Nursery+Learning+Objectives


 * Nursery Rotation Learning Objectives – Learning Settings and Activities – Evaluation**

Learning Objectives:
 * Breastfeeding**

1) Counsel patients on the benefits of breastfeeding to both baby and mother in a culturally sensitive manner. 2) Evaluate a baby’s latch, and assist mothers to improve the latch if needed. 3) Troubleshoot common difficulties mothers may have during breastfeeding, such as nipple pain, decreased milk production, engorgement, and breast infections. 4) Refer mothers appropriately to resources such as lactation consultants, the lactation warm-line, WIC, and dental clinic for frenotomy. 5) Access internet resources to determine if a medication is safe during breastfeeding. 6) Describe situations when a baby would need to be supplemented or fed with formula.

Settings and Activities: 1) Lactation rounds on post-partum during the nursery rotation. 2) Video/online tutorial on breastfeeding. 3) Evaluate patients in FPC or pediatrics clinic, with debriefing of this case with lactation consultant (during nursery rotation or during outpatient pediatrics). 4) Potential experience in WIC with lactation consultant in outpatient setting (during the nursery rotation or during outpatient pediatrics rotation.)

Evaluation: 1) (yes/no) Participation in the evaluation and counseling of at least 3 mothers on post-partum and 3 mothers in an outpatient setting with a lactation consultant. (Lactation consultants can check off residents like anesthesiologists check off intubations.)

Learning Objectives:
 * Jaundice/Hyperbilirubinemia**

1) Understand the causes for hyperbilirubinemia and assess infants for risk factors for severe hyperbilirubinemia. 2) Evaluate an infant for signs and symptoms of hyperbilirubinemia through physical exam findings and appropriate laboratory exams. 3) Develop a plan for follow-up/treatment as necessary for babies who have an elevated bilirubin. 4) Manage hyperbilirubinemia utilizing phototherapy in the nursery. 5) Determine if phototherapy is effective and if not, consult with an attending pediatrician or neonatologist regarding further care.

Setting/Activity: 1) Routine care of newborns on post-partum and in the nursery during the nursery rotation, or while on-call. 2) 48 hr to 1 week follow-ups in pediatrics clinic/FPC

Evaluation: 1) (yes/no) Resident needs to have assessed at least 5 high risk infants (the 48 hour follow-up in the nursery or in clinic) 2) (yes/no) Residents should manage at least 2 infants who require phototherapy.


 * Fluids, Nutrition, Electrolytes**

Learning Objectives: 1) Calculate maintenance IV fluid requirements for term and late preterm infants. 2) Develop a strategy to advance an infant who has difficulty feeding from IV fluids to gavage/nipple feeds. 3) Monitor and interpret total fluids, daily caloric intake, and urine output correctly. 4) Describe when a peripheral IV or an umbilical catheter would be indicated, and when a UVC would be contraindicated. 5) Describe the correct technique for insertion of an umbilical line and how to assess for appropriate placement. 6) Describe at least 3 circumstances for which an infant would require IV fluids.

Setting/Activities: 1) Management of infants in newborn nursery. 2) Didactic lectures. 3) Wiki materials/ video of umbilical catheter placement. 4) Placement of an umbilical catheter either during an actual resuscitation or on a length of umbilical cord.

Evaluation: 1) (yes/no) Resident has calculated and ordered IV fluids on at least two infants in the nursery. 2) (yes/no) Resident has managed at least two infants who are advancing towards nipple feeds. 3) (yes/no) Resident has been observed placing at least one umbilical catheter either during a resuscitation or on a length of umbilical cord.


 * Infection**

Learning Objectives: 1) Recommend appropriate measures for secondary prevention of early-onset GBS disease based on current guidelines. 2) Describe how to arrange appropriate follow-up for babies with maternal HIV, Hepatitis B, and Hepatitis C. 3) Recognize when babies need to be tested for congenital HSV infection, toxoplasmosis, CMV, Rubella, Chlamydia and Syphilis based on maternal history and neonatal exam. 4) Initiate work-up and empiric antibiotic therapy for presumed neonatal sepsis based on factors such as prematurity, maternal fever, and symptoms of infection.

Setting/Activity: 1) Care of infants on post-partum and in nursery during the nursery rotation and when on-call. 2) Didactic lectures on GBS, maternal chorioamnionitis, and congenital infections.

Evaluation: 1) (yes/no) Resident has managed at least 2 infants who require antibiotic therapy (regardless of indication) in the nursery.

Learning Objectives: 1) Correctly diagnose and counsel parents on the prognosis of Erb’s Palsy, clavicle fracture, cephalohematoma, and caput succedaneum. 2) Perform the Barlow-Ortolani test correctly to diagnose developmental dysplasia of the hip. 3) Recommend appropriate follow-up including diagnostic testing for infants at risk for DDH.
 * Birth Trauma/DDH**

Setting/Activity: 1) Routine post-partum and nursery rounding with at least one exam observed by attending. 2) Findings of caput succedaneum, cephalohematoma, clavicle fracture, and Erb’s Palsy to be pointed out and shared with attending/resident. 3) Didactic talks by attendings.

