Diabetes Treatments

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Summary of Educational Curriculum

I Maternal-Fetal Medicine
A Pregnancy For Reproductive genetics, See Section V
1 Factors of pregnancy See also VIA1
Understand the physiology of maternal adaptation to pregnancy and the
normal changes in physiologic variables and in laboratory values
Know the normal development and role of the placenta, including gas
exchange, fetal oxygenation, and electrolyte and nutrient transport
Identify the factors influencing growth of the fetus
Know the components of good pre-pregnancy health and prenatal care,
including maternal nutrition and vitamin intake
Know the types of and effects on the mother of multiple gestation pregnancy

2 Maternal medical disorders affecting the fetus
Identify the effects of maternal immunologic disease with
transplacental passage of immunoglobulins and its treatment on
the fetus
Know the effect of renal disease and its treatment on the fetus
Understand the effect of malignancy maternal/placental/fetal
and its treatment on the fetus
Know the effect of diabetes mellitus and its treatment on the

fetus
Know the effect of hypertension preeclampsia and HELLP and their
treatment on the fetus
Understand the effect of maternal bacterial and viral infection,
including human immunodeficiency HIV, cytomegalovirus CMV,
group b streptococcusGBS, etc
Recognize the effects of significant hematologic and
thromboembolic disease and their treatment on the fetus
Know the effect of maternal cardiac disease and its treatment on
the fetus
Recognize the effect of maternal endocrine and metabolic
disorders other than diabetes mellitus and their treatment on
the fetus
Know the effect of maternal pulmonary disease and its treatment
on the fetus
Know the effect of maternal nervous system diseases, including
seizures, and their treatment on the fetus
Understand the significance and management of maternal seizures
Know the maternal and fetal risks and the management of a
pregnant patient involved in a traumatic injury

3 Obstetric conditions and complications affecting the fetus
Know the causes
and assessment of spontaneous first trimester loss
Know the definition, risks to the fetus, and management of post-term
pregnancy

4 Effect of medications and environmental agents on fetus
Understand the probable gestational age of teratogen exposure
for common fetal anomalies
Know effects on the fetus of medications, including radioactive
substances, used to treat maternal conditions See also IA2
Know the effects on the fetus of maternal substance abuse,
including alcohol, smoking, and drugs of abuse
Know the effect on the fetus of environmental agents, such as
radiation and industrial chemicals

B Fetal assessment and treatment modalities during pregnancy
1 Screening
Determine the management of women with abnormal screening tests,
such as alpha-fetoprotein, triple-screen, and glucose
intolerance
Know the maternal and fetal conditions requiring evaluation
during pregnancy and the proper modes of evaluation and
screening
Know the indications for and complications of methods of direct

assessment of the fetus, including chorionic villus sampling,
amniotic fluid sampling and fetal blood sampling
Recognize ultrasonographic patterns of common fetal anomalies

2 Ultrasonography
Know the general principles, applications, and limitations of
ultrasonography, including Doppler blood flow, in assessment of
fetal conditions, well-being, and gestational age

3 Assessment of fetal status
Understand the rationale, interpretation, and shortcomings of
various methods of assessing fetal well-being during pregnancy,
including fetal activity, fetal heart rate patterns, and
biophysical profile

4 Fetal conditions which jeopardize the fetus during pregnancy
Know how to diagnose and manage complications of multiple
gestation, such as cord problems, twin-twin transfusion, stuck
twin, conjoined twins, etc
Know how to diagnose and manage fetal-maternal blood group
incompatibility
Understand the pathophysiologic consequences and plan
appropriate management of a dysrhythmia in a fetus,
including
management of electrophysiologic disturbances, and understand
the potential adverse effects of approaches used
Know how to diagnose and manage fetal anemia and hydrops,
including intrauterine transfusion
Know how to diagnose and manage abnormalities of intrauterine
growth rate
Know how to diagnose and manage fetal infection
Know how to diagnose and manage abnormal volume of amniotic
fluid: polyhydramnios or oligohydramnios, and know their
significance

5 Evaluation of fetal lung maturity See also IVB1
Understand the indications for and interpretation of tests
of fetal lung maturity
Know the medications, indications for, and complications of
drugs used to enhance fetal lung maturity

C Labor
1 Factors of labor
Understand the physiology of normal labor
Understand the factors and mechanisms contributing to preterm
labor
Know how to assess fetal well-being during labor See also
IB3

2 Complications occurring during labor which affect the
fetus
Know the effect on the fetus of medications, including
tocolytics, administered to the mother during labor See also
IA4
Understand the diagnosis and management of maternal/fetal blood
loss such as placenta previa, placenta abruption, and vasa
previa
Understand the diagnosis and management of maternal hypertension
or hypotension
Understand the significance and management of meconium-stained
fluid
Understand the significance, interpretation, and management of
normal/abnormal fetal heart rate patterns during labor

3 Other
Know the causes, complications, and management of premature
rupture of the membranes both at term and preterm
Know the significance of maternal temperature increase during
labor
Know the complications and effects of chorioamnionitis in the
mother and the fetus

D Delivery
Know the indications for, complications of, and outcome of
cesarean delivery
Know the advantages and problems of vaginal delivery, including

indications for forceps, vacuum delivery, and vaginal birth
after cesarean delivery
Know how to recognize and differentiate complications of soft
tissue injury to infants scalp, like caput and subgaleal bleed
Know the clinical features and prognosis of birth injuries,
including fractures and neurologic injuries
Know the causes and etiologic agents of maternal septicemia
Know the clinical and laboratory features of maternal septicemia
Know the differential diagnosis of maternal septicemia
Know the causes of maternal and neonatal complications and the
management of abnormal presentations, such as breech, shoulder
dystocia, etc
Know the appropriate management of cord clamping

E Breast feeding See Section VIC1

II Asphyxia and Resuscitation
A Pathophysiology of acute and chronic asphyxia syndromes
1 General
Understand the causes and pathophysiology of acute and chronic
asphyxia syndromes, including cellular mechanisms
Understand the pathogenesis, clinical features, diagnosis,
management, and
outcome of perinatal hypoxic ischemic
encephalopathy

2 Organ effects
Recognize the systemic complications and vascular redistribution
of blood flow caused by asphyxia
Understand reperfusion injury

3 Biochemistry
Know the biochemical responses to and consequences of asphyxia

B Diagnosis and management of asphyxia
1 Diagnosis
Differentiate asphyxia from other causes of depression at birth,
including drug effects and hypovolemia
Understand the significance, limitations, and causes of low
Apgar scores
Understand the interpretation of fetal scalp and umbilical cord
blood gas and pH values

2 Management
a Airway See also IC2 and IVC2
Understand the proper approach to airway management in the
delivery room
Identify the potential complications of airway management
in the delivery room and know their management
Understand the controversies and current recommendations
regarding suctioning meconium from the airway
following
delivery
b Ventilation and oxygenation
Know the indications for assisted ventilation in the
delivery room
Understand the various techniques for, and assessment of,
assisted ventilation in the delivery room
Recognize the problems associated with assisted ventilation
in the delivery room and know their management
c Circulatory support
Understand the indications for, techniques, and potential
complications of chest compression
Understand the indications for and management of
intravascular fluid volume replacement
d Pharmacologic management
Understand the indications, contraindications, methods of
administration, and kinetics of drugs used for neonatal
resuscitation

III Cardiovascular
A Normal and abnormal cardiac embryology and development
Know normal and abnormal embryologic development of the heart
and great arteries and the factors affecting these
Recognize the
cardiac manifestations of maternal diseases and of
common perinatal syndromes in the newborn infant

B Cardiovascular physiology
Understand the factors affecting and regulating myocardial
performance in the fetus and newborn infant and during the
transitional period
Understand the factors affecting and regulating systemic
circulation in the fetus and newborn infant and during the
transitional period
Understand the factors affecting and regulating the pulmonary
circulation in the fetus and newborn infant and during the
transitional period
Know the appropriate techniques to assess cardiovascular
function in the fetus and newborn infant
Understand the physiology, clinical features, approach to
diagnosis, and treatment of the ductus arteriosus

C Congenital heart disease
1 Cyanotic
Understand the pathophysiology, recognize the clinical,
laboratory, and radiographic features, and formulate a
differential diagnosis of a cyanotic neonate
Plan appropriate management for a
cyanotic neonate and
understand the potential adverse effects of specific therapeutic
approaches used

2 Left-to-right shunt lesions
Understand the pathophysiology, recognize the clinical,
laboratory, and radiographic features, and formulate a
differential diagnosis of an acyanotic neonate with a left-to-
right shunt lesion
Plan appropriate management for an acyanotic neonate with a left-
to-right shunt and understand the potential adverse effects of
specific therapeutic approaches used
Understand the pathophysiology, recognize the clinical,
laboratory, and radiographic features, and formulate a
differential diagnosis of an acyanotic neonate with ductus
arteriosus

3 Left-sided obstructive lesions
Understand the pathophysiology, recognize the clinical,
laboratory, and radiographic features, and formulate a
differential diagnosis of an acyanotic neonate with a left-sided
cardiac obstructive lesion
Plan appropriate management for an acyanotic neonate with a left-

sided cardiac obstructive lesion and understand the potential
adverse effects of specific therapeutic approaches used

4 Right-sided lesions cyanotic or acyanotic
Understand the pathophysiology, recognize the clinical,
laboratory, and radiographic features, and formulate a
differential diagnosis for a neonate with a right-sided cardiac
lesion
Plan appropriate management for a neonate with a right-sided
cardiac lesion and understand the potential adverse effects of
specific therapeutic approaches used

5 Mixed lesions
Understand the pathophysiology, recognize the clinical,
laboratory, and radiographic features, and formulate a
differential diagnosis for a neonate with a mixed cardiac lesion
Plan appropriate management for a neonate with a mixed cardiac
lesion and understand the potential adverse effects of specific
therapeutic approaches used

