Background: All Neonatal-Perinatal Medicine (NPM) fellowship programs are required to provide adequate experience during training to ensure that NPM fellow physicians can independently manage very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in the delivery room (DR) including opportunities to provide and/or direct continuous positive airway pressure (CPAP), endotracheal intubation, chest compressions (CC), and the administration of epinephrine. The availability of these critical learning opportunities at NPM fellowship programs is not known. Aim: To estimate the mean number of VLBW and ELBW deliveries and delivery room procedures available to fellows during three years of training and how these numbers vary among training programs. Methods: Vermont Oxford Network (VON) member hospitals contributed data on all infants 401-1500 grams or 22-29 weeks’ gestation born in 2012-2017 and admitted within 28 days of birth. VLBW was defined as ≤1500 grams and ELBW was defined as <1000 grams. Accredited NPM fellowship programs and affiliated DR hospitals were identified from the Accreditation Council for Graduate Medical Education (ACGME) website. Programs were included if all delivery hospitals associated with the program reported to VON. The number of VLBW and ELBW deliveries and procedures over three years at each program were divided by the number of matched fellows in the program during that time frame, which estimated the highest possible mean number of cases per fellow at each program assuming every delivery was attended by one fellow. Results: Of the 93 civilian fellowship programs in the US, 86 programs with 119 delivery hospitals and 63,416 VLBW deliveries (Table 1) were included in the analysis. Included programs had a mean of 6.7 +/- 3.6 fellows, and most programs had only 1 associated delivery hospital (n=57, 66%). The mean number of VLBW deliveries per fellow ranged from 14-214 (median 61) and ELBW deliveries ranged from 7-107 (median 27) (Figure 1A). The most common procedures were DR CPAP (range: 1-131, median 27) and intubation opportunities (range: 5-100, median 27). There were infrequent opportunities to experience chest compressions (range: 1-11, median 3) and epinephrine administration (range: 0-8, median 1) (Figure 1B). Conclusions: The number of opportunities available to fellows for managing VLBW and ELBW infants in the delivery room is highly variable among NPM fellowship programs and fellow exposure to some key, high risk procedures, such as delivery room CPR, is low at all programs in the U.S. Fellowship programs should make efforts to track fellow exposure to neonatal resuscitations in the DR and integrate supplemental learning with simulation into fellowship training.
A. Mean VLBW and ELBW deliveries per fellow over a 3 year fellowship period B. Mean DR procedures per fellow over three years among all VLBW deliveries