Clinical Program

Clinical training in neonatology takes place in the William H. Tooley Intensive Care Nursery (ICN).  It has a licensed capacity of 51 beds and is located on the 15th floor of the Moffitt-Long Hospitals at the UCSF Medical Center.

On the same floor, the Department of Obstetrics and Gynecology has a delivery service with 2000 births per year.  This is a very high risk service and 25% of inborn patients are admitted to the ICN.  The Neonatology Faculty and Fellows work closely with the Obstetrical staff, including daily meetings to discuss prenatal management of high risk patients.  The Neonatology Fellow meets with ante partum, high risk mothers to discuss the expected neonatal care and long term outcome.  These obstetrical patients include a large proportion of high risk pregnancies due to the large number of pregnant women referred to UCSF for very early preterm labor and those referred to the Fetal Treatment Program at UCSF because of prenatally diagnosed fetal anomalies.  These referrals result in a unique population of infants delivered at UCSF which include 2% weighing <1000 grams, 6% weighing <1500 grams and 5% with severe congenital anomalies.  All of these are 5 to 6 times the national average.  The more common congenital anomalies among the inborn population of infants include congenital diaphragmatic hernia, congenital heart disease, neural tube defects, abdominal wall defects and cystic adenomatoid malformation of the lung.  A Neonatal Resuscitation Room is located within the Obstetrical suite and is used for intensive resuscitation of high risk infants.  Depending on the prenatal diagnosis of the infant, the resuscitation team may include all of the following: Pediatric Residents, Neonatology Fellow, Neonatology Faculty, ICN Nurses, Respiratory Therapists and a Blood Gas Technician.

The Clinical Neonatology Service is divided into two teams (Blue and Gold), each with a Faculty Attending Physician.  Depending on the type and acuity of the patients, a team may also include a Neonatology Fellow, Pediatric Residents and Neonatal Nurse Practitioners.  Patients on the Blue team are those with surgical conditions and congenital heart disease as well as those who are on ECMO.  Patients on the Gold team are those with medical diseases.  Approximately 1,000 infants are admitted to the ICN each year.  Of these, ~50% are inborn and the rest are referred from other hospitals.  The patient population in the ICN includes the whole range of medical and surgical diseases that affect newborn infants; 30% have congenital cardiac disease, 27% weigh <1500 grams, 12% weigh <1000 grams and 10% have a primary surgical diagnosis.  All modalities for treatment are available including high frequency ventilation, nitric oxide and ECMO.  Pediatric Medical services that consult in the ICN include Cardiology, Endocrinology, Gastroenterology, Genetics and Dysmorphology, Hematology, Immunology, Infectious Disease, Nephrology, Neurology, Oncology, Pulmonology, Radiology, and Bioethics.  Pediatric Surgical services that consult in the ICN include Pediatric General Surgery, Cardio-Thoracic Surgery, Neurosurgery, Ophthalmology, Orthopedics, Otolaryngology, Plastic Surgery and Urology.  The ICN has a Nursing staff of 140 nurses.  Four social workers attend to the needs of patients and their families in the ICN.  All patients in the ICN are under the care of the Neonatology service; patients with consulting physicians (e.g., Pediatric Surgery, Cardiology) are managed jointly.  There is excellent rapport among all of the ICN staff, including the Neonatology service, consulting Medical and Surgical services and the Nursing staff.

The Neonatal Clinical Physiological Laboratory, located in the ICN, provides point of care measurements of pH and blood gas tensions, electrolytes and hematocrit.  The laboratory staff also performs measurements of pulmonary function in newborn infants.  These are interpreted by the Fellow on clinical service in the ICN under the supervision of an Attending Neonatologist.  The staff members of this laboratory also perform hearing screening of all newborns and they maintain the extensive Neonatal and Obstetrical databases, which are available for clinical research.  Through the database, the ICN participates in the Vermont-Oxford Neonatal data program and the California Perinatal Quality Control Cooperative.

The Neonatal Follow-Up Program, under the direction of Dr. Robert Piecuch, provides comprehensive long term evaluation of infants weighing less than 1500 grams at birth, those who have undergone fetal surgical procedures, ECMO patients and other selected high-risk groups.  The Follow-Up clinics are conducted both at UCSF and at various outreach sites in Northern California.  Fellows rotate through this clinic on a regularly scheduled basis.

A unique aspect of the UCSF Campus is the Fetal Treatment Program, directed by Dr. Michael Harrison, Professor of Pediatric Surgery.  This multidisciplinary group provides comprehensive diagnostic and consultative services and prenatal, intrapartum and postnatal care of patients with certain prenatally diagnosed congenital abnormalities.  The staff of the Program includes Pediatric Surgeons, Radiologists (ultrasound and MRI), Perinatologists, Neonatologists, Pediatric Cardiologists and Social Workers.  Patients are discussed at the weekly multidisciplinary Fetal Therapy Conference.  The more common conditions referred to the Program include congenital diaphragmatic hernia, congenital heart disease, cystic adenomatoid malformation of the lung, meningomyelocele, abdominal wall defects, obstructive uropathy, and twin-twin transfusion syndrome.  The Fetal Treatment Program recently concluded an NIH-sponsored, randomized, controlled trial of fetal tracheal occlusion for severe congenital diaphragmatic hernia.  An NIH-sponsored controlled trial of fetal surgical correction of meningomyelocele is currently in progress.  Many of the ICN patients who have congenital anomalies have been referred to UCSF through the Fetal Treatment Program.