D Cardiopulmonary distress in the absence of congenital heart
disease
Understand the pathophysiology, recognize the clinical,

laboratory, and radiographic features, formulate a differential
diagnosis of, and manage an infant with a condition affecting
myocardial performance, such as cardiomyopathy, myocarditis,
tumor, and electrolyte imbalances
Understand the pathophysiology, recognize the clinical,
laboratory, and radiographic features, formulate a differential
diagnosis of, and manage an infant with a condition affecting
the systemic blood pressure, such as shock and hypertension
Understand the pathophysiology, recognize the clinical,
laboratory and radiographic features, formulate a differential
diagnosis of and manage an infant with cardiac manifestations
produced by perinatal events such as asphyxia, hypervolemia

E Electrocardiography, electrophysiology, and dysrhythmias
Differentiate normal from abnormal electrocardiographic
voltages, patterns, and rhythms in the fetus and newborn infant,
including electrophysiologic characteristics
Understand the pathophysiologic consequences and plan
appropriate management of a
dysrhythmia in a newborn infant,
including management of electrophysiologic disturbances, and
understand the potential adverse effects of approaches used

F Pharmacologic therapy of heart disease
1 Autonomic agonist and antagonist drugs
Understand the mechanism of action, therapeutic indications for,
and toxicity of commonly used autonomic agonist and antagonist
drugs

2 Digoxin and other inotropic agents
Recognize the therapeutic indications for and toxicity of
digoxin in treating cardiovascular distress
Recognize the therapeutic indications for and toxicity of
inotropic agents in treating cardiovascular distress

3 Diuretics
Understand the mechanism of action, therapeutic indications for,
and toxicity of commonly used diuretic drugs, such as
hydrochlorthiazide and furosemide

4 Thrombolytics and anticoagulants
Understand the mechanism of action, therapeutic indications for,
and toxicity of thrombolytics and anticoagulants, such as
coumadin, heparin, and non-steroidal
anti-inflammatory drugs

IV Respiratory
A Embryology and physiology
1 Morphologic development of the lung - normal and abnormal
Understand the stages of normal and abnormal cellular
development of all components of the lung

2 Fetal respiration
Know the factors affecting control of fetal breathing movements
Know the mechanism of production and clearance of fetal lung
fluid, its contribution to amniotic fluid, and its importance to
fetal lung development

3 Control of Breathing - normal and abnormal
Understand the effects of pulmonary reflexes and oxygen, carbon
dioxide, and hydrogen ion concentrations on control of neonatal
breathing

4 Pulmonary surfactant
Determine the effects of surface tension on alveolar and airway
stability and lung mechanics LaPlace law
Understand the timing of the biochemical maturation of the lung
and the factors affecting this timing

5 Pulmonary function - normal and abnormal
a Ventilation/perfusion

Know what determines alveolar gas
composition ie, ability
to predict the effects of changes in altitude on
oxygenation and know how to calculate an alveolo-arterial
gradient
Understand the concepts of anatomic and physiologic dead
space
Identify the causes of and the effects of
ventilation/perfusion mismatching
Understand the determinants of gas exchange
Know the causes of arterial hypoxemia in a patient with a
structurally normal heart and how to differentiate among
them using measurements of arterial blood gas tensions

b Respiratory mechanics - normal and abnormal
1 General
Distinguish the differences in pulmonary mechanics
between the neonate and the adult
Understand the basic gas laws and how they apply to
the clinical setting

2 Lung volume
Know factors that determine residual lung volume,
functional residual capacity, and tidal volume, and

how they change with various pulmonary disorders

3 Lung and chest wall compliance
Recognize the factors that alter lung compliance and
chest wall compliance and how they change with
various pulmonary disorders

4 Airway resistance
Understand the factors that affect airway resistance
and how resistance changes with various lung
disorders

5 Respiratory muscles
Know the factors that influence upper airway patency
Understand the developmental characteristics of
respiratory muscle function

6 Dynamic interactions
Understand the physical principles governing gas
flow, including the ventilatory significance of short
and long time constants
Understand the causes of pulmonary edema and its
effects on lung function
Know how intrapleural pressure affects cardiovascular

function
Understand how chronic lung disease affects
cardiovascular function

6 Oxygen transport and delivery
Understand the various factors affecting oxygen uptake,
transport, and delivery, including the blood and circulation

7 Pulmonary function testing

Understand and be able to interpret the various techniques for
assessing lung function including arterial blood gas
measurements and noninvasive methods for estimating arterial
oxygenation
Understand the interpretation and limitations of methods for
measuring lung mechanics

B Respiratory distress syndrome RDS/Transient tachypnea
1 RDS
Understand the pathogenesis, pathophysiology, and risk factors
of RDS
Recognize the clinical, laboratory, radiographic, and pathologic
features of RDS
Understand the prevention and management of RDS, including
surfactant replacement

2 Transient tachypnea
Understand the pathogenesis, pathophysiology, and risk factors
of transient
tachypnea of the newborn infant
Recognize the clinical, laboratory, radiographic, and pathologic
features of transient tachypnea of the newborn infant
Determine the prevention and management of transient tachypnea
of the newborn infant

C Pneumonias, meconium aspiration, and persistent pulmonary
hypertension
1 Pneumonias
Formulate a differential diagnosis and be able to plan the
management of an infant in whom neonatal pneumonia is suspected

2 Meconium aspiration syndrome See also IC2 and IIB2a
Know the pathogenesis, pathophysiology, and risk factors of
meconium aspiration syndrome
Recognize the clinical, laboratory, radiographic, and pathologic
features of meconium aspiration syndrome
Understand the prevention and management of meconium aspiration
syndrome
3 Persistent pulmonary hypertension
Understand the pathogenesis, pathophysiology, and risk factors
of persistent pulmonary hypertension
Recognize the clinical, laboratory, radiographic, and pathologic

features of persistent pulmonary hypertension
Know the prevention and management of persistent pulmonary
hypertension

D Other causes of respiratory distress
1 Extrapulmonary
Recognize the clinical and radiographic features of
extrapulmonary causes of respiratory distress, including
diaphragmatic hernia, diaphragmatic paralysis, and cord
transection
Plan appropriate therapy for an infant with extrapulmonary
causes of respiratory distress, such as diaphragmatic hernia,
diaphragmatic paralysis, cord transection

2 Airway obstruction
Understand the features of and be able to plan therapy for an
infant with airway obstruction, such as vascular rings, choanal
atresia, and tracheal abnormalities

3 Miscellaneous
Recognize the clinical and radiographic features of congenital
malformations of the lung, including congenital pulmonary
lymphangiectasia, the cystic lung diseases, such as congenital
lobar emphysema, cystic adenomatoid formation, and mediastinal
tumors

4
Pleural disorders effusion, chylothorax
Understand the pathophysiology and recognize the clinical and
radiographic manifestations of hydrothorax/chylothorax
Plan the therapeutic management of hydrothorax/chylothorax

E Apnea of prematurity and neonatal respiratory depression
Understand the pathophysiology and management of apnea of prematurity

F Treatment
1 Mechanical ventilatory assistance
Plan the ventilatory therapy for infants with respiratory
failure of different etiologies
Understand the indications for and techniques, effects, and
risks of Continuous positive airway pressure CPAP
Understand the indications for and techniques, effects, and
risks of high-frequency ventilation
Understand the indications for and techniques, effects, and
risks of positive-pressure ventilation PPV
Understand the indications for and techniques, effects, and
risks of extracorporeal membrane oxygenation ECMO
Understand the indications for and techniques, effects, and
risks of administration of inhaled nitric
oxide

2 Pulmonary barotrauma
Understand the pathophysiology of air leaks
Recognize the clinical, laboratory, and radiographic
manifestations of air leaks
Understand how to prevent and/or manage air leaks

3 Chronic lung disease, bronchopulmonary dysplasia
Understand the pathogenesis, pathophysiology, and risk factors
of bronchopulmonary dysplasia
Recognize the clinical, laboratory, radiographic, and pathologic
features of bronchopulmonary dysplasia
Understand the prevention and management of bronchopulmonary
dysplasia

V Genetics/Dysmorphism
A Basic understanding of molecular genetics
Understand how linkage studies are used clinically
Understand the meaning of the terms point mutation,
polymorphism, and haplotype
Understand basic functional units of a gene, including intron,
exon, promoter, enhancer, and polyadenylation sequence
Understand the principal of polymerase chain reaction PCR
procedure and application for genetic diagnosis
Understand the functions of
messenger, ribosomal, and transfer
RNA
Understand concept of DNA and mRNA sequence encoding amino acid
structure of proteins
Understand concept of types of post-transcriptional modification
of proteins
Understand concept of protein folding and conformation related
to function
Understand function of DNA polymerase, RNA polymerase, and
reverse transcriptase enzymes
Understand function and research utility of restriction
endonucleases
Understand the concept of cis- and trans-acting factors
regulating gene expression
Understand concept of DNA cloning
Understand the concept and utility of RNA-DNA, RNA-RNA and DNA-
DNA hybridization

B Specific patterns of inherited congenital disorders
1 General
Understand the inheritance patterns of the major blood groups

2 Chromosomal disorders
a Types of chromosomal abnormalities
1 Aneuploidy
a Autosomal
Recognize the physical findings and chromosomal
pattern
in trisomy 13
Identify the physical characteristics and chromosomal pattern
in trisomy 18
Be aware of the maternal factors, incidence, and clinical
manifestations of Down syndrome
b Sex chromosome
Understand the implications of a prenatal
diagnosis of sex chromosome aneuploidy for the
long-term developmental outcome of an infant
Recognize the physical characteristics and
chromosomal pattern of sex chromosome aneuploidy
c Polyploidy
Know fetal and placental manifestations of
triploidy

2 Structural chromosomal abnormalities
a Balanced translocations or inversions
Understand the difference between balanced and
unbalanced chromosome translocation
Understand the appropriate cytogenetic follow-up
for an infant with a structural chromosome
abnormality
3
Mosaicism
Understand how mosaicism modifies clinical
presentation
4 Fragile X
Know the clinical features of fragile X syndrome
5 Deletion syndromes
Recognize the karyotype and clinical manifestations
associated with deletions, microdeletions, and
contiguous gene disorders
6 Genomic imprinting
Understand the etiology, molecular phenotype, and
clinical manifestations of disorders associated with
genomic imprinting, such as Prader-Willi syndrome,
Beckwith-Wiedemann syndrome, and uniparental disomy
7 Expanding genes
Recognize the DNA findings, clinical manifestations,
and inheritance of expanding genes, such as myotonic
dystrophy

