Neonatology Specialization Training Program (For European Resident Physicians Only)

First Year

Area: Pediatrics

Modules:

1. Diseases of the respiratory system 2 months
2. Acute diarrheal disease 1 month
3. Other frequent pediatric conditions (miscellaneous) 2 months
4. Care for the critically ill child 5 months

Module 13. Clinical research

Courses: Research methodology

Second Year

Area: Clinical neonatology

Modules:

5. Principle fetal conditions 1 month
6. Care for the neonatal during birth and resuscitation 1 month
7. Care for the healthy newborn 3 months
8. Neonatal intermediate therapy I 2 months
9. Neonatal intensive therapy I 3 months

Module 14. Teaching-learning process

Courses: Computation

Third Year

Area: Clinical-surgical neonatology

Modules:

10. Neonatal intermediate therapy II 2 months
11. Neonatal intensive therapy II 3 months
12. Neonatal heart and surgical conditions 4 months

 

ANALYTICAL PROGRAM

FIRST YEAR

 AREA: PEDIATRICS

 Module 1: Diseases of the respiratory system

1. Development of the respiratory system

Respiratory regulation

2. Diagnostic methods of respiratory diseases
3. Defense mechanisms and metabolic lung functions
4. Diagnostic techniques in child respiratory conditions
5. Foreign objects in the nose.

Bloody nose

6. Infections of the upper airways.

Acute rhinopharyngitis, acute pharyngitis, acute uvulitis, pharyngeal and peritonsillar abscess, sinusitis, tonsillitis, adenoiditis, epiglottitis, laryngitis

7. Obstructive sleep apnea in children
8. Tracheitis
9. Foreign bodies in the larynx, trachea and bronchi
10. Acute and chronic bronchitis in childhood
11. Bronchiolitis
12. Pneumonias
13. Atelectasis
14. Emphysema and pulmonary hyperinflation
15. Bronchial asthma
16. Cystic fibrosis
17. Pleural diseases
18. Pneumothorax
19. Pneumomediastinum
20. Neuromuscular disorders that affect lung function

 

Module 2. Acute diarrheal disease

Content:

1. Development of the digestive system
2. Acute diarrheal disease in children, definition, etiopathogenic classification
3. Etiology of acute diarrheal disease: virus, bacteria, parasites
4. Mechanisms of action of acute diarrheal disease
5. Supportive and specific treatment in acute diarrheal disease
6. Treatment of alterations in hydro saline balance and acid-base balance associated with acute diarrheal disease
7. Complications of acute diarrheal disease in the pediatric patient
8. Prevention of acute diarrheal disease in childhood

Module 3: Other frequent pediatric conditions (miscellaneous)

Content:

1. Hypochromic, hemolytic megaloblastic, hypoplastic and aplastic anemias
2. Idiopathic thrombocytopenic purpura, Henoch–Schoenlein purpura, hemophilia
3. Urinary infection, acute nephritic syndrome, nephrotic syndrome, blood in urine
4. Malabsorption syndrome, hepatitis
5. Congenital and acquired hypothyroidism, diabetes mellitus
6. Assessment of the child with neurological disease
7. Febrile seizure, most common epileptic syndromes
8. Febrile syndrome in children

 

Module 4: Care for the critically ill child

Contents:

1. Planning, organization, structure and function of a pediatric multipurpose intensive care unit
2. Monitoring and follow-up of the critically ill child
3. Humidity, gases and respiratory physiotherapy in the severe pediatric patient
4. Nutrition or artificial feeding: water, energy function, carbohydrates, proteins, fats, vitamins, trace elements, electrolytes; food and the critical patient
5. Infections in the pediatric multipurpose care unit

Risks to the patient in intensive care

Characteristics of the microbial map

Prevention and treatment

Isolation of patients

6. Artificial airway

Methods

Usefulness

Indications

Endotracheal intubation

Tracheostomy

Complications of the artificial airway

7. Artificial respiration

Methods

Forms

Repercussions of mechanical ventilation

Modalities, types and techniques of ventilation

Indications for mechanical ventilation in children

Beginning mechanical ventilation

Initial mode of ventilation

Complications of mechanical ventilation

Classification of ventilators

8. Drowning or incomplete drowning

Human reaction during submersion

Hydro electrolytic alterations

Therapy

9. Systemic inflammatory response syndrome and sepsis

Classification and terminology

Main protagonists of the inflammatory response to infection

Manifestations of the inflammatory response

10. Acute respiratory distress syndrome in children
11. Criteria for multiple organ failure or multiple organ dysfunction syndrome in children
12. Severe head trauma in children
13. Severe polytrauma in children

Basic concepts

Prognostic index

Intensive handling

14. Bioethical aspects of the brain-dead pediatric patient

 

Module 13. Clinical research

Contents:

1. Methodological scientific research, methodology, and methods
2. IT elements, biostatistics elements
3. Composition and classification of resources, function of resources
4. Basic techniques for programming activities
5. Forms of control of scientific activities
6. Methods, techniques and procedures of scientific research, methodological foundations of scientific research
7. MINSAP health policy in the field of health research
8. Scientific report writing technique
9. Branch research programs in the health sector

 

SECOND YEAR

AREA: CLINICAL NEONATOLOGY

Module 5. Main fetal conditions

Contents:

1. Fetal growth and development
2. Fetal-maternal exchange: placental circulation and fetal acid-base balance
3. Maternal pathologies and their neonatal consequences
4. The fetus of a mother with addictions
5. Teratogenic agents
6. Prenatal diagnosis of developmental abnormalities and hereditary diseases
7. Fetal growth disorders: intrauterine growth retardation and excessive prenatal growth
8. Evaluation of fetal well-being
9. Multiple pregnancies
10. Threat of preterm labor
11. Prolonged pregnancy
12. Perinatal non-immune hydrops
13. Premature rupture of membranes
14. Nutrition of the pregnant and lactating mother
15. Fetal surgery: advances and problems

 

Module 6. Care of the infant during birth and resuscitation

Contents:

1. Clinical aspects of a normal birth
2. Medicines that adversely influence the fetus and the newborn at the time of delivery
3. Influence of the delivery type on the fetus and neonate

Effects of caesarean section and instrumentation

4. Physiology of the transition from fetal to neonatal life: fetal and neonatal circulation

Physiological aspects of pulmonary circulation

5. Modifications for the fetal-neonatal transition
6. Immediate care of normal and high-risk newborns at the time of delivery
7. Perinatal asphyxia: causes and pathophysiological alterations
8. Physiological bases for neonatal resuscitation
9. Initial steps of neonatal resuscitation
10. Use of resuscitation bag and mask: equipment and ventilation of the newborn
11. External cardiac massage during neonatal resuscitation
12. Endotracheal intubation in the depressed neonate at delivery
13. Drugs to be used in neonatal resuscitation
14. Resuscitation of the newborn in special situations
15. Bioethical aspects of neonatal resuscitation
16. Thermoregulation: physiological bases, fetal thermoregulation, mechanisms that regulate heat loss in the newborn

Thermogenesis

Neutral thermal environment

17. Temperature regulation and effects of the thermal environment on the newborn
18. Management of the thermal environment
19. Hypothermia and neonatal cold syndrome
20. Basic care during intrahospital transfer of the newborn

 

 

Module 7. Care of the healthy newborn

Contents:

1. Clinical assessment of the gestational age of the newborn
2. Nutritional assessment of the newborn according to intrauterine growth curves
3. Clinical and physiological characteristics of the normal newborn from the first hours of life
4. Neurological assessment of the term newborn
5. Birth injuries: soft tissue, skull, spine and spinal cord injuries, peripheral nerve injuries, adiponecrosis, visceral injuries, fractures
6. General concepts of hereditary conditions

Isolated primary defects

Multiple malformations

7. Most frequent chromosomal syndromes: trisomy 21, trisomy 18, trisomy 13, Turner syndrome, Klinefelter syndrome

Most common malformation sequences

Associations

8. Clinical approach to the newborn with ambiguous genitalia
9. Diagnosis of congenital metabolic diseases and the most frequent endocrine disorders at birth
10. Normal hematological values of the newborn
11. Bilirubin metabolism and physiological jaundice
12. Immunological characteristics of the newborn
13. Immunizations of the neonatal period
14. Normal newborn feeding: breastfeeding and artificial
15. Perinatal and childhood statistics: definitions of live and dead newborn Underweight index

Perinatal, fetal and neonatal mortality

Child mortality

Classifications of the causes of perinatal and infant mortality

 

Module 8. Neonatal intermediate therapy I

Contents:

1. High-risk newborn
2. Low-weight newborn

Definitions

Related factors

Classification

3. General and physiological characteristics and peculiarities of the preterm and low birthweight newborn for their gestational age
4. Spectrum of diseases of the preterm newborn and low birthweight
5. General and specific care of the preterm and low birthweight newborn
6. Comprehensive care of the very low birthweight non-critically ill newborn
7. Enteral feeding of the very low birthweight infant
8. Classification and care of the newborn born of multiple pregnancies
9. Characteristics and management of the post-term newborn
10. Complications and comprehensive care of the large-for-gestational-age and fetal macrosomia
11. Newborn of a diabetic mother
12. Newborn of a mother with toxemia gravidarum
13. Newborn of a mother with thyroid diseases
14. Normal hematological values ​​of the preterm newborn and low weight for gestational age
15. Metabolic disorders: hypoglycemia, hyperglycemia, hypocalcemia, hypercalcemia, hypomagnesemia, and hypermagnesemia
16. Neonatal jaundice

