Neonatal Neuro-Critical Care Education

 

The Harvey Sarnat Clinical Research Fellowship in Neonatal Neurocritical Care

University of Calgary

 

 

Dr. Harvey Sarnat Neonatal Neuro-Critical Care Fellowship is a one year program  sponsored by the Section of Neonatology, Department of Pediatrics, University of Calgary.

Dr. Harvey Sarnat

Dr. Sarnat created the Sarnat and Sarnat neonatal Encephalopathy Staging Scale in 1976. Since its development, this scale has been used by pediatricians and neonatologists around the world. Any trainee in Pediatrics or Neonatology will encounter this scoring system as they learn about brain injury in the newborn. Dr. Sarnat is considered to be a neonatal Neurology legend- with 190 peer-reviewed original publications in the field of Pediatric Neurology and Neuropathology. Dr. Sarnat is Professor Emeritus of Paediatrics, Pathology (Neuropathology) and Clinical Neurosciences at the University of Calgary (Canada), where he continues to do research and see patients. Dr. Sarnat has practiced largely in Calgary since 1981 except for a decade spent on faculty at the University of Washington (Seattle) and then UCLA (Los Angeles). He is board-certified in Paediatrics and in Neurology in the U.S., and in Neurology by the Royal College of Physicians and Surgeons of Canada.

Dr. Sarnat continues to be a frequent invited speaker at medical congresses and institutions within Canada and internationally in Europe, Latin America, Japan, Australia and the U.S. He has received numerous distinguished awards include giving the Keynote Gordon Mathieson Lecture at the 50th anniversary meeting of the Canadian Association of Neuropathologists in 2010, the Bernard Sachs Research Award and Lecture at the 45th Annual meeting of the Child

Neurology Society in 2016, and having an annual endowed lectureship in his name at the University of Calgary; the Harvey Sarnat Developmental Neuroanatomy and Neuropathology Lectureship, since 2013.

Calgary Neonatal Neuro-Critical Care program:

The Calgary Neonatal Neuro-Critical Care Program is a collaborative initiative between the Sections of Neonatology and Pediatric Neurology. Multidisciplinary team members from Neonatology, Pediatric Neurology, Diagnostic Imaging, Neurophysiology, Neurosurgery, Obstetrics, nursing, allied health and Neuropathology contribute to a comprehensive care, research, training, and education experience.

The Neonatal Neuro-Critical Care training was recognized recently  by the Royal College of Physicians and Surgeons of Canada as an area of focused competence (AFC) diploma and by the United Council for Neurologic Subspecialties  (UCNS)   in the United States.

This prestigious fellowship will be awarded to candidates with strong interest and drive towards developing a career in neonatal neuro-critical care.

 

NNCC program 

Background:

The neonatal brain is susceptible to injury throughout the prenatal, early transition, and NICU hospitalization periods. Neonatal brain injury may have a lifelong impact on the baby and family. The goal of the Neonatal Neurocritical Care (NNCC) Program is to develop and implement evidence-based guidelines and protocols to either prevent brain injury, or remodel and rehabilitate the injured neonatal brain through multidisciplinary collaborative services.

The Neonatal Neuro-Critical Care (NNCC) program is based on a collaborative multidisciplinary consultation model with expertise in neonatal neurology and brain imaging. The Program draws on the skills of many groups, including Neonatology, Pediatric Neurology, Pediatric Neurosurgery, Neuropathology, Neuroradiology, Pharmacy, Nursing and other services. The team is responsible for developing and implementing guidelines, protocols, quality improvement (QI) projects, educational and training programs, clinical consultative management, and longterm follow up after hospital discharge. The service focuses on high-risk term and preterm newborns or those who sustain prenatal or postnatal brain injury such as hypoxic ischemic encephalopathy (HIE), neonatal stroke, and brain malformation.