3 Single-gene disorders
a Types
Differentiate between homozygous and heterozygous
Be able to calculate the gene frequency of a
disease
inherited on a single gene by knowing the population
incidence of that disease

b Incidence
Recognize specific patterns of Mendelian inheritance
Know the incidence of various single-gene disorders

c Clinical features
1 Autosomal dominant disorders
Demonstrate understanding of the genetic implications
for family members, clinical features, and
inheritance patterns of autosomal dominant disorders
2 Autosomal recessive disorders
Recognize the clinical features, approach to
diagnosis, recurrence risks, and inheritance patterns
of autosomal recessive disorders
3 X-linked disorders
Understand the mode of transmission, clinical
features, and approach to X-linked recessive
disorders

4 Multifactorial disorders
Differentiate between multifactorial and Mendelian inheritance
Know the
recurrence risks and factors of multifactorial
disorders

C Specific patterns of noninherited congenital defects
1 Environmental factors See IA4

2 Maternal metabolic disorders See 1A2

3 Deformations/disruptions
Differentiate between a malformation, a deformation, and a
disruption
Recognize the consequences of the amniotic band syndrome

4 Infections
a Maternal infections See IA2 and XB

b Diagnosis See VD2C

D Congenital anomalies See also IB1
1 Diagnostic approach
a History
Know the components of a complete family history for
genetic disorders
Understand how age at presentation in utero, neonate,
infancy, or later affects the differential diagnosis of
genetic disorders

b Physical evaluation
Recognize the diagnostic implications of single vs
multiple anomalies
Know the frequency of minor congenital anomalies
Know the frequency of major congenital malformations

Recognize the clinical features of syndromes, such as
Waardenburg, Treacher Collins, Cornelia de Lange, Mobius,
Vater, Rubenstein-Taybi, Beckwith, etc
Recognize the clinical features and know how to manage
craniofacial anomalies
Identify the clinical features and know how to manage
congenital anomalies of the upper extremities, such as
syndactyly, polydactyly, absent clavicles, absent radius,
sprengel deformity, limb reduction
Recognize the clinical features and know how to manage
congenital anomalies of the lower extremities, such as
metatarsus adductus, talipes equinovarus, syndactyly,
polydactyly limb reduction
Know the clinical features and know how to manage skeletal
dysplasias, such as achondrogenesis, achondroplasia,
chondrodermal dysplasia, epiphyseal dysostosis,
osteogenesis imperfecta, hypophosphatasia, etc
Recognize the clinical features, inheritance patterns, and

complications of neural tube defects

c Cytogenetic studies
Identify appropriate cases in which to obtain chromosomal
studies
Understand the indications and limitations of molecular
cytogenetic studies eg FISH, specifically in the
diagnosis of aneuploidy and microdeletion
Know when to obtain chromosomes on parents or other family
members

d DNA diagnostic studies
Understand the disorders for which molecular genetic
studies are clinically indicated, such as cystic fibrosis

2 Counseling
a Long-term outcome and survival of the affected infant
Know the long-term outcome and survival of infants with
various congenital abnormalities

b Recurrence risk
Understand and be able to provide genetic counseling to
parents whose first child died of an inborn error of
metabolism
Know the recurrence risks of various single-gene disorders
Understand the concept that
phenocopies have different
recurrence risks

VI Nutrition
A Nutrition and growth
1 The fetus
a Changes in body composition
Know how body composition changes during fetal growth

b Nutrient requirements See also IA1
Determine the nutrients and the relative amounts required
for normal fetal growth

c Factors that influence intrauterine growth See also
IA1
Understand the hormonal, maternal, placental, and fetal
factors that affect intrauterine growth

2 Normal infants
a Changes in body composition
Understand how body composition changes during the growth
and development of preterm and full-term infants

b Energy requirements kcal/kg/day
Understand how to ascertain and calculate the caloric
requirements to ensure optimal growth of preterm and full-
term infants
Understand the caloric cost of physical activity
Understand the caloric cost of
maintaining body temperature

c Protein requirements
Distinguish essential amino acids from nonessential amino
acids
Understand the protein requirements of preterm and full-
term infants
Understand the physiology of protein/amino acid digestion,
absorption, and metabolism in newborn infants
Understand the consequences of feeding low-birth-weight
infants too little or too much protein

d Fat requirements
Identify the clinical and laboratory features of essential
fatty acid deficiency and how to prevent it
Distinguish between essential and nonessential fatty acids
Understand the role of medium-chain triglycerides in
neonatal nutrition
Understand the physiology of fat digestion, absorption, and
metabolism in newborn infants
Understand the fat requirements of preterm and full-term
infants

e Carbohydrate requirements
Understand the physiology of
carbohydrate digestion,
absorption, and metabolism in newborn infants
Understand the carbohydrate requirements for preterm and
full-term infants

3 Large- and small-for-gestational age LGA - SGA infants
a General
Understand how extremes of intrauterine growth affect
postnatal nutritional requirements

b LGA infants
Understand the body composition of LGA infants

c SGA infants
Recognize that there may be a period of catch-up growth in
SGA infants
Understand that the nutrient and energy needs of the SGA
infant are greater than those of the AGA or LGA infant
Understand the differences in body composition betweeen
SGA, LGA, and AGA infants

B Minerals, vitamins, and trace elements
1 Minerals see Section VIII
Understand the changing requirements of sodium, potassium,
chloride, calcium, and phosphorous by the neonate at various
gestational ages

2 Vitamins
Understand that
the requirements for vitamins in newborn
infants, and the difference between the preterm infant and the
full-term infant
Understand the clinical and laboratory manifestations of
deficiencies and excesses of vitamins

3 Trace elements
a Zinc
Understand the clinical manifestations and diagnosis of
zinc deficiency
Understand the management and prevention of zinc deficiency

b Copper
Recognize the clinical manifestations and diagnosis of
copper deficiency
Understand the management and prevention of copper
deficiency

c Iron
Understand the clinical manifestations and diagnosis of
iron deficiency
Understand the management and prevention of iron deficiency

d Selenium
Understand the clinical manifestations and diagnosis of
selenium deficiency
Understand the management and prevention of selenium
deficiency

e Manganese

Understand the clinical manifestations and diagnosis of
manganese deficiency
Understand the management and prevention of manganese
deficiency

f Chromium
Understand the clinical manifestations and diagnosis of
chromium deficiency
Understand the management and prevention of chromium
deficiency

C Enteral nutrition
1 Human milk
Know the differences between the composition of the breast milk
of the mother of a preterm infant and that of a full-term infant
Understand the differences in the nutritional composition of
human milk and cow milk
Understand the immunologic constituents in human milk and their
physiologic effects
Recognize the effects of different methods of processing of
human milk, such as freezing, pasteurization, sterilization,
microwaving
Be familiar with the ability of human milk, infant formulas, and
milk fortifiers to meet the nutritional needs of the very low-
birth-weight infant

Understand the physiology and pathophysiology of human milk
secretion and ejection
Realize the problems associated with breast feeding

2 Formulas
Understand the distribution of nutrients protein, fat, and
carbohydrates in infant formulas
Understand the benefits and risks of formulae that contain
hydrolyzed and soy proteins

D Parenteral nutrition
1 Indications
Understand the indications and advantages of total parenteral
nutrition TPN

2 Composition and energy content
Understand the nutritional composition and caloric content of
parenteral solutions
Understand the importance of protein and non-protein nutrients
in achieving optimal utilization of energy and nitrogen

3 Complications of parenteral nutrition See also XID1
Recognize the causes and clinical manifestations of catheter and
metabolic complications of parenteral nutrition
Recognize the relationship between the calcium and phosphorus
content of parenteral nutrition solutions and osteopenia

Understand the appropriate therapy for infants who have
parenteral nutrition-induced cholestasis
Recognize the association of cholestasis with total parenteral
nutrition and understand how to diagnose other possible causes

VII Water/Salt/Renal
A Water and electrolyte metabolism
1 Water metabolism
a Body water compartments during development
Understand the changes in body water distribution and body
fluid composition during fetal and postnatal development

b Methods of monitoring water balance
Know how to evaluate a neonates state of hydration

c Insensible water loss
Recognize the mechanisms of insensible water loss IWL in
the neonate and the changes in IWL that occur during the
first weeks after birth

d Endocrine control of water metabolism
Understand the specific hormonal factors that influence
water balance in neonatal life
Know how to diagnose and treat the syndrome of
inappropriate secretion of arginine
vasopressin
antidiuretic hormone
Understand the effects of arginine vasopressin
antidiuretic hormone on sodium and water balance

e Management of water balance
Be aware of the influence on water requirement of renal
dysfunction following asphyxia
Recognize and know how to manage dehydration and water
overload
Recognize and manage the water requirements of infants with
renal and metabolic fluid disorders that arise because of
endocrine dysfunction

2 Electrolyte metabolism
Understand the etiology, identify the clinical manifestations
and laboratory features, and determine the management of
electrolyte abnormalities in the neonate
Understand the etiology, clinical manifestations, laboratory
features, and management of metabolic acidosis and metabolic
alkalosis

B Normal and abnormal renal function in the fetus and neonate
1 Development of renal function
a Glomerular and tubular function during
development
Know the changes in glomerular and tubular function during
development, including the handling of glucose, sodium,
potassium, calcium, and phosphate

b Hormonal controls of renal function during development
Understand the production sites and actions of renin and
angiotensin and of the prostanoids that affect renal
function

c Evaluation of renal function
Know how to calculate renal clearance and understand the
effect of various illnesses on renal function

2 Abnormal renal development
Know the causes, laboratory, and clinical signs of congenital
nephrosis
Recognize the etiology, clinical manifestations, laboratory
features, and approach to therapy of infants with anatomic
abnormalities of the urinary tract

3 Acquired renal disease
a Renal vascular thrombosis
Know the etiology, clinical manifestations, laboratory
features, and management of renal vein thrombosis
Know the
etiology, clinical manifestations, laboratory
features, and management of renal artery thrombosis

b Hypertension
Know how to diagnose, evaluate, and manage an infant with
hypertension

c Acute renal failure
Identify the etiology, clinical manifestations, laboratory
features, and management of acute renal failure in the
neonate, including hemofiltration, peritoneal dialysis, and
hemodialysis

VIII Endocrine/Metabolic/Thermal
A Endocrine and metabolism
1 Normal and abnormal sexual differentiation
a Normal sexual differentiation
Understand normal fetal sexual differentiation

b Abnormal sexual differentiation
1 Disorders of sexual differentiation
Understand the etiology and management of sexual
differentiation
Differentiate among disorders of testicular hormone
synthesis or action
Know the etiology, diagnosis, clinical manifestations,
laboratory features, and
approach to therapy of an infant
with ambiguous genitalia, including congenital adrenal
hyperplasia
2 Other disorders of sexual differentiation
Know how to evaluate and manage an infant with
hypospadias and epispadias
Know the importance of the combination of micropenis
and hypoglycemia
Know how to evaluate and manage an infant with
cryptorchidism
Know how to evaluate and manage an infant with
micropenis

2 Adrenal disorders
Recognize the clinical manifestations, laboratory features, and
appropriate therapy of the various types of congenital adrenal
hyperplasia

3 Thyroid disorders
a Embryology and physiology
Know the physiological roles of the hormones and other proteins
involved in the regulation of thyroid function
Understand the relationship between fetal and maternal thyroid
physiology
Understand the embryology and normal
physiological function of
the normal thyroid gland
b Tests of thyroid function
Understand the proper use of laboratory tests including
screening tests in the diagnosis of thyroid dysfunction
c Congenital hypothyroidism
Know the etiology, clinical manifestations, laboratory
features, and approach to therapy of congenital
hypothyroidism
d Transient disorders of thyroid function
Understand the causes of transient hypothyroidism in the
neonate
e Thyrotoxicosis
Identify the etiology, clinical manifestations, laboratory
features, and treatment of congenital hyperthyroidism

4 Glucose metabolism
a Normal fetal and neonatal carbohydrate metabolism
1 General
Know the amino acid precursors to gluconeogenesis
Know the fuels used for brain metabolism
Understand the relationship of maternal blood glucose to
fetal glucose uptake and metabolism
Know the normal
range of endogenous glucose production in
preterm infants
2 Hypoglycemia
Recognize the etiology, clinical manifestations,
laboratory features, approach to therapy, and
potential sequelae of neonatal hypoglycemia
3 Hyperglycemia
Know the etiology, clinical manifestations,
laboratory features, and approach to therapy of
neonatal hyperglycemia, including transient diabetes
mellitus

b Intermediary metabolism
Understand the metabolic consequences of starvation
in the neonatal period

5 Calcium, phosphorous, and magnesium metabolism
a Normal
Understand the normal calcium, phosphorous, and magnesium
metabolism during the prenatal period, including fetal
accretion rates
Understand the interrelated effects of various hormones,
including parathormone, calcitonin, and vitamin D on
calcium, phosphorus, and magnesium
metabolism in the fetus
and neonate

b Abnormal
1 Hypocalcemia/hypercalcemia
Understand the etiology, clinical manifestations,
laboratory features, and approach to therapy of
neonatal hypocalcemia and hypercalcemia
2 Osteopenia of prematurity
Understand the etiology, clinical manifestations,
radiographic features, and approach to treatment of
osteopenia of prematurity
3 Hypomagnesemia/hypermagnesemia
Understand the etiology, clinical manifestations, and
approach to therapy of hypomagnesemia and
hypermagnesemia

B Inborn errors of metabolism
Understand the clinical manifestations, laboratory features, and
treatment of metabolic disorders including disorders in the
metabolism of amino acids, fatty acids, organic acids, the urea
cycle, and carbohydrates excluding glucose, and cholesterol
synthesis
Understand the etiology, clinical manifestations,
laboratory
features, treatment, and management of infants with lysosomal and
peroxisomal, and mitochondrial disorders
Recognize and diagnose the metabolic disorders that lead to coma

C Thermal regulation
1 Physiology of temperature regulation in the neonate
Understand the mechanisms of heat gain and loss
a Neutral thermal environment and management of the thermal
environment
Understand the definition and physiological implications of
a neutral thermal environment
Know the various types and mechanisms of action of devices
to maintain a neutral thermal environment

b Hypothermia/hyperthermia
Understand the causes, metabolic consequences, and
treatment of infants with hypothermia and hyperthermia

IX Immunology
A Developmental biology of the immune system
Know the timing and developmental stages of lymphoid tissues in the
neonate and infant
Know the various factors specific host defense mechanism that
affect the normal development of the
human immune system and their
timing
Understand the origin, maturational process, and regulation of
leukopoiesis during development

B Specific components of the immune system
1 Beta-lymphocytes and immunoglobulins
a Development and function
Know the normal immunoglobulin pattern in the newborn
infant
Understand the function of B-lymphocytes
Know the function of immunoglobulins, their placental
transfer, and consequences of their deficiencies

b Diagnosis and management of abnormalities
Know the laboratory methods nitroblue tetrazolium,
quantitation of immunoglobulins IgM, quantitation of
immunoglobulins IgG for for diagnosing immune deficiencies
Know the role of immunoglobulin supplementation

2 T-lymphocytes
Know the function of T-lymphocytes
Recognize the clinical and laboratory manifestations of T-cell
function, including the manifestation of DiGeorge anomaly

3 Polymorphonuclear leukocytes neutrophils

Recognize the causes and consequences of alterations in number
and distribution of neutrophils
Know the consequences of leukocyte defects of chemotaxis,
phagocytosis, or quantitative killing
Know the role of neutrophils and how to evaluate their function
Recognize the etiologies, pathophysiology, differential
diagnosis, and management of neonatal leukopenia and
leukocytosis, including infection, maternal drug effects, and
neonatal stress

4 Eosinophils
Understand the distribution and function of eosinophils and
basophils/mast cells in the immune response

5 Mononuclear phagocytes
Know the development and function of monocytes and macrophages
Know how to diagnose and manage abnormalities of monocyte
functiom

6 The complement system
Know the consequences of defects in the complement system
Know the role of complement in host defense

7 Circulating factors
Understand the role of fibronectin, lactoferrin, and c-reactive
protein in host defense
Know that
cytokines regulate immune function and phagocyte
development and function
Know the changes in cytokines that occur with infection

8 Inflammation
Understand the vascular and cellular components of acute
inflammation
Differentiate the roles of the secretory components of
inflammation including polypeptide hormones IL-1, INF alpha,
TNF, extracellular matrix proteins, reacitve exoygen
intermediates SOD, H2O2, enzymes lysozyme, eicosanoids
prostaglandins, leukotrienes,and complement

9 The Spleen
Understand the role of the spleen in normal and abnormal states

C Abnormal function of the immune system
Be aware of the clinical features, diagnosis, treatment and
prognosis for neonates with various common disorders of host
defense mechanism recognizable in the newborn period

X Infectious Diseases
A Infections of organ systems
1 Sepsis
Understand the causes, risk factors, clinical manifestations,
laboratory features, differential diagnosis, treatment, and
complications of
sepsis

2 Respiratory infection
Understand the causes, clinical and laboratory features,
differential diagnosis, treatment, and complications of
pneumonia

3 Gastrointestinal infections
Understand the causes, clinical and laboratory features,
differential diagnosis, treatment, and complications of
gastrointestinal infections

4 Omphalitis
Understand the causes, clinical and laboratory features,
differential diagnosis, treatment, and complications of
omphalitis

5 Ocular infections
Understand the causes, clinical and laboratory features,
differential diagnosis, treatment, and complications of neonatal
ophthalmia

6 Otitis media
Recognize the causes, clinical and laboratory features,
differential diagnosis, treatment, and complications of neonatal
otitis media

7 Osteomyelitis and septic arthritis
Understand the causes, clinical and laboratory features,
differential diagnosis, treatment, and complications of
osteomyelitis and septic
arthritis

8 Cutaneous infections
Understand the causes, clinical and laboratory features,
differential diagnosis, treatment, and complications of
infections of the skin and mucous membranes

9 Central nervous system CNS infections
Understand the causes, clinical manifestations, laboratory
features, treatment, and complications of meningitis and
meningoencaphalitis

10 Genitourinary infections
Understand the causes, clinical and laboratory features,
differential diagnosis, treatment, and complications of
urinary tract infections

B Etiologic agents
1 Bacteria
a Bacteroides
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal Bacteroides infections

b Listeria monocytogenes
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of
Listeria monocytogenes

c Group B streptococcus
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of group B streptococcal infections

d Gonococcal infections
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of neonatal Neisseria gonorrhea infection

e Staphylococcal infections
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of neonatal infection with Staphylococcus
aureus and Staphylococcus epidermidis

f Mycoplasma and ureaplasma
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal infection with mycoplasma
and ureaplasma

g Syphilis

Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal infections with Treponema
pallidum

h Escherichia coli and other gram-negative bacilli
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of neonatal infections with Escherichia
coli, Klebsiella, Enterobacter, Proteus, Citrobacter,
Salmonella, and Pseudomonas

i Hemophilus influenzae
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of neonatal infection with Hemophilus
influenzae

j Chlamydial infections
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of neonatal infection with Chlamydia

k
Clostridial infections
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of infections with Clostridial infections
including Clostridium botulinum, difficile, and tetani
l Tuberculosis
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal infections with
Mycobacterium tuberculosis

2 Viruses
a Herpes viruses
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal infections with herpes 1,
herpes 2, cytomegalovirus, Epstein-Barr virus, and
varicella-zoster
Plan the management of an infant born to a mother with
active genital herpes lesions or with a history of genital
herpes infection

b Hepatitis viruses

Plan the management of an infant whose mothers serum
contains hepatitis B surface antigen
Understand the epidemiology, pathogenesis, prevention,
clincial manifestations, diagnostic criteria, treatment,
and complications of perinatal infections with hepatitis A,
hepatitis B, and hepatitis C

c Rubella
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal infections with rubella

d Enteroviruses
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal infections with
coxsackievirus, echovirus, enterovirus, and poliovirus

e Myxoviruses
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal infections with mumps,

rubeola, and influenza

f Respiratory syncytial virus
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of neonatal infections with respiratory
syncytial virus

g Rotavirus
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of neonatal rotavirus infection

h HIV
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal HIV infection

i Parvovirus
Understand the epidemiology, pathogenesis, prevention,
clinical manifestations, diagnostic criteria, treatment,
and complications of perinatal parvovirus infections