Unconjugated hyperbilirubinemia

Conjugated hyperbilirubinemia

 

Module 9. Neonatal intensive therapy I

Contents:

1. Organizational, administrative and hygienic-epidemiological control aspects in the neonatal intensive care unit
2. Monitoring in the neonatal intensive care
3. Fluid balance and hydro-electrolyte alterations in the newborn
4. Alterations of the acid-base balance
5. Nutrition of the critically ill neonate
6. Physiological basis for neonatal ventilation
7. Oxygen therapy
8. Ventilation of the newborn: continuous positive pressure ventilation, conventional mechanical ventilation, high frequency conventional mechanical ventilation
9. Types of neonatal ventilators
10. Other ventilatory modalities: synchronized ventilation, volume-controlled ventilation, pressure support ventilation, high frequency ventilation, proportional assisted ventilation and computerized ventilation
11. Medications in respiratory assistance
12. Ventilation in newborns weighing less than 1000 grams
13. Indications and complications of extracorporeal membrane oxygenation
14. Techniques for weaning from neonatal respiratory assistance
15. Complications of the different modalities of neonatal respiratory assistance
16. Positive and etiological diagnosis of neonatal respiratory distress syndrome
17. Essential examinations and supportive treatment of respiratory distress syndrome in the newborn
18. Transient tachypnea of the newborn
19. Hyaline membrane disease
20. Meconium aspiration syndrome
21. Air blockage: pulmonary interstitial emphysema, pneumomediastinum, pneumothorax, pneumopericardium, massive air embolism
22. Recurrent apnea of the preterm newborn
23. Pulmonary hemorrhage
24. Bronchopulmonary dysplasia
25. Antibiotic therapy in the neonatal intensive care
26. Sedation and analgesia in the critically ill newborn

 

Module 14. Teaching-learning process

Contents:

1. The medical education system in Cuba

Training programs

2. The teaching-learning process: main teaching-patient care activities that comprise the teaching-learning process
3. Educational objectives and their importance in the organization and execution of the teaching-learning process
4. Educational contents

Knowledge and skills system

5. Organizational structure of education In-service training in the medical sciences
6. Teaching methods

Professional methods as teaching methods in medical science education Problematization

7. Teaching aids, their effectiveness in cognitive activity. The use of proof in medical sciences
8. Importance of medical ethics when teaching with patients
9. Evaluation and control: concepts, functions, objective-assessment relationship
10. Process to identify learning needs

Techniques and models for the identification of learning needs

THIRD YEAR

AREA: SURGICAL-CLINICAL NEONATOLOGY

Module 10: Neonatal intermediate therapy II

Contents:

1. Anemia due to acute blood loss, accelerated destruction of erythrocytes and inefficient production or defect in the production of red blood cells
2. Indications for transfusion with packed red blood cells
3. Indications for whole blood transfusion
4. Complications of blood transfusions or transfusions with packed red blood cells
5. Polycythemia or erythrocytosis, hyper viscosity
6. Disorders of hemostasis in the newborn: causes and differential diagnosis
7. Investigations to evaluate a neonatal bleeding diathesis
8. Conduct to follow in the event of a neonatal hemorrhagic diathesis
9. Primary hemorrhagic disease of the newborn
10. Alterations of leukocytes and myeloproliferative conditions in the newborn: congenital leukemia and transient myeloproliferative syndrome
11. Minor digestive disorders of the neonatal stage
12. Minor infections of the newborn
13. Urinary tract infection
14. Care for the febrile newborn
15. Prevention and management in the newborn born to an HIV-positive mother

 

Module 11. Neonatal intensive therapy II

Contents:

1. Patent ductus arteriosus
2. Neonatal persistent pulmonary hypertension
3. Hypotension and systemic arterial hypertension in the newborn
4. State of shock in the neonate
5. Thrombocytopenia and platelet dysfunction
6. Disseminated intravascular coagulation
7. Severe hemolytic disease of the newborn
8. Perinatal asphyxia
9. Neonatal seizures and convulsive status
10. Neonatal epilepsies
11. Hypoxic ischemic encephalopathy
12. Intracranial hemorrhage
13. Neonatal onset neuromuscular diseases
14. Necrotizing enterocolitis
15. Neonatal hematuria
16. Kidney disease
17. Prenatal infections
18. Early onset perinatal infections
19. Late onset perinatal infections
20. Hospital-acquired infections in neonatal intensive care
21. Neonatal meningoencephalitis
22. Neonatal tetanus
23. Bioethical aspects linked to neonatal intensive care: principles, conflicts and dilemmas in the face of diagnostic and therapeutic options for the main dilemmas of neonatal intensive care

 

Module 12. Neonatal heart and surgical conditions

Content:

Heart conditions

1. Prevalence and survival of congenital heart disease
2. Clinical elements of suspected congenital heart disease

Diagnostic approach to congenital heart disease

3. Fundamental characteristics of the electrocardiogram in the newborn
4. Aortic stenosis, coarctation of the aorta, interruption of the aortic arch, left heart hypoplasia syndrome
5. Pulmonary stenosis, pulmonary atresia, tricuspid atresia, tetralogy of Fallot, Ebstein’s anomaly
6. Transposition of the great vessels
7. Septal defects, atrioventricular canal
8. Myocarditis, transient myocardial ischemia, dilated and hypertrophic cardiomyopathies
9. Heart failure
10. Cardiac arrhythmias of the neonatal period

Surgical conditions

1. General preoperative care
2. Immediate postoperative care
3. Mediate postoperative care
4. Sedation, anesthesia and analgesia in the surgical neonate
5. Special enteral feeding in the surgical neonate
6. Total parenteral nutrition
7. Interhospital transfer of the surgical or pathological newborn
8. Congenital diaphragmatic hernia
9. Diaphragmatic paralysis and eventration
10. Esophageal atresia, tracheoesophageal fistula
11. Gastroesophageal reflux
12. Congenital hypertrophic pyloric stenosis
13. Omphalocele and gastroschisis, inguinal hernias
14. Gastric ulcer, gastric and intestinal perforation
15. Bowel obstruction
16. Intestinal malrotation
17. Intestinal duplication
18. Digestive stenosis, annular pancreas, intraluminal diaphragm
19. Congenital bridles
20. Intestinal atresia
21. Meconium plug syndrome, meconium ileus
22. Hirschsprung syndrome
23. Imperforate anus
24. Peritonitis
25. Abdominal masses: kidney, tumors, adrenal hemorrhage, ovarian cyst or tumor, pancreatic cyst, choledochal cyst, mesenteric cyst, intestinal duplication
26. Upper airway abnormalities: choanal atresia, laryngomalacia, tracheomalacia, congenital laryngeal stridor
27. First branchial arch syndrome, mandibular facial dysostosis, Pierre Robin syndrome, cleft lip, cleft palate, macroglossia
28. Bronchopulmonary malformations
29. Congenital lobar emphysema
30. Rupture of solid viscera: liver, spleen, adrenal
31. Kidney and urinary tract malformations
32. Hydrometrical
33. Hydrocele, testicular torsion, testicular hematoma
34. Hypospadias and epispadias
35. Bladder exstrophy
36. Congenital anomalies of the omphalomesenteric duct and urachus
37. Myelomeningocele, hydrocephalus, encephalocele
38. Most frequent associations: Vater, Charge, DiGeorge and others
39. Tumors: neuroblastoma, Wilms’ tumor, teratomas, botryoid sarcoma
40. Other tumors: hemangiomas, lymphangiomas, hepatoblastomas, hepatomas, hamartomas, nephroma
41. Neck tumors, goiter, cystic hygroma
42. Cataract and tumors of the eye and orbit
43. Mediastinal tumors
44. Cellulite, mastitis, omphalitis
45. Arthritis and osteomyelitis
46. Late onset neonatal infections
47. Neonatal community-acquired infections

Module 15. The Administration in the national health system

Contents:

1. Historical background of management theories and techniques

Current trends and their impact on the management of hospitals

Management methods and styles

2. Management functions, strategic and participatory management by objectives
3. Planning, structure of a plan, the emerging work within the plan
4. Hospital organization, change and development, hospital processes, services and their management, techniques to establish priorities
5. The health situation, characteristics and value of the most used indicators of health status
6. Components of the human resources management system

Particularities of health human resources

Work, leadership, creativity, and communication teams

7. Human resources, recruitment, selection, and employment strategy

Human resources training and development

8. Control, supervision, importance in hospital care, ways to carry out control, supervision guidelines, ethical aspects of supervision and control
9. Quality improvement, documentation and audit programs. Economy and quality.