Evaluation: 1) Direct observation of a resident’s exam of an infant by an attending.


 * Cardiology/Heart Murmurs**

Learning Objectives: 1) Describe and correctly document an infant’s heart exam, including murmurs. 2) Name characteristics of murmurs that distinguish pathologic from benign murmurs. 3) Formulate a reasonable plan to initiate a work-up of an abnormal cardiac exam. 4) Name at least 5 prenatal risk factors for congenital cardiac disease. 5) Identify signs and symptoms of heart failure in an infant.

Setting/Activities: 1) Rounding on post-partum and nursery, where all murmers should be shared and discussed between attendings and residents. 2) Attendance at cardiology clinic at CHO-Walnut Creek. 3) Cardiology tutorial. 4) Didactic lectures, CCRMC Wiki site for audio clips.

Evaluation: 1) (yes/no) Resident identifies at least two infants with an abnormal cardiac exam (i.e. irregular rhythm, bradycardia, murmur), describes the abnormality, and manages their work-up.


 * Respiratory Distress**

Learning Objectives: 1) Describe signs and symptoms of respiratory distress in an infant. 2) Develop a differential for respiratory distress in an infant and initiate work-up. 3) Describe when an infant might require blow-by oxygen, positive pressure ventilation, CPAP, and intubation. 4) Effectively administer positive pressure ventilation to an infant. 5) Intubate an infant (or dummy) using appropriate technique.

Setting/Activities: 1) Attendance of newborn resuscitations during the nursery rotation and on-call. 2) NRP course/ renewal of NRP. 3) Care of infants in the newborn nursery. 4) Didactic sessions in the nursery.

Evaluation: 1) (yes/no) Resident passes the NRP course. 2) (yes/no) Resident attends at least 20 newborn resuscitations. 3) (yes/no) Resident manages at least one infant with respiratory stress.


 * Infant of a Diabetic Mother**

Learning Objectives: 1) Describe potential complications in newborns of mothers with pregestational or gestational diabetes. 2) Monitor for hypoglycemia utilizing the chemstick protocol. 3) Utilize appropriate methods of treatment of hypoglycemia in the newborn. 4) Identify potential complications of LGA status. 5) Describe other infants who may be at risk for hypoglycemia and would need to follow the chemstick protocol.

Settings/Activities: 1) Management of well newborns and nursery infants. 2) Didactic sessions. 3) Evaluation of infants during call.

Evaluation: 1) (yes/no) Resident manages at least two infants of diabetic mothers.


 * Jittery Baby**

Learning objectives: 1) Develop a differential for a jittery newborn. 2) Assess an infant for possible causes of jitteriness or shaking.

Setting/Activities: 1) Care of infants in post-partum or in the newborn nursery. 2) Care of infants during overnight call. 3) Didactic sessions.

Evaluation: 1) (yes/no) Resident has evaluated at least one infant with jitteriness (of any etiology).


 * GI Issues**

Learning Objectives: 1) Assess a baby with feeding intolerance. 2) Discuss the differential of emesis, and know what red flags would cause you to refer to a higher level of care. 3) Describe the workup of a baby with no stool within 48 hours. 4) Describe how to initiate a work up of a baby with abdominal distention, emesis, or hematemesis.

Setting/Activities: 1) Didactic sessions. 2) Care of infants on call and in the nursery.

Evaluation: 1) (yes/no) Resident has reviewed the above topics with an attending during the nursery rotation.


 * Neonatal Abstinence Syndrome/Maternal Drug Abuse**

Learning Objectives: 1) Identify risk factors for neonatal abstinence syndrome. 2) Monitor for neonatal abstinence syndrome using abstinence scoring. 3) Describe the general treatment for an infant with neonatal abstinence syndrome. 4) Utilize an infant toxicology screen according to protocol. 5) Intervene for the safety of an infant with a positive urine toxicology screen, by contacting CFS and potentially limiting breastfeeding.

Setting/Activities: 1) Direct care of infants on post-partum and the nursery. 2) All cases of utox positive infants and infants with neonatal abstinence syndrome should be shared and discussed between residents and attendings. 3) Didactic sessions.

Evaluation: 1) (yes/no) Resident has managed at least one infant with neonatal abstinence syndrome, a maternal history of drug use, or a positive urine toxicology screen.


 * Dermatology**

Learning Objectives: 1) Diagnose common dermatologic findings in infancy, including nevus flammeus, milia, miliaria, pustular melanosis, erythema toxicum, and neonatal acne.

Setting/Activities: 1) Dermatologic findings to be shared between residents and attendings during post-partum rounding. 2) Dermatology atlas/powerpoint presentation.

Evaluation: 1) Residents to check off each finding as it is confirmed on the nursery rotation.


 * Prematurity**

Learning Objectives: 1) Understand the potential complications in late preterm infants. 2) Learn how to manage the complications seen in late preterm infants. 3) Describe the discharge criteria for late preterm infants (?)

Settings/Activities: 1) Care of late preterm infants in post-partum or newborn nursery. 2) Didactic sessions. 3) Attending late preterm deliveries while on the nursery rotation or when on-call.

Evaluation: 1) (yes/no) Resident has managed at least 1 late preterm infant.