3 Fungi
Understand the epidemiology, pathogenesis, prevention, clinical
manifestations, diagnostic criteria, treatment, and complications

of neonatal infections with candida, coccidiomycosis, cryptococcus,
histoplasmosis, and Malassezia

4 Protozoa
Understand the epidemiology, pathogenesis, prevention, clinical
manifestations, diagnostic criteria, treatment, and
complications of neonatal malaria
Understand the epidemiology, pathogenesis, prevention, clinical
manifestations, diagnostic criteria, treatment, and
complications of perinatal infections with toxoplasmosis

5 Other

C Prevention of infections
Understand the effective techniques for control of nosocomial
infection in the nursery, neonatal intensive care unit, and
obstetrical unit
Recognize infectious agents that are transmitted in human milk
Plan the management of an exposure to varicella in the newborn
nursery or newborn intensive care unit
Understand the pathogenesis and prevention of transmission of
infections with multi-drug-resistant bacteria

D Immunization
Know the immunizations recommended by the American Academy of
Pediatrics and the
appropriate schedules for immunizing preterm
and full-term infants

XI Gastroenterology
A Development
1 The gastrointestinal GI tract
a Morphogenesis
Know the mode of inheritance of various inherited and genetic
disorders of the GI tract
Understand the morphogenesis of the GI tract and factors that
lead to congenital malformations

b Cellular proliferation, differentiation and maturation
Determine dietary and hormonal agents that have trophic
effects on the infants GI tract

c Development of digestive and absorptive capabilities
1 Protein digestion and absorption
Understand the changes that occur in gastric acidity
in term and preterm infants during the immediate
neonatal period
Know the factors involved in protein digestion and
absorption
2 Carbohydrate digestion and absorption
Understand the developmental pattern of enzymes
required for
carbohydrate digestion
Know other factors involved in carbohydrate digestion
and absorption
3 Lipid digestion and absorption
Understand the factors involved in the process of
lipid digestion and absorption
Know the difference between the digestion and
absorption of medium versus long-chain fatty acids

d Development of motility
Identify the developmental pattern for motility of various
segments of the alimentary canal
Understand the factors that may improve intestinal motility
e Development of immune function of the intestinal tract
Recognize the immaturity of the immune function of the GI
tract during development

2 Developmental anomalies
a General
Understand the significance of vomiting and abdominal
distention in the neonate
Know how to recognize and evaluate an infant with excessive
gastric contents and hydramnios

Realize the differential diagnosis of delayed passage of
meconium

b Mouth and pharynx
Recognize the developmental anomalies of the mouth and
pharynx

c Esophagus
Know the clinical and pathological features of duplication
of the GI tract
Understand the clinical manifestations, diagnosis, and
treatment of tracheoesophageal fistulae and esophageal
atresias
Understand the clinical manifestations, laboratory and
radiographic findings, and treatment of gastroesophageal
reflux in term and post-term infants

d Stomach
Recognize the developmental and acquired defects of the
stomach, including absence, volvulus, and pyloric stenosis

e Small intestine
Understand the embryology, clinical manifestations and
diagnosis of atresias, stenosis, diverticulae, duplications
of the small intestine, and annular pancreas
Know how to treat atresias, stenosis,
diverticulae, and
duplication of the small intestine
Recognize the clinical manifestations, diagnosis, and
treatment of patients with malrotations and volvulus

f Large intestine
Realize the consequences of resection of the distal ileum
and cecum
Understand the embryology, clinical manifestations, and
diagnosis of atresias, stenosis, diverticulae of the large
intestine, and small left colon syndrome
Know how to treat atresias, stenosis, and diverticulae of
the large intestine
Recognize the pathophysiology, diagnosis, and significance
of the meconium plug syndrome

g Rectum and anus
Know the clinical and pathological features and approach to
therapy of Hirschsprung disease
Understand the embryology of rectal and anal malformations
and associated anomalies
Understand the diagnosis of rectal and anal malformations
and associated anomalies

Understand the management of rectal and anal malformations
and associated anomalies

h Pancreas
Understand the development of the pancreas
Recognize the clinical manifestations and diagnosis of
pancreatic aplasia and hypoplasia, including Shwachman
syndrome
Understand the clinical manifestations of cystic fibrosis
in the newborn infant
Understand the clinical manifestations, diagnosis, and
treatment of meconium ileus and meconium peritonitis in the
neonate
Understand the pathophysiology of cystic fibrosis in
newborn infants
Understand the diagnosis of cystic fibrosis in newborn
infants
Understand the management of cystic fibrosis in newborn
infants

i Abdominal wall defects
1 Gastroschisis
Understand the embryology, clinical manifestation,
associated anomalies, and treatment of gastroschisis
2 Omphalocele

Understand the embryology, clinical manifestations,
associated anomalies, and treatment of omphalocele

j Syndromes associated with gastrointestinal malformation
Realize the association of major congenital anomalies
involving the GI tract with those involving other organs

B Acquired defects of the GI tract See Section V
1 Hemorrhagic disorders
Understand the differential diagnosis of hemorrhagic disorders
of the GI tract of newborn infants, including the various
coagulation disorders that cause GI hemorrhage
Understand the clinical manifestations of hemorrhagic disorders
of the GI tract of newborn infants, including the various
coagulation disorders that cause GI hemorrhage
Understand the laboratory and radiographic findings of
hemorrhagic disorders of the GI tract of newborn infants,
including the various coagulation disorders that cause GI
hemorrhage
Understand the approach to therapy of hemorrhagic disorders of
the GI tract of newborn infants,
including the various
coagulation disorders that cause GI hemorrhage

2 Necrotizing enterocolitis NEC
Understand the clinical manifestations, laboratory and
radiographic findings of NEC
Know the approach to therapy of NEC
Recognize the clinical manifestations, diagnosis, and treatment
of patients with spontaneous perforations of the
gastrointestinal tract

3 Intussusception
Recognize the clinical signs, radiographic features, and
treatment of intussusception

4 Strictures of the intestines
Understand the etiology, clinical manifestations, diagnosis, and
treatment of GI strictures

5 Infectious enteritis and colitis See XA3
Identify the etiologic agents and understand presentations,
approaches to diagnosis and appropriate treatment of infectious
enteritis and colitis

C Malabsorption syndromes
1 Congenital
Understand the etiology, clinical manifestations, diagnosis, and
treatment of congenital malabsorption syndromes in newborn
infants, including the
congenital mineral and electrolyte
malabsorption syndromes

2 Acquired
Know the clinical manifestations, diagnosis, and treatment of
acquired malabsorption syndrome

D Liver disease of the newborn infant
1 Congenital malformations of the liver and bile ducts
a Choledochal cysts
Know the clinical manifestations, diagnosis, and treatment
of patients with choledochal cysts

b Intrahepatic biliary hypoplasia
Identify the clinical features, differential diagnosis, and
treatment of intrahepatic biliary hypoplasia

c Extrahepatic biliary atresia
Recognize the clinical manifestations of extrahepatic
biliary atresia that differentiates it from neonatal
hepatitis and other causes of cholestasis in the newborn
infant

2 Cholestasis of the neonate
a Metabolic and familial causes of cholestasis
Recognize, diagnose, and treat metabolic and familial
causes of cholestasis in the neonate

b
Cholestasis associated with TPN See VID3

3 Infectious diseases of the liver
Recognize the etiology, clinical manifestations, and approach to
diagnosis of neonatal hepatitis
Be able to differentiate and provide management for infants with
liver abnormalities, including primary neonatal, and bacterial,
protozoal and viral hepatitis secondary to systemic infections,
extrahepatic/intrahepatic biliary atresia, and hypoplasia

E Abdominal masses/Neonatal ascites
Know the etiology, clinical and laboratory features, and
treatment of abdominal masses in the neonate
Identify the etiology, clinical manifestations, and approach to
diagnosis and therapy of neonatal ascites

XII Bilirubin
A Biochemistry, metabolism, and measurement
1 Biochemistry and metabolism
Understand the factors that affect the biological properties of
bilirubin, including its solubility
Understand bilirubin metabolism in the fetus and neonate
Understand the factors associated with an increase and decrease
in neonatal serum
bilirubin concentrations, including those that
affect the enterohepatic circulation of bilirubin

2 Measurement
Understand the differences between physiologic and
nonphysiologic jaundice
Understand the noninvasive techniques that can be used to screen
jaundiced infants and the limitations of these techniques
Understand the tests that have been used to measure serum
bilirubin and the binding of the bilirubin to albumin, and the
limitations of these tests

B Bilirubin toxicity and pathologic hyperbilirubinemia
1 Bilirubin toxicity
a Pathophysiology
Understand the pathologic features of kernicterus
Understand the factors affecting the binding of bilirubin
to albumin
Understand the mechanisms by which bilirubin enters the
brain
Understand the factors that increase the risk of
kernicterus

b Acute manifestations
Describe the clinical features of acute bilirubin
encephalopathy on newborn infants
including the infants
cry and BAER results

c Sequelae
Understand the clinical features of chronic bilirubin
encephalopathy, such as kernicteric and subtle types

2 Pathologic hyperbilirubinemia
a Etiology and differential diagnosis
Understand the differential diagnosis, evaluation, and
approach to management of infants with indirect
hyperbilirubinemia
Understand the differential diagnosis and evaluation of
mixed forms of jaundice

b Management
Understand the indications for exchange transfusions
Understand the risks and complications of exchange
transfusions
Understand the indications for use, the mechanism of
action, the efficacy, and the dose-response relationship of
phototherapy in the treatment of neonatal
hyperbilirubinemia
Understand the side effects and complications of
phototherapy
Understand the effect of phenobarbital on
bilirubin
metabolism and its use in the treatment of
hyperbilirubinemia
Understand the mechanism of action of the metalloporphyrins
and phenobarbital in the management of hyperbilirubinemia

