Neonatal medicine - sub-specialty

Neonatologists are paediatric specialists with expertise in looking after newborn infants or those born prematurely.

This page is for those exploring, applying to or already in this sub-specialty training programme! We have insights from current specialists on what it's like working in neonatal medicine, opportunities to try out the sub-specialty and links to the relevant groups and other contacts.

Each sub-specialty has its own syllabus as part of Progress+ which you can download from this page, plus get details of the College Specialty Advisory Committee (CSAC) managing this sub-specialty.

Neonatologists are true "generalists". We deliver care from the intensive care unit through to low dependency and to outpatients. The variety of patients I see on the ITU ward round can range from the 24 week extreme preterm baby to the term baby with complex medical and surgical problems. I work as part of a fantastic team of doctors, nurses, ANNP's and AHPs, who work seamlessly to deliver care to the babies while including families at all times.

The complexity of the babies' problems and their resilience, continue to challenge and inspire me daily and after more than 20 years in the job, I still learn something new every day!

Dr Morag Campbell, Consultant Neonatologist in Glasgow

1. What makes a neonatologist?

A neonatologist provides comprehensive care to the critically-ill infant in the neonatal intensive care unit whilst ensuring the care of well term infants on the postnatal ward. The spectrum of clinical conditions and the care required is vast, from the term baby with feeding issues on the postnatal ward to the sick, fragile, extremely preterm baby with multiple problems.

Neonatologists often face difficult discussions with families in the antenatal and postnatal environment regarding counselling about care, management, prognostication and potentially, palliative care. Ethical and medicolegal knowledge and its application are central to many of these discussions.

Whilst providing team leadership and clinical and skills training, the neonatologist is also expected to be able to perform challenging technical procedures.

Long-term follow-up of neonatal graduates with developmental screening until two years of age is provided in this role. It is the combination of intensive care skills, ethical and emotional support, and clinical follow-up that make this a unique speciality.

2. A day in the life of a neonatologist

By Dr Claire Howarth, Consultant Neonatologist in London

"On a typical day, I arrive at the hospital around 8 am. No two days are the same and that variety is what I love about being a Neonatologist. The spectrum of what happens on any day is extensive- I could be covering SCBU and finally getting to discharge an ex-preterm infant home after months in hospital, which is one of the best moments of the job, or, I could be covering NICU breaking bad news to a family or leading a full resuscitation on labour ward, which can be some of the most challenging and difficult times. I just never know what a particular day will hold.

"When I first get in, I like to check in with the nurse in charge and get a feel for how busy the unit is so I can prepare. However, things can change very rapidly, so even the days which start peacefully can often rapidly become chaotic if we have multiple admissions or several sick babies at the same time!

"The first task of each day is completing the ward rounds with the team. Depending on which area I am covering, and the acuity, this can take anything from 1-2 hours to 3-4 hours! I lead the team but everyone, including parents, participates in discussing each of the babies and planning their care for the day.

"After the ward rounds finish, we either have meetings to attend such as the grand rounds where we discuss clinical cases or mortality and morbidity meetings with the obstetric team, or I use the time to update families. These conversations are never the same as every baby and family is unique. Sometimes these updates focus on a baby’s progress and are positive, but other times they are sad as I have to inform a family that their baby is sadly not responding to our treatment, or I need to explain that redirecting care to palliation may be appropriate. The team I am working with will complete the jobs from the ward round, but I am there for support and in challenging cases will help with procedural skills such as intubation or long lines. A large part of my job is helping teach our MDT, which I love, and this can range from leading formal teaching presentations to running simulations or ad hoc bedside teaching. We also try to have team breaks/lunch which really helps build camaraderie and boost morale.

"At the end of each day before I leave I handover each baby to the consultant for the night. My day typically ends between 5 pm and 6:30 pm, unless I am on call, which happens on average once every two weeks.

"Although I have described a typical day there is actually no such thing! Unexpected things, such as new admissions, or a deteriorating baby where my input is urgently required, often disrupt the plans I make and mean the length of my working day changes significantly! Being a neonatologist is emotionally demanding, but fortunately, the positive times far outweigh the sad times. I am proud of working for a team dedicated to improving patient outcomes and one of my favourite parts of the job is when families bring their child back to see us after they leave the unit. There is no greater satisfaction than seeing the smiles on the parents' faces and their baby, who may have had an exceedingly difficult neonatal stay, now as a toddler running around the unit saying hi to us. If I ever have a difficult day, these are the memories that remind me how important our job is, how lucky I am to do it, and how what we do on the neonatal unit has such a lasting impact on the families we look after."

3. How and where to experience neonatal medicine in your early medical career

There are many opportunities to gain experience from undergraduate through to core training in paediatrics.

There are opportunities for medical students to spend time in neonatology during their paediatric rotations. Those with a developing interest in the specialty can undertake student selected components (SSC), special study modules (SSM) or elective placements.

Some Foundation (FY) programmes offer rotations in neonatology during a paediatric rotation. Other options include undertaking taster weeks during FY placements.

The progress + curriculum for paediatrics provides placements in neonatology between ST1-4 providing opportunities to develop knowledge and practical skills.

Transferable skills for neonatology can be developed in placements in other specialties such as paediatric intensive care, cardiology, respiratory and communication skills in primary care.

Universities may host their own paediatric & neonatal societies providing undergraduates with insights into the specialty. The British Association for Perinatal Medicine (BAPM) offers a range of useful online resources and hosts national meetings throughout the year. Membership with BAPM is open to undergraduates and doctors at all stages in their careers. 

4. Applying to a neonatal medicine programme

Be prepared! Don’t leave it until the last minute to work on your CV for your application, as some things take a long time such as publications or completing cycles of a QI project. Review the paediatric sub specialty training guide, look at the shortlisting scoring criteria and score yourself. This will provide ideas for areas you can build upon to give yourself the strongest possible application. Try to have some evidence in all sections of the application form. The shortlisting criteria may change each year so ensure you review the latest version on the RCPCH sub-specialty training website.
 
You need to back yourself! You need to believe in yourself that you are THE best person for the job. If shortlisted, practice interviewing, both face-to-face and on MS Teams, with consultant colleagues or senior neonatal medicine trainees. Whilst it is important to be prepared, it is also important to not be too rehearsed. In the interview, listen to the questions asked and take a breath before answering. If you haven’t heard the question, ask the panel to repeat the question. You need to answer the questions the panel are asking you, not what you think they have asked you. They are not looking for fully formed neonatal consultants, but people who have the potential to be one. You are not the finished product of this interview.

Neonatal medicine training is highly competitive so carefully consider how you rank your choices of training programmes.

If you are unsuccessful, seek feedback to enable you to develop your application for the future.

If you are applying to neonatal medicine it is helpful to seek advice from neonatologists in your local tertiary centre, your Educational Supervisor and your Training Program Director.

If you have been unsuccessful or are looking to get training time prospectively recognised then you need to contact neonatal medicine CSAC to get formal approval. Only UK training posts can be pre-approved to count towards sub-specialty training.

5. Information for neonatal medicine trainees

Neonatal medicine CSAC is a helpful resource to trainees in the later stages of sub-specialty training in addition to giving advice on curriculum coverage they are able to provide support and guidance on applying for consultant posts, post-CCT neonatal fellowships and other potential career options.

To find out more about neonatal medicine, the CSAC recommend the following websites as useful resources: