changes at birth. Development of organ systems and physiological changes after birth. Physiology of breast feeding.

Pathophysiology of prematurity: Respiratory development and pathology including surfactant deficiency and its sequelae. Cardiovascular problems including patent ductus arteriosus and persisting pulmonary hypertension. Gastrointestinal development and feeding, renal maturation and fluid balance. Neurological problems, including pathogenesis of ìntraventricular haemorrhage and periventricular leucomalacia.

Pathophysiology of conditions encountered in premature and mature infants: Congenital abnormalities and their management. Perinatal hypoxia and consequences of hypoxia and ischemia. Metabolic adaptation to postnatal life. Inborn errors of metabolism including screening programs for their detection. Neonatal immunity and pathogenesis of perinatal / neonatal infection.

 Pharmacology in the perinatal/neonatal period: Pharmacokinetics in the term and preterm newborn, drug toxicity and interactions; Influence of maternal medication on neonatal condition, effects of maternal drug abuse on the fetus and newborn infant, and transmission of drugs via breast milk.

Principles of neonatal care: Theory and organisation of resuscitation. Respiratory care and mechanical ventilation, endotracheal intubation and delivery of respiratory support. Management of complications and long term sequelae of prolonged neonatal ventilation. Cardiovascular support, assessment of cardiovascular system and of patent arterial duct. Postnatal growth, breast feeding, composition and use of neonatal formulae and supplements. Parenteral nutrition, prescription, administration and indications. Assessment, diagnosis and management of severe enteral diseases. Neonatal skin and thermal care. Assessment of fluid balance and nutritional requirements. Assessment of bone mineralisation. Assessment of structural and functional integrity of the brain using clinical examination and special investigations. Prognosis of major neuropathology, screening preterm and 'at risk' babies for retinopathy and hearing loss. Diagnosis and assessment of congenital abnormality and dysmorphology. Investigation of suspected inborn errors of metabolism. Use of genetic investigations and diagnostic aids. Routine care of the newborn in relation to jaundice, breast feeding, infections. Screening for neonatal disease by examination and investigation. Early, medium term and late sequelae of neonatal and perinatal events and ethical issues in neonatal care.

Follow-up of high risk infants: Outcomes associated with perinatal high risk groups (e.g. prematurity, fetal growth restriction and intrapartum hypoxia), diagnosis and counselling associated with cerebral palsy, visual and hearing defects, chronic respiratory problems and an understanding of the importance of other neurocognitive outcomes.

Ethical issues and legal problems: including National and European practice

Trainees will be expected to have acquired extensive skills in the following domains:

Practical procedures: Resuscitation of the newborn, tracheal intubation and techniques of artificial ventilation. Insertion of arterial catheters (umbilical and peripheral), establishment of intravenous infusion and long intravenous lines. Blood transfusion and exchange transfusion. Arterial puncture, pleural drainage of pneumothorax, suprapubic aspiration of urine, lumbar and ventricular puncture.

Diagnosis: Interpretation of neonatal chest and abdominal radiological investigations. Role of specialised investigations, e.g. MRI, CT. Experience in interpreting results of ultrasound examination of the nervous system, the abdominal organs, and of congenital hip dysplasia. Ordering and interpretation of common laboratory and micro-biological investigations. Use and interpretation of the results of EEG, cortical evoked responses and neuromuscular electro-physiological tests.

Clinical practice: Clinical examination of sick and healthy newborn baby, recognition of specific neonatal problems including deformation and malformation, assessment of gestational age. Developmental and neurological assessment of the older infant and child and the assessment of disability.

Communication: Counselling and communication skills including appropriate approach to distressed and bereaved parents, disclosure of “bad news”, handling of autopsy reports. Staff support and team dynamics. Co-operation and consultation with other medical specialists.

Technology: The neonatologist will be expected to understand basic mechanical and electrical function of radiant heaters, incubators, ventilators, and monitoring equipment.

Teaching: The neonatologist should be trained and involved in teaching activities including teaching programs for doctors and nurses.

Personal development:

The neonatal specialist role includes leadership within the clinical team and many neonatologists undertake important management roles within the team and within their host organisation (usually their Hospital or University).  In particular the training programme must equip the trainee with the personal skills necessary to fulfil these roles, for example:

• Counsellor
• Manager
• Leader
• Teacher
• Clinical governance and audit
• Statistical and interpretative skills

Click here for more information

Click here for information on the Assessment Framework for Specialist Trainees in Neonatal Medicine