The Division of Neonatology provides clinical services at three facilities: University of Utah Hospital, Primary Children’s Hospital (PCH) and Intermountain Medical Center (IMC). In-hospital neonatology attending and neonatal nurse practitioner coverage is provided at all three units 24 hours a day, 7 days a week. Three neonatologists provide attending coverage at PCH and two neonatologists at University Hospital and IMC, each of the sites during the day. At night, there is one neonatologist covering both University of Utah Hospital and PCH NICUs and one neonatologist at IMC. Each facility has its own neonatal nurse practitioner coverage.
The 48-bed Level III NICU provides care for critically ill newborns, with gestational ages ranging from approximately 22 weeks to over 40 weeks. The unique layout of the unit allows for passage of the neonate from the delivery room directly into the NICU for resuscitation to occur in the unit. This is a high-volume delivery center with a robust maternal-fetal-medicine program and high-risk delivery service. It serves as a referral center for high-risk maternal and neonatal transports, with over 600 NICU admissions annually. Infants known prenatally to require subspecialty care at Primary Children’s Hospital are delivered at the University of Utah NICU and transferred to PCH by our transport team via the connecting enclosed walkway following resuscitation and stabilization. The NICU utilizes both conventional and high-frequency ventilation (HFOV and HFJV), total body cooling, inhaled nitric oxide (iNO) and subspecialty consultations from Primary Children’s Hospital. Additionally, there is special expertise in the care of the extremely-low-birth-weight infants. First-year pediatric interns rotate through this NICU, allowing for ample teaching opportunities.
The 52-bed NICU at PCH is the neonatal referral center for complex medical and surgical management for the Mountain West Region, consisting of Utah as well as parts of Nevada, Idaho, Montana and Wyoming. It is the state’s only Level IV NICU. There are approximately 430 NICU admissions annually and 10 extracorporeal membrane oxygenation (ECMO) runs in the NICU each year. The NICU utilizes both conventional and high-frequency ventilation (HFOV and HFJV), total body cooling, iNO, ECMO and all subspecialty consultation services. Neonatal ECMO is performed in the NICU, with the neonatology team managing the care in coordination with our surgical colleagues. There is broad exposure to both pre- and post-surgical management of general surgical cases, such as congenital diaphragmatic hernia, gastroschisis, tracheoesophageal fistula/esophageal atresia, and intestinal atresias. Fellows also participate in medical care of patients with subspecialized surgical interventions including neurosurgery, ENT, cardiothoracic, urologic, ophthalmologic, and others. Some surgeries are performed in the NICU if the neonate is too ill to travel to the operating room. With our unique patient population, there is also excellent exposure to complex congenital anomalies, genetic studies, palliative care and long-term management of chronic/complex conditions coordinated with a special care team. Third-year fellows rotate with the Neuro-NICU team.
The fellow, with attending physician support, is also responsible for carrying the “transport phone” and serves as the medical control for local and regional neonatal transports utilizing two transport services (each with ground, helicopter and fixed-wing capabilities) and takes neonatal consult phone calls from local and regional pediatricians and neonatologists.
For fellows who are interested in pursuing more clinical experience, there is an option to rotate through the 48-bed Level III Intermountain Medical Center NICU during the second and third years of fellowship. In addition to providing both conventional and high-frequency ventilation (HFOV and HFJV), total body cooling, iNO, and laser surgery for retinopathy of prematurity, there is also exposure to the “bread and butter” of neonatology, including hypoglycemia and respiratory distress.