Northwestern’s NICU fellows learn to care for critically-ill newborns

A competitive fellowship offered by Northwestern University’s Feinberg School of Medicine gives young doctors hands-on training in a particularly challenging medical subspecialty: caring for some of Chicago’s smallest and most vulnerable patients.

The three-year neonatal-perinatal medicine program, which attracts more than 100 applicants annually, accepts just four fellows each year and involves a combination of clinical practice and research, said Patrick Myers, the fellowship’s program director.

“I think people skills are actually the thing that I’m the most interested in,” Myers said. “Because if you’re dealing with parents that have a really critically ill child, being able to communicate well, be empathetic, communicate fairly complicated science and medicine to people—in a way that people understand when people are really stressed—is super critical. And then I look for people that are able to clinically handle the load, because it’s pretty stressful, and I like people that have a research interest with what the section does.”

Myers said he was drawn to neonatology because of the opportunity to work closely with families during “a really tough point in their lives.”

“You get to develop a relationship over sometimes weeks and months, and you can really make a difference in people’s lives,” he said. “The other cool thing about babies is that the trend is toward health— generally, every day you get a little bit bigger and stronger as a baby.”

Ivana Brajkovic, a Milwaukee native, is now in her second year in the program. A graduate of the University of Illinois College of Medicine, she completed her residency at University of California San Francisco and spent an additional three years as a hospitalist at Stanford University before joining the fellowship program.

One of the factors that initially attracted Brajkovic to the fellowship was the opportunity to work with James Collins, a Feinberg professor who has researched racial and ethnic group disparities in birth outcomes. Brajkovic’s research also focuses on how racial disparities in care affect infants’ morbidity and mortality, and she is currently investigating potential differences in infants born to Caucasian and Hispanic mothers by using an epidemiological tool that engages the contrast between poor and wealthy individuals in Chicago neighborhoods.

Brajkovic’s time at the fellowship is divided between two Chicago hospitals: Lurie Children’s Hospital and Prentice Women’s Hospital, which she described as one of the busiest delivery hospitals in the country.

“Lurie is all subspecialty care, so referrals from around the Chicagoland area and beyond, and they have a lot of interesting, rare cases, surgical cases,” Brajkovic explained. “So, there’s a good mix of both traditional and very premature infants that are born at Prentice, and then having a lot of different subspecialty care at Lurie’s.”

In addition to getting hands-on training in essential neonatology skills such as critical intubations and central line placements, one of the most important skills she has learned so far is how to have difficult conversations with families, she said.

“It’s something they’re probably going to think about for the rest of their lives and remember that that’s the beginning of their child’s life,” she said. “I model from my attendings how best to do that, how not to speak as much, give them time to process things and present information in the way that families are interested in hearing it. So, I’ll now start and ask them a couple of questions to see how to make the conversation go.”

This year has been especially unusual in that the COVID-19 pandemic has created a lot of new changes in the NICU, Brajkovic said. Health care providers now wear increased personal protective equipment, and because of limitations on the number of visitors who can come to the hospital, video calls through iPads have become a common way to communicate with parents.

“We never would have thought to do that before, and we have to adapt,” Brajkovic said. “And in a way, it’s kind of nice. It makes it convenient for families to see their kids more often and talk to their providers more often.”

After completing the fellowship, Brajkovic plans to stay in an academic medical center and focus on both research and clinical medicine. She is also working toward a master’s degree in public health through Northwestern and said she would ideally like to work with a public health department or look at epidemiological data along with her clinical responsibilities.

Brajkovic said she would advise students interested in neonatology to know that while it’s “a long road ahead,” it’s also a rewarding career that is worth all of the training.

“I’d get exposure to pediatrics or neonatology early on in training, because neonatology in particular is a pretty specific specialty within medicine, and within pediatrics,” she said. “You might not even have experience with it in medical school. So, seeing it ahead of time before making a decision about a specialty would be important.