During their 3 years of training, fellows spend a total of 56 weeks on clinical service: 46 weeks on rotations in the two teaching hospital NICUs (Seattle Children's Hospital & University of Washington Medical Center), 8 weeks on clinical services including perinatology, cardiac ICU, and pediatric surgery, and 2 weeks in one of the division's community hospital NICUs. Fellows also attend NICU follow-up clinic 8 half days each year. Clinical rotations are generally 2 to 4 weeks duration and nearly half of these rotations (24 weeks) are scheduled in the first year. Night call is in-house at both hospitals and averages approximately 50 nights per year. During the first year, fellows focus on expanding their clinical knowledge base & skills. They participate as learners and then teachers in procedural skills labs, and they are required to take an ECMO training course. In the second year, in addition to continuing their life-long learning, fellows begin the transition from trainee to attending neonatologist, developing higher-level patient management and team leadership skills. In the third year, they complete this transition, including learning the administrative roles of the attending physician through "subattending" experiences. Fellows are required to attend their own weekly Core Curriculum conference. They regularly attend all division conferences and are required to lead one Journal Club and M & M review each year, as well as co-lead joint clinical conferences with pediatric surgery and perinatology.

Fellowship training in at University of Washington includes the following rotations:

1. University of Washington Neonatal Intensive Care Unit (UWMC NICU).  Fellows spend approximately half of their NICU time in this unit, which specializes in the care of the preterm infant, most of whom are inborn. Fellows gain delivery room experience, (including the initial management of congenital anomalies such as abdominal wall defects, congenital heart disease, and diaphragmatic hernias), mastery of care of preterm infants, and participate in prenatal consults. Night call is in house.
2. Seattle Children's Hospital Neonatal Intensive Care Unit (SCH NICU). Fellows spend approximately half of their NICU time in the SCH NICU, a quaternary referral center for a 4 state area (Washington, Alaska, Montana and Idaho). Fellows participate in the care of newborns with respiratory distress, neurologic diseases, complex congenital anomalies including surgical problems, congenital heart disease, and inborn errors of metabolism. Night call is in house.
3. Perinatology. First year fellows spend two weeks on Maternal-Fetal Medicine at University of Washington Medical Center under the direction of Dr. Michael G. Gravett. This rotation provides exposure to the many high risk OB clinics, and insight into high risk obstetrical care.
4. Pediatric Surgery. During their first or second year, fellows rotate for two weeks with the Pediatric Surgery team at SCH under the direction of Dr. John Waldhausen. This rotation provides insight into pre and post operative care of neonatal surgical disease.
5. Cardiac Intensive Care Unit. During either their second or third year, fellows spend 4 weeks on a cardiac intensive care rotation at SCH under the direction of Dr. Harris Baden. The experience includes both pre and post operative care.
6. Providence Regional Medical Center Everett Neonatal Intensive Care Unit (PRMCE NICU). Senior fellows will have the opportunity to participate for 2 weeks in neonatal intensive care at one of the division's community sites for both exposure and a "subattendingship" experience.
7. Follow-Up Clinic. Follow-up clinic designed specifically for NICU graduates is scheduled one day per week. Fellows participate 8 half-day clinics per year under the direction of Dr. Curt Bennett. Time is spent participating in the medical, OT/PT, and psychological assessment of these infants at the corrected ages of 4 months. 8 months, 1 year, 2 years, 4.5 year, and 7 years old, with the goal of following longitudinally patients cared for in the NICU.

SAMPLE CLINICAL SCHEDULE

Year	NICU		Selectives	Call		Vacation
First	24 weeks		2 weeks perinatology	54 nights*		3 weeks
	12 UW	12 SCH		22 UW	32 SCH
Second	10 weeks		4 weeks CICU 2 weeks peds surgery	50 nights *		3 weeks
	6 UW	4 SCH		20 UW	30 SCH
Third	12 weeks		2 weeks PRMCE	46 nights *		3 weeks
	6 UW	6 SCH		18 UW	28 SCH
Total	46 weeks (276 days/2760 hrs)		10 weeks	150 nights (2400 hours)		9 weeks
	24 UW	22 SCH		60 UW	90 SCH