 The NNCC Fellowship Program is an educational collaboration between the Sections of Neonatal Perinatal Medicine and Pediatric Neurology in the Department of Pediatrics, the Department of Neuroradiology and the Department of Pediatric Neurosurgery, all at the University of Calgary. The Program goals are to enable trainees to enhance their knowledge in neonatal neurology, acquire skills in diagnosis of the common neonatal brain injuries, provide evidence-based treatment and implement neuroprotection strategies. The training program includes exposure to neonatal Neurophysiology (EEG), Neuroimaging (Brain MRI and cranial ultrasound), neuropathology and attendance at long term outcome clinics (Neonatal follow up, Stroke, Brain malformation, and Neuro-Critical Care). The trainees will have the opportunity to learn to perform Neonatal cranial ultrasonography and Neonatal neuro-exam using state-of-the-art simulation and technology (learn more about innovation in NNCC education lab NNCC innovation (thinkific.com)) . This Fellowship is an optional 3^rd year for Canadian trainees who have completed two years of residency training in Neonatal-Perinatal Medicine, or external Neonatal-Perinatal -Medicine with funding from their sponsoring institution/government.  Interested applicants should submit a letter of intent and CV showing strong interest in the area of Neonatal Neuro-Critical Care.

 

 

All trainees must successfully complete the online modules:

 https://nncceducation.thinkific.com/ 

 

NEONATL NEUROCRITICAL CARE FELLOWSHIP COMPETENCIES

 

At the completion of training, the fellow will have acquired the following competencies and will function effectively as a:

 

Medical expert:

The fellow will have the opportunity to establish clinical knowledge and skills in: 

1. Neonatal neuroimaging:
   1. Neonatal head ultrasound:  Fellows will have the opportunity  to perform and read neonatal head ultrasounds using 3D printed brain phantoms, computer-based simulators, and hands-on imaging in the NICU with NNCC faculty and ultrasound technicians.  
   2. Neonatal MRI:  Attendance at weekly pediatric neuroradiology rounds, quarterly neonatal neuroradiology rounds, and individualized learning sessions with NNCC faculty and neuroradiologists will allow Fellows to attain skills in MRI interpretation and clinical correlation in neonatal brain injury. 
2. Neonatal EEG:  Experience with bedside consultations, attendance at regular EEG reading sessions, and individualized learning sessions on common neonatal neurological abnormalities will be provided. 
3. Neonatal neurologic examination: 

By attending and conducting NICU neurology consultations, utilizing audio-visual aids and virtual reality technology, as well as participating in the Southern Alberta Neonatal Transportation Outreach Program (4-5 times a year visiting referring centres to talk on neuroprotection) Fellows will hone their clinical examination skills.

Attend weekly brain dissection sessions led by neuropathologists at the Alberta Children’s Hospital will add to the fellows knowledge of the pathophysiology of neurologic conditions of the newborn.

1. Clinical Management of neonatal neurocritical issues including:
   1. Extremely preterm infant during the first 72 hours “critical window for brain injury”
   2. Neonatal seizure
   3. Neonatal stroke
   4. Neonatal hypoxic-ischemic encephalopathy 
   5. Post Haemorrhagic Ventricular Dilatation 
   6. Cerebral Sinus Venous thrombosis 
   7. Congenital CNS malformations 
2. Long term follow up:

Fellows will have the opportunity to attend the Neonatal Follow up Clinic, as well as the Stroke Clinic, Neuro-Critical Care Clinic, and Brain Malformation Clinic, all at the Alberta Children’s Hospital

Communicator:

1. Establish therapeutic relationship with patients and communicate effectively with parents and caregivers, regularly updating them of patient’s condition and care plans. 
2. Develop skills in providing families with difficult prognostic information as well as communicating uncertainty through direct clinical experience with families as well as by utilizing simulation.
3. Maintain professional relationship with other healthcare providers.
4. Demonstrates sensitivity and respect for diversity including culture, gender, age, socioeconomic status, and religious beliefs.
5. Maintains complete and relevant clinical summary and consultation notes. 