C Physiologic and human milk jaundice
1 Physiologic jaundice
a Influencing factors
Understand the mechanisms for physiologic jaundice:
production, enterohepatic circulation, clearance,
excretion, and hepatic circulation
Understand the course of physiologic jaundice of the
newborn infant
Understand the range of normal serum bilirubin
concentration and the effect of an infants age, race, and
feeding method on serum bilirubin
2 Human milk jaundice
a Influencing factors
Know the pathogenesis, clinical course, diagnosis, and
management of human-milk jaundice

XIII Skin Disorders
A Hair and nail disorders
Understand the diagnoses associated with abnormalities of
hair and
nails

B Vesicobullous lesions
1 General
Understand the etiology, differential diagnosis and treatment of
bullous skin lesions in the newborn infant

2 Infectious
Determine the clinical and laboratory manifestations and
treatment of congenital syphilis
Know the clinical and laboratory manifestations and
treatment of severe candidiasis
Identify the clinical and laboratory manifestations and
treatment of bullous impetigo, either staphylococcus or
streptococcus
Understand the clinical and laboratory manifestations and
treatment of herpes simplex and varicella-zoster
Know the clinical and laboratory manifestations and treatment of
listeria monocytogenes
Recognize the clinical and laboratory manifestations and
treatment of pseudomonas aeruginosa
Know the clinical and laboratory manifestations and treatment of
scalded skin syndrome

3 Non-infectious
Know the clinical and laboratory manifestations and treatment of
acrodermatitis
enteropathica
Determine the clinical and laboratory manifestations and
treatment of epidermolysis bullosa
Recognize the clinical and laboratory manifestations and
treatment of incontinentia pigmenti

C Maculopapular eruptions
1 Petechial or purpuric
a Infectious
Understand the cutaneous manifestations and treatment of
CMV
Know the cutaneous manifestations and treatment of
Listeriosis
Identify the cutaneous manifestations and treatment of
rubella
Recognize the cutaneous manifestations and treatment of
septicemia

b Noninfectious
Know the cutaneous manifestations and treatment of immune
thrombocytopenia
Understand the cutaneous manifestations and treatment of
Langerhans cell histiocytosis
Know the cutaneous manifestations and treatment of graft
versus host disease

2 Nonpurpuric
Know the etiology, clinical manifestations, and treatment of

nonpurpuric skin lesions such as drug-induced, congenital
syphilis, toxoplasmosis, CMV, fungal

D Scaly disorders
Know how to recognize and diagnose scaly disorders of the skin

E Vascular lesions
Know how to recognize, diagnose, and manage capillary and
cavernous hemangiomata
Determine how to recognize, diagnose, and manage Kasbach-Merritt
syndrome
Recognize, diagnose, and manage Port wine stain
Understand how to recognize, diagnose, and manage Sturge-Weber
syndrome
Know how to recognize, diagnose, and manage multiple
hemangiomata

F Other
1 Pigmentary anomalies
Understand how to recognize, diagnose and manage
hyperpigmentation, including Cafe au lait spots, Peutz-Jeghers
syndrome, giant hairy nevus, incontinentia pigmenti, and
pigmented nevi
Recognize, diagnose and manage hypopigmentation, including
albinism, phenylketonuria, Chediak-Higashi syndrome, tuberous
sclerosis, partial albinism, and Waardenburg syndrome

2 Other
Understand how
to recognize, diagnose, and manage ichthyosis
Recognize, diagnose, and manage ectodermal dysplasia
Know how to recognize, diagnose, and manage neonatal lupus
erythematosus

XIV Hematology/Oncology
A Erythrocytes
1 Biology of hemoglobin
Understand the biochemical characteristics and developmental
biology of hemoglobin
Understand the clinical and laboratory features of neonatal
presentations of hemoglobinopathies, including the thalassemias
Understand the indications, methodology, and application of
screening for hemoglobinopathies in the newborn population

2 Erythropoiesis
Understand the normal physiology of erythropoiesis, including
the role of growth factors, in the fetus and neonate

3 Anemia
a General
Understand the etiology and diagnostic approach to an
infant who is anemic at birth

b Hypoproduction
Know the physiologic consequences, mechanisms, and approach to
therapy for anemia of prematurity
Understand the mechanism and timing of
placental transfer of
iron to the fetus and the effect of gestational age on iron
stores in newborn infants
Recognize the etiology, clinical manifestations, laboratory
features, and hematologic consequences of iron deficiency anemia
Understand the association between infection and anemia
Understand the association between anemia and congenital
anomalies

c Hemolysis See also XIIB2
Understand the etiologies, clinical and laboratory
findings, pathophysiology, complications, and treatment of
hemolytic anemia in the neonate
d Blood loss
Understand the etiologies, clinical and laboratory
findings, and treatment of acute blood loss at and before
birth

4 Polycythemia
Understand the etiologies, clinical and laboratory
manifestations and treatment of neonatal polycythemia

B Platelets and coagulation
1 Platelets
a Developmental biology
Understand the normal pattern of platelet production and

maturation

b Thrombocytopenia/thrombocytosis
Understand the etiologies, pathophysiology, and clinical
and laboratory manifestations and treatment of neonatal
thrombocytopenia and thrombocytosis

2 Coagulation
a Developmental biology
Understand the tests used to evaluate bleeding disorders,
including prothrombin and partial thromboplastin times and
serum fibrinogen concentration and their normal values in
term and preterm infants

b General
Know the etiologies, pathophysiology, clinical and
laboratory manifestations, and treatment of acquired
defects in hemostasis including differentiated
intravascular coagulation and hemorrhagic disease of the
newborn
Understand the inheritance pattern of the common factor
deficiencies
Understand the etiologies, pathophysiology, clinical
manifestations, laboratory findings, and treatment of
congenital defects in
hemostasis and various factor
deficiencies
Understand the etiologies of congenital and acquired
thrombotic disorders
Understand the pathophysiology of congenital and acquired
thrombotic disorders
Understand the physical findings of congenital and acquired
thrombotic disorders
Understand the laboratory findings of congenital and
acquired thrombotic disorders
Understand the treatment of congenital and acquired
thrombotic disorders

C Oncology
1 Leukemias
Identify the clinical and laboratory features of congenital
leukemia

2 Solid tumors and others eg, histiocytosis
Recognize the clinical and laboratory features of common
neonatal malignancies, including teratomas, hemangiomas,
neuroblastoma, Wilms tumor, retinoblastoma

D Transfusions and component therapy
Know the clinical indications and potential complications of
using blood products in neonatal transfusions

XV Neurology
A
Neurologic evaluation
1 Physical examiantion See XVIA1

2 Neurodiagnostic tests See also XVIIB2
Know the indications for and limitations of various
neurodiagnostic tests, including electroencephalography EEG,
brainstem auditory evoked response BAER, visual evoked
response VER, and somatosensory evoked potential SEP
Understand the indications for, contraindications, and
interpretation of spinal fluid analysis

3 Neuroimaging studies
Understand the indications for and limitations of various
neuroimaging studies including ultrasonography, magnetic
resonance imaging study, positron emission tomography, and near-
infrared spectroscopy, and be able to recognize normal and
abnormal structures

B Development of the nervous system
1 CNS morphogenesis
Understand the normal course of dorsal induction, ventral
induction, neuronal proliferation, neuronal migration, and
myelination and the consequences of abnormalities of each

2 Cerebral blood flow
Determine the effects of
variations in blood gas tensions on
cerebral blood flow and cerebral vascular resistance

3 Neurotransmitters
Know the important neurotransmitters and understand how they
change with development and brain injury

4 Macrocephaly/Hydrocephalus
Be able to differentiate the familial/genetic features of
neurologic disorders associated with increased head
circumference
Understand the etiology, familial/genetic features, and
abnormalities associated with hydrocephalus
Understand the prenatal and postnatal treatment of hydrocephalus

5 Microcephaly
Understand the recognition, evaluation, and management of an
infant with microcephaly

C Hypoxic-ischemic encephalopathy See IIA1
Identify which treatments of severely asphyxiated infants have
been shown to improve neurodevelopmental outcome and which have
not

D Intracranial hemorrhage and vascular injury
1 Prenatal vascular injury
Know the risk factors for and how to evaluate the fetus and
infant with prenatal vascular
brain injury

2 Periventricular-intraventricular hemorrhage PIVH
Understand the proposed mechanisms, clinical features, and
diagnosis of PIVH
Understand the treatment and long-term consequences of the
different types of PIVH

3 Intraparenchymal cysts, echodensities, periventricular
leukomalacia
Understand the risk factors of intraparenchymal
cysts/periventricular leukomalacia, and intraparenchymal
echodensities
Understand the clinical features of intraparenchymal
cysts/periventricular leukomalacia, and intraparenchymal
echodensities
Understand the evolution of intraparenchymal
cysts/periventricular leukomalacia, and intraparenchymal
echodensities
Understand the outcome of intraparenchymal cysts/periventricular
leukomalacia, and intraparenchymal echodensities

4 Perinatal cerebral/cerebellar infarction
Understand the proposed mechanism, clinical features, diagnosis,
management, and outcome of perinatal cerebral and cerebellar
infarction,
including intraparenchymal, hemorrhagic infarction

5 Subarachnoid hemorrhage
Understand the pathogenesis, clinical and radiographic features,
diagnosis, management, and outcome associated with subarachnoid
hemorrhage

6 Subdural hematoma
Know the clinical and radiographic features of subdural hematoma
Differentiate the clinical features of supratentorial from
infratentorial subdural hematoma

E Cranial and neurologic trauma
1 Extracranial hemorrhage
Understand the clinical and radiographic features of
extracranial hemorrhage, including cephalohematoma and subgaleal
hemorrhage
Understand the diagnosis of extracranial hemorrhage, including
cephalohematoma and subgaleal hemorrhage
Understand the management of extracranial hemorrhage, including
cephalohematoma and subgaleal hemorrhage
Understand the outcome of extracranial hemorrhage, including
cephalohematoma and subgaleal hemorrhage

