The neonatal fellowship program has trained over 120 clinical and research fellows in neonatology over the past 25 years. Many of these fellows have gone on to develop neonatal units in the United States or continued to work in academic settings at medical centers throughout the US and the world.

The USC Neonatal-Perinatal Medicine Fellowship Program had been a two-year training requirement until 1990, after which it was extended by the Board of Pediatrics and the Sub-board of Perinatal-Neonatal Medicine to three years. Presently we have 13 fellows in the program. We will be expanding to 15 fellows in the coming academic year 2006-2007. This expansion is fueled by the presence of the unique and novel training opportunities offered by the recently established Institute for Maternal and Fetal Health, the Developmental Cardiovascular and Pulmonary Research Programs, the Functional Neonatal Echocardiography Course, the Developmental Translational Epidemiology Program and the expanding Basic Research Program. Dr. Ramanathan, as the Director of the Fellowship Program with the strong support and involvement of the entire faculty, is responsible for program planning for the fellows. Our objective is to keep the program individualized depending on the given fellow's professional goals.

Interested candidates for the neonatal fellowship program can send their Fellowship Application forms via e-mail to Dr. Ramanathan.

Expansion of our flexible and individualized fellowship program is a vital part of the academic profile of our division and this process has been initiated by Istvan Seri, MD, PhD, head of the division. Dr. Seri’s achievements in postgraduate medical education are reflected by the fact that he received several hospital- and university-wide teaching awards during his tenure at the University of Pennsylvania (1994-2001) and by the establishment, in 2001, of the “Istvan Seri Faculty Teaching Award in Neonatology” at the Children’s Hospital of Philadelphia, University of Pennsylvania.

Philosophy and Goals

The USC Division of Neonatal Medicine and its faculty seek earnestly, as a primary objective of the Neonatal Fellowship Program, to provide the environment and guidance for the neonatal fellow to develop into a superbly skilled clinician. With this earnest effort we also seek to provide a comprehensive and individualized training experience that fosters an interest in research and academia with the aim being the development of a degree of expertise therein. These goals are accomplished by guaranteeing opportunities for growth in clinical decision-making and for leadership development; and by providing instruction on technical and basic research skills through the exposure to superb researchers in the areas of both clinical and bench research.

Teaching Program: Courses and Conferences

In the beginning of the fellowship, each fellow goes through a process whereby he/she is paired with a preceptor/mentor, who is a member of the faculty. Selection of the mentor-fellow pair is based upon mutually expressed interest and complimentary personality traits. The mentor oversees the clinical and research progress of the fellow and, hopefully, serves as a role model during the early phases of the fellow’s career development. In addition the fellow may choose an investigator to work with at the medical school, in another department or at the Childrens Hospital Los Angeles for research specific to his or her interests.

Throughout the training program the fellow attends and helps (with faculty supervision) direct daily bedside teaching- and work-rounds while on clinical service. At the LAC+USC Medical Center site, he/she attends weekly fellows' conferences where topics are prepared and presented by the faculty, visiting guest speakers or the fellows themselves. The fellows also attend the morning case conferences two times a week (Monday and Wednesday), where they present clinical cases and their management for review by faculty and for academic and research-associated discourse. The fellows also participate in our monthly journal club meetings; weekly neonatal-perinatal statistics rounds and high risk OB conferences; bioethics and discharge planning conferences; and perinatal high risk clinics as well as follow-up clinics for premature infants under 1500 grams. In addition, the fellows attend specific courses on research design and protocols and the writing of research papers during their training.

Each fellow has to attend the week-long intensive ECMO training course at the Childrens Hospital Los Angeles site at least once during fellowship.

Research

Each fellow is expected to develop a project plan in collaboration with a faculty member (most frequently his/her mentor) for basic and/or clinical research by the end of the first year. Each fellow spends at least 6-12 weeks in the basic research lab to become familiar with the atmosphere and principle way that basic researchers approach problem solving. However, his/her ultimate research project may be in basic, translational or clinical epidemiology research areas according to the interest of the fellow, the expertise of the mentor and the actual research opportunities available. The neonatal fellow is encouraged to participate in research in newborn, obstetrical, and subspecialty fields of pediatrics to supplement his or her particular interests and goals. Bench research in molecular biology is available depending on the particular interests of the neonatal fellow. The fellow will be expected to have a presentation at a national meeting by the end of the second year; in addition, each fellow is encouraged to complete a minimum of one research paper by the end of the third year of his/her training.

Programs

The neonatal program consists of NICU service duties at LAC+USC Women's & Children's Hospital and Childrens Hospital Los Angeles, as well as fellows having optional clinical opportunities in the NICU at Good Samaritan Medical Center. The Women's and Children's Hospital delivers approximately 1,600 mostly high-risk deliveries per year to a primarily Hispanic lower socioeconomic patient population. The NICU is a 48 bed unit, which admits about 600 patients each year with approximately 4-8 ventilator cases at all times, and includes chronic care and observation units. The babies are mostly inborn with some referrals into the NICU from outside hospitals. The NICU cares for all types of tertiary and surgical patients except for cardiac surgery. Since July 1996 our fellowship program has been a combined program that includes LAC+USC Women's & Children's Hospital and Childrens Hospital Los Angeles (CHLA). Our fellows rotate in the 36-bed NICU at CHLA (named the Center for Newborn and Infant Critical Care), where they learn the management of critically ill, complex newborn cases requiring extracorporeal membrane oxygenation (ECMO) therapy as well as the care of a variety of surgical cases including cardiac surgery. This tertiary center is very challenging because of the high acuity, where there are 13-20 ventilators at all times and around 25 ECMO runs every year. Due to the high acuity and rich and challenging learning opportunities, as of July 2003, there are two fellows on service at the CHLA center most of the year. In addition, third-year fellows have the opportunity to spend an elective clinical month on service in the Cardiothoracic Intensive Care Unit at CHLA to gain valuable experience in the pre- and post-operative management of neonates requiring cardiac surgery.

Patient Care

Two staff neonatologists direct neonatal intensive care every month at each host site. They round daily with their teams consisting of pediatric residents, neonatal nurse practitioners and the fellows. The units have access to all subspecialists. Our units are equipped with state-of-the-art cardiac and general ultrasound equipment and the fellows are offered an elective rotation to learn functional echocardiography within the framework of the Developmental Cardiovascular Research Program that is under the direction of Bijan Siassi, MD, a board certified pediatric cardiologist and neonatologist. The Women's & Children's Hospital at the LAC+USC Medical Center is a referral center for women with complex medical problems including HIV, diabetes, Rh-disease and genetic problems, while the center at CHLA transports in the sickest neonates and infants from the large metropolitan Los Angeles area and beyond.

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