 

Collaborator:

1. Understands the role of each member of the multidisciplinary team collaborates and functions effectively in the provision of safe and high quality patient care including formulating plans in organizing long-term follow-up.  
2. Demonstrates respect while efficiently collaborating with members of other specialities in care of the infant. 

Leader:

 

1. Be aware of limitations in available diagnostic and interventional resources in both the acute and chronic care of neonates and employ cost-effective measures in the delivery of effective care.
2. Develop the ability to manage time efficiently.
3. Participate in quality improvement initiatives including the patient and their family in ongoing evaluation and provision of safe health care. 

 

4. The trainee will have the opportunity to acquire leadership skills through involvement in: 

1. Neonatal neuro-critical care consults, where he or she will learn how to organise the care, navigate the complex system, and negotiate the plan of care. 
2. Teaching activities and clinical rounds through supervising and helping junior residents and medical students 
3. Quality assurance and improvement projects to lead practice change
4. Development of guidelines and protocols
5. Participate in the development of conferences and workshops organized by the NNCC group.

Health Advocate:

1. Identify determinants of health in infants with neurological disorders.

2. Promote the health of infants’ affected by neurological conditions. 

 

Scholar:

Demonstrate the ability to critically review neurology literature, particularly that pertaining to neonatal neurology to provide evidence-based care in patient diagnosis, investigation and management. The Fellow will participate in the following educational activities:

 

• Weekly Neuroscience rounds
• Weekly Pediatric neuroimaging rounds 
• Quarterly Neonatal neuroimaging rounds 
• Regular EEG reading sessions 
• Sonographic Clinical assessment of the Newborn (SCAN) sessions
• Complete a research or quality improvement projects

Professionalism:

1. Exhibit appropriate professional skills such as punctuality, honest, compassion, integrity, confidentiality and altruism. The trainee will learn professionalism through:

• Emphasis on principles of maintaining patient privacy and work place ethics 
• Involvement in quality improvement projects
• Disclosure of medical errors, if occurred, to the family 
• Maintaining boundaries and respect diversity 
• Proper documentation 

STRUCTURE AND ORGANIZATION OF FELLOWSHIP

 

ACH LEVEL III NICU 

 

ACH NICU is a neonatal neuro-critical care centre. All outborn HIE infants, Neonatal Seizure < significant PHVD and other neonates with acute neurological problems from Southern Alberta are admitted to ACH NICU. The large volume of NNCC cases at this site helps the trainee to become proficient in providing brain-oriented care along with the multidisciplinary team.  

Trainees will have the opportunity to perform at a senior level in the care of surgical, cardiac and complex care newborns and infants. Trainees are expected to provide per- and post-operative care of neonates and infants with congenital or acquired surgical conditions. Participation in general and academic teaching rounds is expected.

FMC LEVEL III NICU 

 

The rotation blocks gives the trainee opportunities to liaise with members of the inter- professional team, conflict resolution, discharge planning, communication with parents, mentoring   the  junior  staff   and  collaborating  with   other  specialties  and  the  regional transport network.

The large volume of high-risk deliveries at this site helps the trainee to become proficient in resuscitation and provides them with the opportunity to train junior medical and, allied staff - case room management, teamwork skills and debriefing. This rotation also gives the trainee ample opportunities to perform and teach diagnostic and therapeutic procedures relevant to Neonatal-Perinatal Medicine and, to appreciate the significance of regionalized health care system, patient prioritization, resource utilization and ethical issues relevant to patient care. From NNCC perspective, Trainees will have the opportunity to learn the implementation of Neuroprotection strategies in preterm infants, Performing cranial ultrasonography studies, and diagnosis and management of PHVD. 

 

4 – 5 in-house calls per block in the NICU at ACH 

• Assessment:
  1. The training committee (NNCC lead, NCC chair, NPM program director) will receive cumulative feedback from the Faculty members and will meet every 3 months to assess the trainee’s progress and provide feedback 
  2. Program lead will meet with the trainees regularly to assess their progress. 
  3. The trainees with keep track of activities by filling a standard tracking tool 
  4. The final evaluation will be given by the committee at the end of the training with letter of support