Residency Training Program in General Pediatrics
Critical Care Rotations
Experiences in neonatal and pediatric critical care are an exciting, challenging, often rewarding, and always memorable part of our pediatric residency training. As a true university and teaching hospital based training program, we provide our residents with experiences in state recognized and appropriately certified and designated pediatric and neonatal intensive care units at both core hospitals, Kings County Hospital and University Hospital of Brooklyn, on our Clarkson Avenue campus in the heart of Brooklyn, New York. It is in large part because of our location, the populations we serve and the status of our units as referral centers that the range of interesting, complex and critically ill patients our residents care for is so impressive. Of course, the residents in all our ICUs are supported, supervised and taught by appropriately trained specialists in pediatric critical care and in neonatal-perinatal medicine. Residents are directly engaged in all aspects of the patients' care: initial evaluation and stabilization in the ED or L&D, clinical, laboratory and imaging assessment, physiologic monitoring, management with therapeutic interventions and invasive procedures, and coordination of care. Because of the continuous availability of a comprehensive range of pediatric subspecialists as well as surgical specialists, nearly all problems confronted in the critical care units can be managed within our intstitutions. In fact, as a referral center, our ICUs coordinate transport of patients into our facilities for care not available for children at surrounding hospitals throughout the area.
Neonatal Intensive Care
At the Children's Hospital at Downstate in University Hospital of Brooklyn, residents in pediatrics work alongside residents in Emergency Medicine, nurse practitioners, physician assistants, pediatric respiratory therapists, pediatric nutritionists, a pediatric pharmacologist in a NYS designated Regional Perinatal Center (RPC). This brand new, 29+ bed, state-of-the-art unit is supervised and staffed by attending physician's who are in house 24 hours a day, 7 days a week caring for over 850 neonates admitted annually. Being an RPC, residents assigned to this unit are exposed to some of the highest risk and most challenging neonatal cases delivered at UHB or transported in from other facilities requiring sophisticated treatment with interventions including high frequency oscillation, inhaled nitric oxide, dialysis, cerebral and core cooling strategies — everything except ECMO which is rarely needed.
The Neonatal Intensive Care at Kings County Hospital Center, the Brooklyn flagship of the NYC HHC Network is also a level 3, new state-of-the-art 14 bed NICU with 16 bed stepdown/intermediate units. While the KCHC NICU receives some patients from other NYC public hospital facilities, it is under the HHC RPC umbrella. At KCHC, residents work in cooperation with nurse practitioners and physician assistants. Attending supervision is also provided by KCHC neonatologists who are in-hospital 24/7. KCHC also provides high tech therapies such as nitric oxide, high frequency ventilation and cerebral cooling. The KCHC NICU admits over 750 patients annually.
Pediatric Intensive Care
The Pediatric Intensive Care Unit (PICU) at Kings County Hospital Center is a 7 bed unit admitting over 450 patients annually. The unit consists of individual closed rooms with breakaway sliding glass doors. Two beds are in negative pressure isolation rooms. Four beds are under closed-circuit video monitoring and all beds have central station physiological monitoring. The unit utilizes computerized physician order entry, fully computerized electronic medical records and lab results, PACS imaging retrieval, pneumatic tubes for specimen and medication transport and computerized unit dosing. The spectrum of patients consists of critically ill children admitted through the ED, from the clinics, transferred from the OR or from the inpatient unit as well as trauma patients brought because of the hospital's Level 1 Trauma Center status. The unit has Heliox, nitric oxide, high frequency oscillation as available interventions. This unit is supervised and staffed by three full time attending intensivists.
At the Pediatric Intensive Care Unit of Childrens' Hospital at Downstate (University Hospital of Brooklyn), there are 5 beds plus 1 procedure bed with over 300 patients admitted annually. This PICU is an open unit plus has one room as an isolation bed; an additional 4 stepdown beds are provided on the inpatient unit. The unit is computerized for the ordering of intravenous drips, labs, imaging studies as well as receiving lab results and PACS image retrieval. Medications are unit dosed and dispensed via the Pyxis system and all drips are provided via standardized dosing. A pneumatic tube system is used for specimen and medication transport. All beds have central station monitoring, and video EEG and 24 hour EEG monitoring are available. Therapeutic modalities available here include high frequency oscillation, nitric oxide, Heliox, peritoneal dialysis, hemodialysis, chemotherapy, plasmapheresis. The spectrum of patients admitted to the PICU at UHB range from acutely ill children with no significant past history who present to the ED to patients with serious complications of chronic illnesses followed by our subspecialists (e.g. oncologic disorders, end-stage renal disease, transplantation, chronic lung disease, etc.) to post-operative patients who have undergone neurosurgical, orthopedic, otolaryngologic procedures, for example. This unit is also supervised and staffed by three full time pediatric intensivists.