DM Neonatology Program

Updated On : 02-11-2016

COURSE CURRICULUM FOR DM (NEONATOLOGY) [Some parts of this curriculum have undergone minor revisions since the last major update]
A – Aims of the course :

To train a pediatrician having requisite postgraduate qualifications (MD Pediatrics or its equivalent) as a specialist in Neonatology. During training he will develop expertise in specialized neonatal care and also train himself in handling modern equipment and techniques used in neonatal intensive care and research. After completing the training he should be able to identify and solve the problems related to neonatal care and independently set up a neonatal care facility complete with clinical, investigative and research components.
B – Number of seats:

Eight senior residents (four open and four inservice sponsored) candidates in three years course. The position regarding number of seats shall be reviewed after 2-3 years once the upgraded Advanced Pediatric Centre with additional neonatal beds becomes operational.
C – ELIGIBILITY :

MD. Pediatrics or equivalent
D – DURATION ; Three years
E – PROPOSED TRAINING ;

i) Indoor service : The candidate will manage all the hospitalized neonates. They would decide and administer the treatment to babies in consultation with faculty members. They would supervise the activities of junior residents and participate in their clinical teaching. They would perform specialized diagnostic and therapeutic procedures wherever indicated and learn the use and maintenance of various neonatal care equipment.

ii) Perinatology: The candidates will learn the management of pregnancy, their early diagnosis of foetal diseases, interpretation of various tests and procedures for optimal neonatal outcome. They would

attend antenatal ultrasound examination of foetus under guidance of obstetrician and help in performing intrauterine procedures like amniocentesis, intrauterine transfusion etc.

iii) Community Neonatology : The candidate during the his/her training would be exposed to community Neonatology. He/She would be expected to develop an insight into the problems of neonatal care and the innovations required to deliver appropriate care at different levels of neonatal care. They would participate in the teaching/training of skills and care to various levels of health workers.

iv) Morbid Anatomy : The candidate would be trained to perform neonatal autopsy and interpret the gross morphological diagnosis. He would be trained to evaluate perinatal pathology and correlate it with perinatal events.

v) Research : The candidate would be introduced to research methodologies and would be expected to complete an independent research project under the supervision and guidance of the faculty.

PROPOSED TIME SCHEDULE :

Clinical Neonatology              22 months

Perinatal Obstetrics               2 months

Community Neonatology        1 month

Neonatal Surgery                  1 month

Morbid Anatomy                   1 month

Elective                               3 months

Research                             6 months

TEACHING PROGRAMME :

The candidate would participate in all teaching activities of the department. He/She would present and discuss case materials in the clinical meetings and other conferences like :

a) Clinical meetings, perinatal meetings, clinico-pathological conferences, mortality meetings, statistical meetings and autopsy conferences.

b) Ward rounds c) Perinatal conference, d) Bedside demonstration e) Radiology rounds f) Journal Clubs g) seminars

SYLLABUS

Teaching syllabus would cover the following

A. Basic Sciences :

  • Applied anatomy and embryology
  • Feto-placental physiology
  • Neonatal adaptation
  • Development and maturation of lung, respiratory control, lung functions, ventilation, gas exchange, ventilation perfusion.
  • Physiology and development of cardiovascular system, developmental defects, physiology and hemodynamics of congenital heart disease.
  • Foetal and intrauterine growth
  • Development and maturation of brain, cerebral blood flow, blood brain barrier.
  • Developmental pharmacology
  • Developmental hematology, bilirubin metabolism
  • Renal pathophysiology
  • Physiology of gastrointestinal tract, digestion, absorption.
  • Applied microbiology
  • Applied epidemiology
  • Biostatistics
  • Genetics

B. Principles and Practices of Neonatology

i) PERINATOLOGY

  • Perinatal mortality, morbidity, epidemiology
  • High risk pregnancy, detection, monitoring management
  • Foetal monitoring – clinical electronic
  • Intrapartum monitoring and precesudes
  • Disorders during pregnancy-monitoring, evaluation, assessment of foetal risk, decision for termination.\
  • Diagnosis and management of foetal disorders.
  • Medical diseases effecting pregnancy and foetus, psychological and ethical consideration.
  • Neonatal resuscitation
  • Inutero foetal procedures

ii) NEONATAL EXAMINATION, ASSESSMENT OF GESTATION, SMALL FOR DATE, PREMATURITY, TWINS

iii) RESPIRATORY SYSTEM :

  • Neonatal airways : Physiology, pathology, management
  • Pulmonary Diseases : Hyaline membrane diseases, Transient Tachypnoea, Aspiration Pneumonias, Pulmonary Air leak syndromes, Pulmonary Hemorrhages Developmental defects , Apnoea
  • Respiratory failure and mechanical ventilation
  • Oxygen therapy and its monitoring
  • Pulmonary infection
  • Miscellaneous pulmonary disorders

iv) CARDIOVASCULAR SYSTEM :

  • Fetal circulation, transition
  • Examination and interpretation of cardiovascular signs and symptoms
  • Special tests and procedures
  • Diagnosis and management of congenital heart disease
  • Acyanotic Heart Diseases
  • Cyanotic Heart Diseases
  • Rhythm disturbances
  • Hypertension in neonates
  • Shock : Pathophysiology, monitoring, management

v) GASTROINTESTINAL SYSTEM :

  • Disorders of liver and biliary system
  • Bilirubin metabolism
  • Neonatal jaundice : diagnosis, monitoring, management, phototherapy, exchange transfusion
  • Prolonged hyperbilirubinemia
  • Conjugated hyperbilirubinemia
  • Kernicterus
  • Foetal and neonatal nutrition
  • Feeding schedules, problems
  • Intravenous hyperalimentation
  • Congenital malformations
  • Necrotizing enterocolitis

vi) RENAL SYSTEM :

  • Developmental disorders
  • Renal functions
  • Fluid and electrolytes
  • Acute renal failure, diagnosis, monitoring, management

vii) ENDOCRINE AND METABOLISM :

Glucose metabolism, hypoglycemia, hyperglycemia calcium metabolism

Magnesium metabolism

Thyroid disorder : Hypothyroidism

: Hyperthyroidism

Adrenal disorders

Ambiguous genitalia

Inborn errors of metabolism

viii) HEMATOLOGY :

  • Physiology
  • Anaemia
  • Polycythemia
  • Haemolytic Anaemias – Rh Diseases
  • Bleeding and coagulation disorders

ix) NEUROLOGY :

  • Clinical neurological assessment
  • EEG, Ultrasonography, CT Scan
  • Neonatal seizures
  • Intracranial haemorrhage
  • Brain oedema
  • Hypoxic Ischaemic Encephalopathy
  • Neuro-muscular disorders
  • Degenerative diseases
  • CNS malformations and neural tube defects.

x) SURGERY AND ORTHOPEDIC :

  • Diagnosis of neonatal surgical conditions
  • Pre and postoperative care
  • Neonatal anaesthesis
  • Metabolic changes during anaesthesis and surgery
  • Orthopedic problems

xi) NEONATAL INFECTIONS :

  • Intrauterine infections
  • Superficial infections
  • Diarrhoea
  • Septicemia
  • Meningitis
  • Osteomyelitis and Arthritis
  • Pneumonia
  • Miscellaneous infective disorders

xii) NEONATAL OPHTHALMOLOGY

  • Developmental aspects
  • Retinopathy of prematurity

xiii) NEONATAL DERMATOLOGY

xiv) TRANSPORT OF NEONATES

xv) NEONATAL PROCEDURES

xvi) DEVELOPMENTAL ASSESSMENT AND FOLLOW UP

xvii) ORGANISATION OF NEONATAL CARE AND REGIONALIZATION OF NEONATAL CARE :

RESEARCH ACTIVITIES :

In addition to prospectively following their cases for 2 years, the candidate would be encouraged to undertake independent research projects and also actively associate with the ongoing research activities. He/she would be expected to publish the results of his/her research in journals of repute.

ASSESSMENT AND EVALUATION :

a) Internal assessment : This will be done at the end of each semester and after each special posting and will include theory, practical and evaluation of skills. The results of internal assessment would be given substantial weightage in the final examination.

b) Final theory papers : At the end of two years, theory examinations would be held like all other DM courses.

PAPER I : Applied Sciences as related to

Neonatology/Perinatology

PAPER II : Principles and practice of neonatology

PAPER III : Recent advances as related to neonatology

c) Practical examination : This will include clinical cases, neonatal ward round and viva voce. Viva voce shall include skiagrams, spots, clinical problems, investigative data etc.

d) Examiners : There will be four examiners with two internal and two externals. One of the examiner may be a perinatologist. Four qualifications and experience of the examiners, the same rules will apply as for the examiners of any other DM courses of the Institute.