* = at jeopardy for additional calls (maximum 55 calls per year per fellow total)

SCHOLARSHIP

During their first year, fellows will choose their scholarly focus and type of scholarship (e.g. basic science/laboratory, clinical research, ethics, public health, global health, education). They will spend their non-clinical, non-teaching time meeting with the fellowship program's Research Director and with selected division and non-division faculty members in the fellow's areas of scholarly interest. By mid-year, fellows should have identified their scholarly focus and mentor(s). This will determine the composition of their Scholarship Oversight Committee (SOC) and will shape the content and direction of their 2nd and 3rd years of training. Training will include the formation of a hypothesis-driven research question, planning and excecution of the project, data analysis and publication of the work. Fellows will learn to critically evaluate the relevant literature and will take necessary coursework, including biostatistics. For fellows choosing a basic science or clinical research focus, grant preparation will be emphasized in the 2nd and 3rd year so that funding is likely to be available for an optional 4th year. For fellows choosing a global health, education, or ethics scholarly focus, there is an opportunity to obtain a Masters degree at University of Washington during training, although fellows are strongly encouraged to take an additional year to complete all their requirements. All fellows are strongly encouraged (and supported) to attend annual research conferences such as those of the Pediatric Academic Societies (PAS), Society for Neurosciences or the Perinatal section of the American Academy of Pediatrics.

Areas of Concentration:

Basic Science Research
Director of Scholarship and Research: Sandra Juul, MD, PhD
Active Faculty: Sandra Juul, MD, PhD; Christine Gleason, MD; Dennis Mayock, MD;
Ryan McAdams, MD; Christopher Traudt, MD; Colin Studholme, PhD

Two main areas of investigation are pursued in the Neonatology Basic Science Lab:

Neurodevelopment and Neuroprotection
Research funded by the NIH (Institute of Child Health and Development), March of Dimes, and the Roche Foundation for Anemia Research focuses primarily on the neuroprotective effects of erythropoietin (Epo) in neonatal models of brain injury. Dr. Juul has identified Epo and its receptor in the developing human brain, demonstrated the functionality of the Epo receptor on cultured neurons, and documented Epo in the spinal fluid of human neonates. Her research shows that Epo protects the neonatal brain from injury due to hypoxia and oxidative injury. Using a variety of approaches, we are working to identify mechanisms of Epo neuroprotection, and how to optimize its function in the developing brain at risk for injury. Our ultimate goal is to bring this new treatment from the laboratory to the bedside. Additional research interests include the study of possible interactions between Epo and retinopathy of prematurity, iron balance in the neonate, as well as the long-term effects of neonatal stress on adult parameters including learning and memory.

Long-term neurobehavioral, neuropathological and neurovascular effects of neonatal stress and morphine treatment
In projects funded by the NIH (NINDS) neonatal rat and mouse models are utilized to study the long-term cerebrovascular, neuropathologic, and behavioral effects of neonatal stress and narcotic exposure similar to that experienced by preterm infants in our NICUs.  Morphine is used increasingly in the management of non-surgical ELBW babies, yet little is known about its effects on the developing brain.  Behavioral, neuropathological, and microcirculatory studies are performed in adult offspring exposed to morphine and/or stress as neonates.

Clinical Research
Director of Clinical Research: Dennis Mayock, MD
Active Faculty: Sandra Juul, MD, PhD; Christine Gleason, MD; Dennis Mayock, MD; Shilpi Chabra, MD

Our division has a long history of participation in both multi-center and single center clinical research trials. Areas of particular interest for this Division have included research on lung disorders [surfactant trials, high frequency oscillation trials, prevention of bronchopulmonary dysplasia (NO CLD)], as well as studies having to do with erythropoietin and iron balance. Ongoing projects, or those in the planning stages include the NEAT trial, a pilot study of high dose Epo treatment for hypoxia ischemia in term infants; the CRP study, a study to determine whether CRP is a valid tool to help establish the presence or absence of infection in surgical newborns, and surfactant booster trial, a study of late surfactant dosing to decrease bronchopulmonary dysplasia. In addition, our fellows participate in studies with the Infectious Disease Division, including studying the vertical transmission of HIV, and pathogenesis of streptococcal infections.