2 Nerve injury
Recognize the features of VII nerve palsy
Understand the
diagnosis of cervical root injury and brachial
plexopathy
Understand the management of cervical root injury and brachial
plexopathy
Understand the outcome of cervical root injury and brachial
plexopathy

3 Spinal cord injury
Understand the diagnosis of spinal cord injury
Understand the management of spinal cord injury
Understand the outcome of spinal cord injury

F Seizures
1 Classification clinical types
Understand the spectrum of clinical seizures in the newborn
infant
2 Diagnosis and management
Understand the differential diagnosis, evaluation, management,
and prognosis of neonatal seizures

G Other
1 Hypotonia
Understand the differential diagnosis of neonatal hypotonia
Understand the management of neonatal hypotonia
Understand the outcome of neonatal hypotonia

2 Arthrogryposis
Understand the etiology of neonatal arthrogryposis
Understand the pathogenesis of neonatal arthrogryposis
Understand the evaluation of neonatal
arthrogryposis
Understand the management of neonatal arthrogryposis
Understand the outcome of neonatal arthrogryposis

3 Vascular malformations
Understand the clinical features of arteriovenous malformations
Understand the evaluation of arteriovenous malformations
Understand the management of arteriovenous malformations
Understand the outcome of arteriovenous malformations

4 Congenital cerebral neoplasms
Understand the diagnosis of congenital cerebral neoplasms
Understand the management of congenital cerebral neoplasms
Understand the outcome of congenital cerebral neoplasms

5 Neurocutanous disorders
Understand the clinical features of neurocutaneous disorders,
including neurofibromatosis and tuberous sclerosis
Understand the diagnosis of neurocutaneous disorders, including
neurofibromatosis and tuberous sclerosis
Understand the management of neurocutaneous disorders, including
neurofibromatosis and tuberous sclerosis
Understand the outcome of neurocutaneous disorders, including

neurofibromatosis and tuberous sclerosis

XVI Development and Behavior
A Neurodevelopmental examination
1 Components of examination
a Spontaneous activity, movements, and posture
Understand how posture reflects a neonates tone

b Head size and shape
Know the upper and lower limits of normal head
circumference
Know the different factors that influence an infants head
shape

c Eyes
Know the normal ophthalmologic findings in preterm and full-
term infants

d Cranial nerves
Understand the functions of the cranial nerves
Know the neuroanatomic basis and methods of testing cranial
nerve function in the newborn infant

e Muscle tone
Distinguish between active and passive tone
Identify the various maneuvers used to evaluate extremity,
shoulder, hip, trunk, and neck tone

f Reflexes
Realize that deep tendon reflexes DTRs are present in the

newborn infant and that hyperreflexia is common
Know the normal integrated primitive reflexes that are
present in the newborn infant, such as Moro, tonic neck,
rooting and grasping

2 Maturation from fetus through infancy
Recognize the qualitative and quantitative differences in
spontaneous movement of preterm and full-term infants
Differentiate the normal resting posture of preterm infants at
varying gestational ages from that of full-term infants
Know the normal developmental milestones in preterm infants, and
which to correct for degree of prematurity
Be familiar with normal developmental milestones in full-term
infants
Know the normal evolution of voluntary movement during infancy
a Muscle tone
Know the normal pattern of evolution of extremity and axial
tone from the fetus through infancy

b Reflexes
Understand the normal pattern of evolution of integrated
primitive reflexes such as grasp, Moro, asymmetric tonic
neck
reflex, and postural reactions, such as equilibrium
reaction and parachutes in infants

c Sensory abilities and behavior
Understand how states of alertness, sleep, activity, and
visual attention change with increasing gestational age in
the fetus and preterm infant
Understand the evolution of the sensory abilities of the
fetus and the preterm infant

d Full-term infant vs preterm infant at term
Know the differences on neurodevelopmental examination
between preterm and full-term infants

3 Abnormalities of development and their significance
a Spontaneous activity, movements, posture
Be able to distinguish normal from abnormal posture

b Head size and shape
Identify the clinical findings of idiopathic sagittal
suture craniostenosis in the first days after birth
Recognize the clinical features of several intracranial
lesions

c Eyes
Recognize the ocular signs associated with
increased
intracranial pressure
Know the differential diagnosis of fixed dilated pupils
Realize the importance and neurodevelopmental consequences
of optic atrophy

d Muscle tone
Differentiate hypertonia from hypotonia
Know how to assess extensor tone in the newborn infant

e Reflexes
Recognize that the persistance of integrated primitive
reflexes, such as grasping, Moro, or assymmetric tonic neck
reflex is abnormal
Recognize that the obligatory primitive reflexes are
abnormal

f Neuromotor abnormalities
Recognize the significance of neuromotor asymmetries in the
neonate
Know what neuromotor abnormalities are common
Understand the significance of transient neuromotor
abnormalities
Know the significance of persistent neuromotor
abnormalities

g Behavior
Recognize and know the significance of abnormal behavior,

such as lethargy, irritability, jitteriness, coma

B Cerebral palsy
1 Incidence
Know the incidence of cerebral palsy in the general population,
and in high risk groups such as extreme prematurity, symptomatic
congenital infection, perinatal asphyxia, and hypoxic-ischemic
encephalopathy
Know the temporal changes in incidence and type of cerebral
palsy

2 Clinical features
a Diagnosis
Know how to diagnose the infant or child with cerebral
palsy, and what further evaluations are indicated

b Classification of types
1 Physiologic spastic, extrapyramidal, mixed
Identify the most common type of cerebral palsy in
preterm infants
Understand the pattern of neuromotor development with
extrapyramidal cerebral palsy
Recognize the most common type of cerebral palsy in
asphyxiated full-term infants and infants with
hypoxic-ischemic encephalopathy

2 Topographic hemiplegia, diplegia, quadriplegia
Recognize the diagnostic criteria for spastic
quadriplegia
Identify the diagnostic criteria and pattern of
neuromotor development in spastic diplegia
Determine the diagnostic criteria for spastic
hemiplegia
3 Severity
Understand the ranges of severity of cerebral palsy,
including minimal, mild, moderate, and severe
c Associated disorders
Know the disorders associated with cerebral palsy,
including cognitive disorders, communication disorders,
seizures, sensory impairments, orthopedic deformities,
emotional and behavioral disorders

3 Etiologies
Know the level of correlation of Apgar scores with development
of cerebral palsy
Know the prenatal events associated with development of cerebral
palsy
Know the perinatal and neonatal risk factors associated with the
development of cerebral palsy

Know the relative frequencies of the various etiologies and risk
factors for cerebral palsy, including the proportion of children
with unknown causes of cerebral palsy

4 Interventions
Know the various interventions available for children with
cerebral palsy, including physical therapy, occupational
therapy, orthopedic surgery, rhizotomy, bracing, botulinum toxin
injections, and indications for referral for these interventions

5 Outcome
Know the functional impairments of the various types of cerebral
palsy

C Mental retardation
1 Incidence
Know the incidence of mental retardation
Know the range of severity of mental retardation
Know the incidence and range of severity of mental retardation
in high risk groups, including infants with extreme prematurity,
hypoxic-ischemic encephalopathy, or congenital infection

2 Clinical features
Recognize the clinical characteristics that identify infants
with mental retardation
Understand the pattern of development in
infants with mental
retardation
Know the definition of mental retardation

3 Etiologies
Know the most common causes of mental retardation
Know the developmental consequences of congenital hypothyroidism
Know the chromosomal disorders and syndromes associated with
mental retardation
Understand the relationship of mental retardation to asphyxia
Know the prenatal, perinatal, and neonatal risk factors
associated with mental retardation

4 Interventions
Know the efficacy of various interventions targeted to improve
cognitive outcome

5 Outcome
Know the functional impairments of the different levels of
mental retardation

D Visual impairment See also Section XVIIA
1 Incidence
Know the incidence of visual impairments in the general
population and in specific risk groups, such as premature
infants, infants with congenital toxoplasmosis, and infants with
hypoxic-ischemic encephalopathy

2 Etiologies See also Section XVIIA3d
Know that
hypoxic-ischemic brain injury can cause visual
impairment in the full-term infant
Know the ophthalmologic findings associated with congenital
infection

3 Clinical features
Determine the methods employed to evaluate visual activity in
infants
Know the effects of visual impairment on behavior and
development

4 Interventions
Plan the management of an infant with suspected visual
impairment

5 Outcome
Know the neurodevelopmental consequences of congenital blindness

E Hearing impairment
1 Incidence
Know the incidence of hearing impairment in preterm infants
Know the incidence of hearing impairment in infants with hypoxic
ischemic encephalopathy, persistent pulmonary hypertension,
congenital infection
Know the incidence of hearing impairment in the general
population

2 Etiologies
Know dysmorphic syndromes associated with hearing loss, such as
Waardenburg and Goldenhar syndromes
Know the prenatal, perinatal, and neonatal risk
factors
associated with hearing impairment

3 Clinical features
Understand the pattern of development in infants with hearing
loss
Know the methods employed to assess hearing in the infant, both
in the nursery and during infancy

4 Interventions
Know what interventions are recommended for hearing impairment

5 Outcome
Know the neurodevelopmental consequences of congenital or
prelingual hearing impairment

F Learning disability and school problems
1 Incidence
Know the incidence of learning disabilities and school
behavioral problems in the general population
Know the type and frequency of school-related and behavior
problems in preterm infants

2 Etiologies and risk factors
Understand the prenatal, perinatal, and neonatal risk factors
associated with learning disabilities

3 Clinical features
Identify the spectrum of behavioral and neurodevelopmental
problems that are encompassed in minimal cerebral dysfunction
Determine the diagnostic
criteria for learning disability

4 Interventions
Know some of the treatments and intervention strategies designed
for children with learning disabilities, minor neuromotor
dysfunction, attention deficit hyperactivity disorder, and
behavior problems

G Diagnosis of neurodevelopmental disabilities
1 Development
Know the various streams of development, such as language, gross
motor, fine motor, problem solving, adaptive, social, and
emotional
Know the significance of delay in development in one or more
streams of development

