(JULY 3, 2019) Before she became a neonatal fellow at The University of Vermont Medical Center, Adrienne Pahl, M.D., practiced as a primary care pediatrician in Vermont for three and a half years. Through this work, she got to know parents of babies who were exposed to opioids during development, witnessing how these families faced not only the usual pressures of caring for a newborn but also the challenges of a child with serious medical problems.
Pahl, a Larner College of Medicine graduate who did her pediatrics residency at UVM Medical Center, had those families in mind when she returned to the university in 2017 for a fellowship in perinatal-neonatal medicine. “I really enjoy taking care of acutely ill babies and supporting their families,” she says. Pahl is one of three UVM fellows specializing in care of critically ill newborns. In the three-year Perinatal-Neonatal Medicine Fellowship Program, they handle problems that arise at the time delivery or within four weeks after it. These might include premature births, emergencies such as uterine rupture during labor or surgery to correct abnormal organ development—anything that puts the child at risk.
“We are there to provide therapy for the baby, so we can get the best outcome for the parents,” says Deirdre O’Reilly, M.D., M.P.H., fellowship director and assistant professor of pediatrics and neonatology at the Larner College of Medicine.
UVM launched its fellowship in the 1980s, when Jerold Lucey, M.D., internationally renowned pediatrician and neonatologist, was chair of newborn services. He recognized the need for expertise in this area, O’Reilly says. Last year, the program expanded from two fellows to three.
O’Reilly, who did her fellowship at Harvard University’s neonatal-perinatal medicine training program, says UVM’s program benefits from a close-knit professional community and an emphasis on evidence-based medicine. “It has the strength of bigger academic centers but the ability to work one-on-one with attendings who are nationally and internationally known,” she says.
Each month, one fellow is on service in the neonatal intensive care unit with attending physicians and residents. They are an integral part of the family-centered care model, performing physical examinations, formulating differential diagnoses, and advising parents on the best ways to meet their child’s needs.
Recently, parents wanted to take home a newborn patient who wasn’t eating well, and a fellow worked with the family’s pediatrician to develop a plan for the child, O’Reilly says.
“We train our fellows to be experts in the field and provide these types of resources to parents and pediatricians,” she adds. In their non-service time, fellows develop a quality improvement project, seeking to enhance treatment for patients and their families, and complete a research project. They do a rotation in cardiac surgery at Boston Children’s Hospital. They also work with the Vermont Oxford Network, a Burlington-based nonprofit organization that Lucey founded in 1988 to encourage neonatal professionals worldwide to collaborate and share data to improve outcomes.
Pahl’s quality improvement effort and research both focus on babies born exposed to opioids during development. For quality improvement, she is working with a multidisciplinary group to implement a new assessment tool for infants suffering from opioid withdrawal.
Traditional evaluation involves a check of physical symptoms, which requires “disturbing the baby” every three to four hours, Pahl says. The new tool does not require this step. Instead, it goes beyond these markers to assess the child’s responses to eating, sleeping and consoling—crucial aspects of normal infant function, she says.
“What I hope to offer through my work in fellowship is to improve the experience for families and to really empower parents to help their children through what is a very stressful time,” Pahl says. “It is a big deal for families and for babies.”
About the Division of Neonatology
The Division of Neonatal Perinatal Medicine provides medical care to premature and sick newborns, including inpatient intensive and convalescent care, acute infant transport, and outpatient prenatal consultation, medical follow-up, and standardized neurodevelopmental assessment. The division includes six board-certified neonatologists, three neonatal perinatal medicine fellows, and ten advanced practice providers including eight neonatal nurse practitioners and two physician assistants. In 2018, our division welcomed Whittney Barkhuff, M.D., Ph.D.; Meagan Oakes, P.A.; and Morgan Nealy, NNP.
The 29-bed NICU is the only level III unit in Vermont. Renovations to create a single room-based unit arein the planning stage, with a goal to support exemplary family-centered care and high staff satisfaction. Our neonatal perinatal subspecialty fellowship training program, directed by Deirdre O’Reilly M.D., M.P.H., welcomed Delia Horn, M.D., and Adrienne Pahl, M.D., to their second year of fellowship, and Anna DiCarlo, M.D., to her first year of fellowship.
Scholarly activities are critical to the mission of the division. Roger Soll, M.D., remains editor of the Neonatal Collaborative Review Group and president and director of clinical trials at Vermont Oxford Network (VON). As director of global health at VON, Danielle Ehret, M.D., M.P.H., has developed a VON database for resource limited settings. On the leadership team for the NIH-supported Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome Collaborative, Leslie Young, M.D., serves as principal investigator for a multicenter clinical trial assessing a new regional care model for neonatal opioid withdrawal syndrome management. Dr. O’Reilly is implementing with a team real-time telemedicine at community hospitals to help assess newborn infants at risk for hypoxic encephalopathy.