North Bristol NHS Trust Southmead Hospital
Sub-Specialty Training - Neonatology
The Bristol neonatal service is provided at St Michael’s and Southmead hospitals – both of which are the accredited centres for National Grid training in Neonatology, within the South West. The Department of Neonatal Medicine at Southmead provides care for all the infants born at the hospital, in addition to providing a Level 3 service to the Western Neonatal Network.
The NICU comprises 11 intensive care, 5 high dependency and 18 special care cots. In addition, there are 10 transitional care cots. Conventional ventilation, high frequency oscillation, inhaled nitric oxide, therapeutic hypothermia, ventricular lavage are all available as treatment modalities. Neurophysiological monitoring, MRI and BSID-III assessments are also available. There is a strong focus on supporting parents and families. The department contributes data to both the Vermont-Oxford Network (VON) and NNAP centralised data collection schemes.
The Obstetric Unit at Southmead Hospital is one of the major units in the country, with 6500 deliveries per annum dealing with a full range of both normal & abnormal obstetrics. The Obstetric Unit achieved CNST Level 2 & has a strong history of research in obstetric training. In 2008 the unit gained a Hospital Doctor of the Year award for the innovative in-house multidisciplinary obstetric skills training.
In 2010 there were 2570 neonatal admissions (includes Transitional Care), of whom 178 were <1500g and 89 were <27 weeks. The activity for 2010 comprised 2897 intensive care days, 3323 high dependency days (BAPM 2001), 1173 ventilator and 4133 nCPAP days.
A tertiary service in neonatal neurology has been developed with close collaboration with the paediatric neurosurgical team at Frenchay hospital. There are facilities for CT and MRI scanning in the hospital as well as cerebral function monitoring and neurophysiological testing in NICU. Other specialist interests within the department include evidence-based medicine, neonatal nutrition, neonatal cardiology, drug misuse in pregnancy, prevention of ventilator-induced lung injury, and the Parent-Baby Interaction Programme.
The medical team consists of 7 Consultant Neonatologists, 2. SASG doctors, 5 ST6-8 trainees (including one tertiary grid trainee), 7 Neonatal ST1-3 trainees (including one academic clinical fellow) and 2 clinical fellows.
The department is active in neonatal research, particularly in the area of neonatal neurology. including therapeutic hypothermia in the treatment of perinatal asphyxia and the management of posthaemorrhagic ventricular dilatation.. The unit provides ventricular drainage and anti-fibrinolytic therapy in infants with post-haemorrhagic ventricular dilatation (DRIFT). The Unit also participates in several UK multicentre research trials.
Illustrative Timetable
Monday
am - Ward Round
pm - Neonatal ST1-3 education session
Tuesday
am - Journal Club - Neurodevelopment follow up clinic
pm - Neonatal ST6-8 educational session -Monthly Perinatal Club meeting
Wednesday
am - Ward Round (Teaching)
pm - Out-patients clinic
Thursday
am - Ward Round - X-ray and Neuro-imaging meeting
pm - Out-patients clinic
Friday
am - Ward Round - Medical Student Teaching
pm - Lunchtime Case Presentation - Monthly Perinatal mortality meeting
Other Medical Staff
The five senior (ST6-8) trainees and two Staff Grades on the NICU distribute their work to provide cover for the Intensive Care infants or the low dependency area plus delivery suite & postnatal wards. The trainees are included in all regular departmental meetings such as journal club, Perinatal Club, perinatal mortality and morbidity meetings and Teaching Rounds. The medical rota is supported by a tier of ANNPs.
Education
The post-holder will have a nominated clinical and educational supervisor, and together they will devise an appropriate educational programme. The trainees are included in all regular departmental meetings such as journal club, Perinatal Club, perinatal mortality and morbidity meetings and Grand Rounds. It will be possible to attend some of the locally organised neonatal courses, such as Neonatal Life Support, Neonatal Neuro-imaging, Neonatal Neuro-physiology, and Neonatal Echocardiography courses. There is an undergraduate and postgraduate teaching programme in neonatology.