The pediatric critical care experience at Naval Hospital Guam: Suggestionsfor critical care training during residency

Objectives: To determine the critical care experience encountered by three recently graduated military pediatricians at an overseas military hospital and present one model of maximizing allowable critical care training time d uring residency. Method: Retrospective reviews of all admissions to the spe cial care nursery and intensive care unit at U.S. Naval Hospital Guam were performed for a 3-year and a 2-year period, respectively. Age, diagnosis, b irth weight (if applicable), level of nursery care, invasive procedures per formed in the nursery (endotracheal tube, umbilical artery, and umbilical v enous catheter placement), patient outcome, and the need for medical transp ort were recorded. Results: During a 3-year period, there were 122 admissio ns to the special care nursery (7.1% of all deliveries). In addition, pedia tricians performed a total of 53 invasive procedures on these patients, and 29 infants required medical transport to an off-island neonatal intensive care unit for additional care. During a 2-year period, 70 pediatric patient s were admitted to the adult intensive care unit, representing 10.2% of all intensive care unit admissions during this period. Fourteen of these patie nts required medical transport to an off-island referral hospital. Conclusi on: Graduating military pediatric residents may be faced with caring for a wide range of critically ill neonatal and pediatric patients depending on t heir assignment. Residency training programs, with the recent increased emp hasis on primary pediatric care, will need to streamline instruction in ped iatric critical care to provide maximal benefit to the resident while maint aining compliance with Residency Review Committee guidelines.