What are the key topics I need to know to successfully pass my Neonatal Intensive Care Unit (NICU) rotation?

Key Topics for Successfully Passing Your NICU Rotation

To successfully pass your NICU rotation, you must master neonatal resuscitation protocols and temperature management, as these are critical skills that directly impact newborn survival and outcomes. 1

Neonatal Resuscitation

Anticipation and Preparation

• Learn to assess perinatal risk factors to anticipate the need for resuscitation and assemble appropriate team members with necessary skills 1
• Understand the importance of having an organized resuscitation area with immediate access to all needed supplies and equipment 1
• Know when a provider capable of performing assisted ventilation versus one skilled in neonatal intubation should be present at delivery 1

Initial Assessment and Intervention

• Master temperature maintenance techniques for preterm infants, including environmental temperature control (23-25°C), warm blankets, plastic wrapping without drying, caps, and thermal mattresses 1
• Understand the importance of maintaining admission temperature between 36.5°C and 37.5°C as it's a strong predictor of mortality and morbidity at all gestations 1
• Learn the current evidence-based approach to suctioning of clear fluid and management of meconium-stained newborns 1

Physiological Monitoring

• Know how to properly monitor heart rate during neonatal resuscitation 1
• Understand the importance of temperature monitoring as a quality indicator and predictor of outcomes 1

Ventilation and Oxygenation

• Master different ventilation techniques including:
  • Sustained inflation 1
  • Positive end-expiratory pressure (PEEP) 1
  • Continuous positive airway pressure (CPAP) versus intermittent positive pressure ventilation (PPV) 1
  • T-piece resuscitator versus self-inflating bag for ventilation 1
• Know the appropriate oxygen targets for both preterm and term resuscitation 1
• Understand the use of inhaled nitric oxide (iNO) for hypoxic respiratory failure, including dosing (20 ppm standard, 80 ppm for non-responders), monitoring for methemoglobinemia, and expected clinical responses 2

Circulatory Support

• Learn proper CPR ratios and techniques (2-thumb versus 2-finger compressions) for neonatal resuscitation 1

Drug and Fluid Administration

• Know the indications, dosing, and administration routes for epinephrine (adrenaline) in neonatal resuscitation 1
• Understand the advantages and disadvantages of intraosseous versus umbilical vein access for emergency medication administration 1
• Learn appropriate volume infusion strategies and indications for sodium bicarbonate during neonatal resuscitation 1

Post-Resuscitation Care

• Master the management of hypothermic newborns, including rewarming techniques 1
• Understand the indications and protocols for induced hypothermia in settings with limited resources 1
• Learn proper post-resuscitation glucose management 1

Common NICU Conditions and Management

• Recognize and manage respiratory complications, which account for approximately 33.5% of NICU admissions 3
• Understand the management of hypoglycemia (17.5% of admissions), perinatal asphyxia (11.4%), and infections (6.5%) 3
• Know the indications and management of inhaled nitric oxide for conditions like meconium aspiration syndrome (MAS), pneumonia/sepsis, idiopathic primary pulmonary hypertension of the newborn (PPHN), and respiratory distress syndrome (RDS) 2

Developmental Care

• Learn to coordinate procedures to prevent overstimulation and excessive energy consumption in fragile neonates 1
• Understand the importance of maintaining a calm environment and limiting unnecessary stimulation 1
• Know how to modulate social interactions with NICU infants to optimize their development 1

Patient Safety and Team Communication

• Master briefing/debriefing techniques following neonatal resuscitation to improve team performance 1
• Understand the importance of standardized behavioral skills that foster optimal teamwork and communication 1
• Recognize that the complexity of the NICU environment increases the risk for medical errors and learn strategies to ensure safe practice 4

Skills Retention and Continuous Learning

• Be aware that neonatal resuscitation skills deteriorate shortly after training, with alarming deficits seen in skills evaluation even immediately after initial NRP certification 5
• Understand that knowledge is generally better retained than skills, so regular practice of technical skills is essential 5
• Know that the most significant skill deficits occur in the initial phases of resuscitation (lessons 1-3 of NRP) 5

Common Pitfalls to Avoid

• Avoid hyperthermia (>38.0°C) in neonates as it introduces potential associated risks 1
• Don't rely solely on initial NRP training; skills deteriorate rapidly without regular practice 5
• Recognize that proficiency in knowledge does not necessarily indicate proficiency in skills 5
• Be aware that some NICU admissions could be preventable through parent education, weight control, and continuous training of resuscitation skills 3

Hybrid Resuscitation Approaches

• Understand when to apply NRP versus Pediatric Advanced Life Support (PALS) algorithms for complex NICU patients 6
• Know the latest advances in the NRP curriculum, including eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing 7