Biomedical and Health Informatics
Active Faculty: Peter Tarczy-Hornoch, MD

Dr. Peter Tarczy-Hornoch serves as Head of the Division of Biomedical and Health Informatics in the Department of Medical Education and Biomedical Informatics, Director for the UW Biomedical and Health Informatics Research Training grant, Director of the Biomedical Informatics Core of the Northwest Institute for Translational Health Sciences, Director of Web Services and Data Integration and Research for UW Medicine Information Technology Services, and Associate Director of the Northwest Institute for Genetic Medicine. Dr. Tarczy-Hornoch's NIH and NSF funded research has included: a) real time biomedical instrumentation control systems, b) bench research and mathematical modeling of liquid ventilation, c) clinical information systems, and d) electronic clinical knowledge resources. His current research on methods and models (in collaboration with computer scientists) focuses on data integration of biomedical and health data including looking at ways of handling semi-structured data, representing uncertainty at various levels in the system, and doing computerized reasoning over integrated data. The challenges and opportunities his research is applied to arise from collaborations with biologists, clinical and translational researchers looking at: a) large scale functional gene annotation of bacteria and protozoans, b) single nucleotide polymorphisms for elucidation of disease mechanisms, c)  collaborative integrated analysis of a combination of clinical data, experimental biological data, and clinical/translational research study data. In addition there are very rich opportunities for research in other areas of biomedical and health informatics (BHI) with 18 core BHI faculty in the Division of BHI, 27 extended faculty, and 37 MS, PhD, and postdoctoral students.

Global Health
Active Faculty: W. Alan Hodson, MD; Maneesh Batra, MD, MPH; Ryan McAdams, MD

Ongoing scholarly projects include establishment of essential neonatal care guidelines for referral-level neonatal care in developing country settings, development of educational programs in global health to address the unmet need in the global health workforce, and assessment of long-term neurodevelopmental outcomes developing country community-based settings. 

Faculty are also involved with the Child Health Epidemiology Reference Group (WHO/UNICEF) and the Global Alliance for the Prevention of Prematurity and Stillbirth.  These groups are involved with global maternal, neonatal and child health policy.

Education
Director of Education Research: Thomas Strandjord, MD
Active Faculty: Thomas Strandjord, MD; Craig Jackson, MD, MHA; Isabella Knox, MD; David Loren, MD

Ongoing medical education research projects include: 1) simulation as an educational tool in neonatal resuscitation training; 2) effectiveness of airway management training and; 3) evaluation of a web-based training and simulation program to improve pediatric trainee error disclosure proficiency. 

Biomedical Ethics
Active Faculty: David Woodrum, MD; Ben Wilfond, MD

There are opportunities for scholarly activity with a focus on such issues as the limits of parental autonomy or factors involved in clinical decision making.  Fellows emphasizing biomedical ethics would be involved in the activities of the Pediatric Bioethics Center, institutional ethics committee activities, ethics consultations, teaching rounds, a targeted reading program, ethics/philosophy course work and, if appropriate, enrollment in a Masters of Ethics program.

Health Services and Quality Improvement
Active Faculty: Linda Wallen, MD; Thomas Strandjord, MD

The division has been actively involved in scholarly work improving the quality of care delivered in neonatal intensive care units and medical education of care providers for newborn infants. Recent quality improvement projects include: collaboration with the Vermont Oxford Network of neonatal intensive care units to reduce nosocomial infections; ongoing review of video-recorded neonatal resuscitations for quality improvement and education; development of quality indicators in perinatal and neonatal care in collaboration with the National Perinatal Information Center; as well as direction of the Northwest Washington State Perinatal Regional Network for regional quality improvement project.

ADMINISTRATION

All fellows are expected to complete a quality improvement project and a project which requires them to use our clinical database. They also participate in the development of our clinical care guidelines and are expected to "own" one during their training. Senior fellows manage their own weekly curriculum conference and are invited to attend the monthly division faculty business meeting.