Normal Term Newborn Experience
Goals and Objectives
The goal of the MGH newborn rotation is to expose first year residents to the well baby nursery and develop their ability to evaluate newborns and counsel new families. The rotation is based in a busy urban hospital with a large referral obstetrical service. In addition to caring for well newborns, interns will care for infants requiring medical intervention in the special care nursery, and they will attend deliveries to learn the basics of neonatal resuscitation. The objectives of this rotation are designed to further the residents’ development of competency in the following six areas:
I. Patient Care
II. Medical Knowledge
III. Practice-Based Learning and Improvement
IV. Interpersonal and Communication Skills
V. Professionalism
VI. Systems-Based Practice
I. Patient Care
- The resident will review the chart and take a directed history from the family of each newborn upon admission. He will perform a complete physical exam and review any laboratory data at that time as well.
- Family education and counseling aimed at supporting optimal neonatal outcomes will be one of the primary responsibilities of the resident on this rotation.
- When indicated, residents will order appropriate laboratory and diagnostic testing for the infants in their care. Through thoughtful review of diagnostic results and assessment of the patient, residents will formulate a differential diagnosis and plan for the patient, including need for transfer to the NICU.
- At all times, it is the resident's responsibility to educate and work with the family, maintaining a strong therapeutic alliance and prioritizing Family-Centered Care.
- As medically indicated, residents will perform appropriate diagnostic and therapeutic procedures after obtaining informed consent from the patient and/or family. Residents will document procedures in the chart and in their personal logbooks. On this rotation, these may include:
- Circumcision
- Residents will focus on anticipatory guidance and counseling when interacting with families. They will order appropriate vaccinations, hearing screenings, carseat tests and state metabolic screening aimed at preventing health problems.
II. Medical Knowledge
- Through the examination of many normal newborns, residents will learn to differentiate medical problems from normal variants.
- In addition to well babies, during this rotation, it is expected that residents will manage patients diagnosed with, but not limited to:
- Hyperbilirubinemia
- Hypoglycemia
- Respiratory distress
- Hypothermia
- Infants of diabetic mothers
- Residents will attend daily lectures on topics important to the care of newborns given by the nursery teaching attending.
III. Practice-Based Learning and Improvement
- In caring for patients, residents will utilize a number of practice parameters that are relevant to the care of infants in the newborn nursery. These include, but are not limited to, the management of:
- Hepatitis B exposure intrapartum
- Hydronephrosis diagnosed on prenatal ultrasound
- Hypoglycemia and glucose monitoring
- Infants of diabetic mothers
- Neonatal abstinence syndrome
- Sepsis evaluation based on GBS status and risk factors
- Residents are expected to familiarize themselves with the common guidelines for newborn care set by the American Academy of Pediatrics, including vaccine schedules, car seat regulations, hearing screenings and circumcisions.
- Residents will take an active role teaching third year Harvard medical students rotating on the newborn service.
IV. Interpersonal and Communication Skills
- Residents will work collaboratively with the nursery teaching attending, obstetricians, nurses, lactation consultants, social workers and other staff on this rotation .
- Daily notes in the chart clearly documenting any issues that arise will be completed in order to maintain an accurate medical record and share information with primary care physicians after discharge from the nursery.
- Residents will receive feedback from their attendings on an ongoing basis throughout the rotation, receiving a final written evaluation that will be placed in their permanent record at the completion of the rotation. Similarly, they will provide a written evaluation of the rotation upon completion. Residents will use constructive feedback to guide their efforts in ongoing learning and self-improvement.
V. Professionalism
- Residents will interact with an extremely ethnically and socio-economically varied patient population during this rotation. Patients will include those living in local communities, as well as those delivered at MGH because of high-risk pregnancies. Residents will care for patients independent of their ability to pay for services.
- Residents will continue to develop compassionate, empathic and culturally sensitive communication with families. They will be particularly sensitive to the unique situation of new parents and families.
- Maintenance of family confidentiality will be of highest priority
- Residents will at all times demonstrate ethical and professional behavior.
- Residents will ensure that families give informed consent for all aspects of care.
VI. Systems-Based Practice
- Residents are expected to provide high quality, but cost-effective health care.
- They will collaborate with case managers and nurses to arrange visiting nurse services for mothers and infants when indicated.
- Residents will communicate with primary care physicians by phone if there are issues that need outpatient follow-up. They will complete discharge paperwork for all infants to be taken to the first well-baby visit.
- At all times, residents will act in accordance with the legal mandate in the Commonwealth of Massachusetts to report any suspicions of child abuse or neglect, being familiar with the process by which such suspicions are reported. The MGH Child Protection Consultation Team will be a unique resource for residents working in the complex referral atmosphere of this rotation