2 Indications for evaluation
Recognize the clinical features of infants who require a
complete formal developmental assessment
Distinguish the neurodevelopmental features that best predict
intelligence
Know the relationship of neurodevelopmental examination results
to developmental outcome
Recognize the importance and advantages of early diagnosis of
developmental disability
Identify the value of developmental follow-up of high risk

populations
Recognize the indicators for visual and hearing assessments in
high risk populations
Distinguish the neurodevelopmental features that best predict
motor impairment

3 Function
Distinguish the different severities of disability
Determine how developmental disabilities affect function
Distinguish between impairment, disability, and handicap

3 Utility of neuropsychology testing
Understand the limitations of the Bayley Scale of Infant
Intelligence and other infant intelligence tests
Know what tests are used to evaluate cognitive and academic
abilities in children and adults

H Perinatal and demographic risk factors
1 Prenatal
Recognize the prenatal risk factors associated with
developmental disabilities
Know the developmental consequences of maternal substance abuse,
such as cocaine, heroin, alcohol, and tobacco, on the fetus,
infant, and child
Understand the long-term sequelae of congenital infections, such
as toxoplasmosis, rubella, CMV

2
Perinatal and neonatal
Identify perinatal risk factors, such as asphyxia, perinatal
depression, or prematurity, which affect subsequent
developmental outcome
Know the neonatal manifestations of asphyxia that predict the
likelihood of cerebral palsy

3 Environmental
Know the importance of maternal-infant bonding on subsequent
development
Identify the effects of environment on cognitive and neurologic
outcome

I Neurodevelopmental intervention strategies
1 Types of interventions and timing
Understand the rationale behind early intervention
Determine what services constitute early intervention, and when
they are indicated

2 Limitations
Know the limitations of early intervention services

XVII Eyes, Ears, Nose, Mouth, Throat, and Neck
A Eyes
1 Normal development and anatomy
Know the anatomy and development of the eye

2 Examination and appropriate timing of examinations See Section
XVI
Recognize the normal variants found in the eye
examination of
extremely premature infants

3 Abnormalities of the eye
a Congenital abnormalities
Recognize the importance of corneal opacifications
Determine the association of chorioretinitis and congenital
infections
Know the syndromes associated with abnormalities of the eye
including cranio-facial abnormalities, abnormalities of the
orbit, the eyebrows, the eyelids, the eyelashes, the
cornea, the iris, and the retina
Recognize the signs of congenital glaucoma and its
associated conditions
Recognize the signs of neonatal cataracts and its
associated conditions
Identify the conditions associated with a white pupil ie
leukokoria

b Acquired abnormalities, other than retinopathy of
prematurity
Know the occular findings associated withcongenital
infections See also section X
Understand the causes and treatment of acute neonatal

infections of the eyes, including ophthalmia neonatorum
See also XA5
Understand the benefits and complications of eye
prophylaxis with antibiotics or silver nitrate eg
obstructed nasolacrimal duct

c Tumors of the eye
Understand the inheritance pattern of retinoblastoma
Understand the clinical manifestations of retinoblastoma
Understand the treatment of retinoblastoma
Understand the outcome including associated conditions of
retinoblastoma

d Retinopathy of prematurity
Understand the normal vascularization of the retina
Understand the factors associated with the pathogenesis of
retinopathy of prematurity
Know the incidence and clinical course of retinopathy of
prematurity
Understand the pathophysiology of retinopathy of
prematurity
Understand the approaches to prevention and treatment of
retinopathy of prematurity
Understand the outcome of
retinopathy of prematurity in
relation to severity and therapy
Know the clinical features of retinopathy of prematurity
and staging of severity according to the international
classification

B Ears
1 Normal development and anatomy
Know the normal anatomy and positioning of the ear

2 Abnormality of the ear
a Congenital
Recognize the association of abnormalities of the ear and
congenital syndromes See also Section XVIB4
Recognize the incidence, pattern, evaluation, and risk
factors for congenital hearing loss in the neonate See
also Section XVIB4

b Acquired
Recognize the incidence, pattern, evaluation, and risk
factors for acquired factors that can cause hearing loss in
the neonate See also XVIB4

C Nose, mouth, throat, and neck
1 Normal development of the nose, mouth, throat, and neck
Know the normal development of the nose, mouth, throat, and
neck

2
Congenital abnormalities
Understand the associated features of DiGeorge syndrome
Recognize the clinical manifestations of branchial cleft cysts
Understand the incidence, genetics, recognition, and treatment
of cleft lip and palate
Recognize the incidence, clinical manifestations, and treatment
of bilateral and unilateral choanal atresia
Recognize syndromes associated with abnormalities of nasal
development including low nasal bridge, broad nasal ridge, short
and antiverted nostrils
Know the clinical manifestations of neck masses in the newborn
infant and the approach to therapy
Know the various causes of stridor in the newborn
Know the associations and clinical manifestations of
macroglossia and hypoplastic mandible

3 Acquired abnormalities
Know the etiology and the clinical features of necrotizing
tracheitis
Know the complications of tracheal intubation, including
subglottic stenosis
Know the indications, complications, and surgical management of
tracheostomies

Know the etiology, diagnoses, and management of nasal discharge
in the newborn infant

XVIII Basic Principles of Pharmacology
A Drug disposition and pharmacokinetics
1 Absorption
Understand the factors that influence drug absorption

2 Distribution
Understand the factors involved in the distribution of a drug
ie, factors influencing peak serum concentrations of a drug
Understand the factors that determine protein-binding of a drug
in plasma
Understand the factors that affect transplacental passage of a
drug
Know the definition of the steady state of a drug during
administration

3 Metabolism
Understand the mechanisms by which various drugs are metabolized

4 Excretion
Understand the mechanisms by which various drugs are excreted
Know how to modify drug therapy in the presence of renal or
hepatic failure

5 Pharmacokinetics
a General
Understand basic pharmacokinetics and basic pharmacokinetic
definitions including the basic
definitions of linear and
nonlinear pharmacokinetics
Understand the relationships between serum concentrations,
clearance, steady-state, and half-life of a drug

b Basic calculations of dosages
Know how to prepare a solution to deliver a known quantity
of a drug
Identify the factors involved in the disposition of a drug
and understand the differences between drug distribution in
infants and adults
Know how to calculate a drug dose in order to achieve a
certain serum concentration
Recognize the effect of interval of administration on
trough drug concentration

B Clinical toxicology
Understand the common maternal drugs which are excreted in human
milk

C Indications/mechanisms/adverse reactions of specific types of
drugs
Know common antibiotics, indications for use, pharmacokinetics,
clinical pharmacology, side effects, and toxicity in the neonate
Know commonly used therapeutic
agents eg, opiates,
theophylline, barbiturates, etc, indications for use,
pharmacokinetics, clinical pharmacology, side effects, and
toxicity in the neonate

XIX Experimental Design/Statistics
A Study design
Identify and evaluate the efficacy of study designs commonly
used in clinical research

B Analysis
Define precision, know what affects it, and how to enhance it
Define accuracy, know what affects it, and how to enhance it
Understand and calculate the standard deviation, the standard
error of the mean, and the median
Realize the importance of the p value
Define null hypothesis
Understand alpha type I and beta type II errors
Determine the importance of calculations of power
Recognize the use of confidence intervals
Know the concept of the normal distribution
Define and calculate prevalence
Define and calculate incidence
Define and calculate sensitivity
Define and calculate specificity
Define and calculate false positive
Define and calculate false
negative
Define and calculate positive predictive value
Define and calculate negative predictive value
Understand the importance and uses of stratification
Distinguish the differences between categorical, ordinal, and
continuous variables
Know when to use parametric tests: Chi square, and Fishers exact
test, Student t test, analysis of variance, logistic regression
Know when to use nonparametric tests: sign rank test, rank sum
test
Define and calculate odds ratio
Define and calculate attributable rise

C Importance of obtaining informed consent
Identify when informed consent is necessary
Identify when informed consent is not necessary
Understand which types of studies must be reviewed by the
Institutional Review Board
Understand the basic criteria that must be utilized if an
Institutional Review Board is to grant permission to use infants
or children as subjects
Define and calculate attributable rise

XX Health Services Delivery, Ethical Issues, and Family Counseling
A
The organization and issues of perinatal and neonatal care
1 The organization of perinatal care
Understand issues in the organization of perinatal care eg,
regionalization, transport quality-control, practice guidelines

2 Awareness of public health issues, services and delivery
a Definitions
Define perinatal, neonatal, postneonatal, and infant
mortality
b Immunizations See Section IX
c Control of infection See Section X
d Early intervention efforts
Understand the importance of a system that provides
comprehensive, coordinated, family-centered early
intervention services

B Ethical and legal issues and death and dying
1 Ethical and legal issues
a Baby Doe - status and implications
Identify the important features of the Baby Doe
regulations and the circumstances when these regulations
may be applied
b Maternal versus fetal right
Understand the evolving issues of maternal versus fetal

rights
c Limit of viability
Recognize the controversies associated with treating
extremely premature infants
d Limits of technology
Recognize the controversies associated with the
introduction of new technologies to treat previously fatal
disorders, such as an experimental therapy that may save a
life, prolong a life, or prolong death

2 Death and dying
Understand all aspects of providing grief counseling prior to,
during, and after the death of a newborn infant
Recognize the importance of obtaining an autopsy and understand
the proper way to seek permission from and to share the results
with the parents

Percent of Questions on Subspecialty Certifying Examination, provided by
the American Board of Pediatrics:

Percent
1 Maternal-Fetal Medicine

80
2 Asphyxia and
Resuscitation
40
3
Cardiovascular
90
4
Respiratory
120
5
Genetics/Dysmorphology
70
6

Nutrition
80
7
Water/Salt/Renal
50
8
Endocrine/Metabolic/Thermal
80
9
Immunology
40
10 Infectious
Diseases
60
11
Gastroenterology
40
12
Bilirubin
20
13 Skin
Disorders
20
14
Hematology/Oncology
50
15
Neurology
50
16 Development and
Behavior
50
17 Eyes, Ears, Nose, Mouth, Throat, and
Neck1
0
18 Basic Principles of
Pharmacology
20
19 Experimental
Design/Statistics
20
20 Health Services Delivery, Ethical Issues, and Family
Counseling10

Last revised 6/03