Dr Teim Eyo (Paediatric ST5) and Dr Diana Aguirre (ST7 GRID trainee)

So, you’ll be starting your first neonatal job, and a million and one thoughts run through your mind.

What am I going to do with such tiny humans? Will I be able to cannulate a 24-weeker? How will I cope with all the drug calculations? Will I be confident I’m not missing anything on a newborn check? How do I get a perfect spot on a Guthrie card?

How do I stop the heel prick from going everywhere but the bottles and capillary tubes it is meant to go into?!  What do I do with these blood gas results? How will I build good working relationships with the very experienced NICU nurses and the rest of the MDT, who know so much more than me? and lots more.

You aren’t the first to ask these questions, nor will you be the last. Thankfully, there is lots of help available. Phew…

So, what can you do?

  • Don’t panic. Easier said than done, but panic has never helped anyone. Ever! Start with a clear plan and strategy for what you want to achieve during your post. Identify knowledge gaps, and skills that you would like to develop, as well as resources available to you. All of this would be great to discuss when you meet with your clinical supervisor, so they can signpost you further on how to achieve your goals.
  • Know you are never alone: Neonates is a closely knit and very supportive subspecialty. There are nurses and other MDT members with a wealth of experience, seniors available to clarify doubts, very handy local and sometimes network guidelines for almost all situations, as well as consultants willing to help you. Everybody would rather you ask than make a mistake. Give yourself time to grow, and be kind to yourself. It’s good to ask for feedback to learn and improve as well.
  • Take advantage of simulation courses: most neonatal posts require you to be NLS-trained – try to complete your NLS course before the start of the job. This will help boost your confidence in carrying out neonatal resuscitation for all of the deliveries to which you will be called. Trust me, you will be called to a ton of them! After NLS, there are lots more courses you can access – like SHINE (Simulation to Help In Neonatal Emergencies), Simulation Training in Neonatal Emergency (STiNE), and ARNI (Advanced Resuscitation of the Newborn Infant). These courses will help build your confidence in stabilising a sick neonate and in understanding human factors. There are also courses on neonatal procedures, airway management, neonatal ventilation, cranial ultrasounds, etc. It’s a good idea to find out what’s available in your deanery and take advantage of it, especially since some of these courses are free for deanery trainees. 
Simulation Program - Neonatology - Pediatrics - University of Rochester ...
  • Communication and documentation are key: Neonates is a speciality where timely communication is crucial. Prioritise communicating plans, changes, and concerns with colleagues and seniors, and don’t forget to keep parents updated. Having a baby in the neonatal unit can be very stressful, and it’s important that there are no misunderstandings between the NICU team and the parents. Don’t be afraid to approach a senior if you feel out of your depth when a question is posed to you, rather than saying something incorrect. Ensure a consistent message from the team is given to parents. It’s helpful to shadow consultants and senior colleagues in various communication scenarios, like breaking bad news, end-of-life care, consent, and antenatal counselling and get them to observe your first few. This will help build your confidence and provide portfolio opportunities. There are also communication courses targeted at neonatal settings. These provide a safe environment for practising your communication skills in difficult scenarios. Ultimately, document, document, document! Document your reviews, discussions, updates, and procedures. It sure pays off, particularly when care is reviewed, for instance after a critical incident, a complaint, or when a baby dies.
  • Time management: Time does seem to fly during busy shifts, and it can be difficult to get everything done if you don’t properly prioritise and plan your day. You don’t want to be the person who always leaves late while trying to finish jobs, nor the one who hands over tonnes of jobs to colleagues. The postnatal ward can be particularly tricky to manage if you’re not used to it. At the start, identify the priority jobs (such as doing blood tests promptly so results can be chased and actioned, senior reviews, and referrals). Check the number of baby checks that are needed and review your work by lunchtime to decide if you need help. Ask for help early rather than close to the handover time, and you and your team are all more likely to leave on time! When you do shifts covering the NICU itself, keep track of jobs generated during ward rounds, and together with your team, prioritise and action them afterwards.
  • Attention to detail: Neonatal medicine involves calculations for fluids, infusions, parenteral nutrition, and medications, some of which are off-licence! Make sure to check and check again, and get someone else to go over your prescriptions. Use the neonatal formularies in your trust. Do your first few calculations with a senior, especially some of the tricky ones like insulin. Some trusts have infusion charts that only need weight, after which the infusion is calculated automatically. Do make use of these, but ensure you are using the most up-to-date weight. As a general rule, birth weight is used in calculations until babies regain and surpass their birth weight.
  • Stay up-to-date and get involved: Keeping up with current guidelines and best practices will help you understand the care your team is giving to your small patients. Journal clubs (regular teaching sessions in most units) are a good way to get your head around the latest evidence in neonatology. You could also volunteer to present interesting cases, do journal reviews, and update guidelines and information leaflets. Get involved in audits, Quality Improvement projects and if possible, research. EBNEO is a great place to stay up-to-date with the latest neonatal research, and they also have commentaries that help make sense of the evidence! As well as using your brain, get hands on: don’t shy away from procedures, offer to assist and then do them under supervision. Remember to include the projects and procedures in your portfolio.
  • Apps and websites can help: Here are a few excellent (FREE!) apps you might want to download: Neomate (useful for umbilical lines length estimation, calculating oxygenation index, estimating ET tubes and lots more like calculating growth centiles). Bilimate (a quick app for determining if a baby needs phototherapy); Growth app ( for checking growth centile; this can also be done on badger if your trust uses it). Some useful websites include BAPM (to check various frameworks of practice), starship (for good cranial ultrasound scan views), and, obviously(!) the neonatal section of PaediatricFOAM (for easy-to-understand explanations of complex topics).
  • Take breaks: It’s tempting, especially on busy days, to just plough through jobs. But being tired or hungry makes it more likely you’ll make a mistake, get grumpy with people, and find everything more challenging – so for the sake of yourself and your patients, take your breaks and make sure your collegaues can take theirs too.
  • Look after your work-life balance: Neonatal medicine can be intense and emotionally taxing. After handing over, try to disconnect from work and avoid bringing any baggage home. If something particularly stressful or bad happens, talk it through with seniors as soon as possible. Resist the temptation of taking on too many projects – it’s better to complete one or two quality projects than to start lots of smaller ones and not finish them. Outside of work, be conscious of creating time to spend with family and friends and time to do the things that help you de-stress. Be aware of the symptoms of burnout, and get help early if you experience them.

Overall, neonatal medicine is a very interesting subspecialty with endless possibilities, and with the right strategy, you can both thrive and enjoy your time there.

Dr Teim Eyo- ST5 Paediatric trainee; Special thanks to Dr Diana Aguirre, ST7 GRID trainee, who helped in editing the content.

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