Hands on or held back? Procedural experience during a neonatal rotation in Ireland

Neonatology is a core component of paediatric training in Ireland and Europe. However, the procedural experience of Senior House Officers (SHOs) during neonatal rotations in Ireland has not previously been formally reported. Concerns have been raised regarding the impact of the European Working Time Directive (EWTD) on postgraduate medical training. At the Coombe Hospital, implementation of an EWTD-compliant rota reduced SHO on-call duties from 16 to 12 hours. This study aimed to describe the procedural experience of a Senior House Officer during a six-month neonatal rotation under a 12-hour EWTD-compliant rota.

We retrospectively audited the clinical logbook of an SHO during a six month rotation (July-December 2024) at the Coombe Hospital, a Level III perinatal centre in Dublin.

The SHO attended 120 deliveries; 91% were term births and the remainder preterm, including four extremely preterm infants, with the earliest gestation attended being 22+5 weeks. The SHO participated in 12 neonatal resuscitations, acted as first responder on seven, and independently delivered intermittent positive pressure ventilation on four occasions. They completed 218 routine neonatal discharge examinations, identifying significant findings. Procedural exposure comprised six intravenous cannulations, 40 phlebotomies and one assisted umbilical line insertion. No opportunities arose for lumbar puncture, central line insertion or endotracheal intubation.

Although exposure to deliveries, neonatal resuscitation and newborn examinations was adequate, hands-on procedural experience was limited. As this rotation is often the only neonatal exposure before progressing to registrar level, reduced shift length may adversely affect training and the acquisition of core competencies.