The winner of the BAPM Student Essay Competition.

The winner of the2025 BAPM Student Essay Competition was Hamza Akbar Khan, University of Exeter.

Runners up

Isha Rawat, University of Plymouth

Sally Balfourth, The University of the West of England

Peter Latchem, University of Southampton

Their essays on the topic 'A Student's Experience of Neonatology' are included below.

Winner - Hamza Akbar Khan

Since beginning my 3rd year of medical school, I have been most excited about my Paediatrics rotation. However, I was slightly apprehensive about the Neonatology week at the Royal Devon & Exeter Centre for Women’s Health. Despite my excitement, I was unsure of what to expect, especially in such a highly specialized area involving premature and critically ill newborns.

During my pre-reading, I learned that Neonatology is a sub-specialty of Paediatric Medicine that deals with the care of newborns who are struggling to thrive, primarily those born prematurely. Premature infants are at higher risk for conditions like Necrotising Enterocolitis, Intraventricular Haemorrhage, and Retinopathy of Prematurity1. However, in my experience, many babies were also admitted for feeding difficulties and respiratory distress.

I was fortunate to observe a range of procedures, including the administration of surfactant to a neonate. I was made aware of the significant cost to the NHS of administering this drug, which made me reflect on the value of the NHS in addressing social inequalities. It reassured me that the NHS provides all children, regardless of their socioeconomic background, with the best start in life—a stark contrast to neonates in developing countries who may lack access to such life-saving interventions2.

One of the more striking experiences occurred during a meeting with the multidisciplinary team (MDT) to discuss safeguarding concerns. I was particularly struck by a case involving the 10th-time mother who had begun to struggle with suicidal thoughts. I had taken a history from this mother the previous day, and she had not mentioned, nor alluded to, any mental health concerns. This experience was eye-opening, as it demonstrated how even experienced mothers could be vulnerable in such emotionally overwhelming circumstances. It also reminded me that, regardless of whether you are a first-time or tenth-time mother, the emotional toll of having an ill child is equally as devastating and mentally draining.

As a Pakistani man, I come from a culture where topics surrounding maternal health, mental health, and childbirth are often considered taboo. However, my time in the Neonatal unit challenged these preconceived notions. I had always thought of such topics as uncomfortable to discuss, perhaps due to the patriarchal components of my culture. Yet, I saw firsthand how essential it is to address these sensitive issues openly. Research shows that ethnic minority mothers in the UK experience poorer perinatal outcomes compared to their indigenous counterparts, which further highlights the importance of doctors confronting these topics3. I was struck by the responsibility and privilege of Neonatal doctors in raising awareness and normalizing conversations around these delicate issues. There is also a need for doctors from diverse backgrounds to engage with varied patient demographics to provide the best care.

In addition to the medical care provided, I was impressed by the use of non-medical treatments in Neonatology. Techniques such as skin-to-skin contact and maternal voice stimulation have been shown to reduce pain in neonates, which I found particularly remarkable4. While social prescribing is often associated with conditions like heart disease or diabetes, its role in Neonatal care was unexpected yet reassuring. These natural methods have been used for centuries and are integral in building trust and engagement with parents. By involving parents in the care process in such a holistic way, the anxiety that often accompanies neonatal care is significantly reduced.

One of the most impactful moments during my week in Neonatology occurred when I attended an emergency C-section after a failed vaginal delivery. I was struck by the mother’s exhaustion and the vulnerability she displayed during this high-pressure situation. I also noticed the baby’s distress upon birth, which made me more aware of the neonate’s role in the delivery process. While the focus in obstetrics is often on the mother, I realised that neonates, particularly premature ones, have distinct needs. Research suggests that premature neonates experience pain differently than full-term infants, which made me more attuned to their care needs in this context5.

The most rewarding experience of this rotation was witnessing the discharge of a premature baby after seven weeks in the unit. This baby had struggled with weight gain but was now healthy enough to go home with their family. I felt a sense of pride and joy as I had developed a rapport with the family over the course of my placement. Seeing them go home was a powerful reminder of the positive impact Neonatal doctors have on the lives of families. The experience left me with a deep appreciation for the emotional rewards of working in Neonatology, and it is something I will cherish throughout my career.

In conclusion, my two weeks on the Neonatal ward were transformative. I’ve gained invaluable insights into both the medical and emotional aspects of neonatal care, and I am deeply motivated to pursue Paediatrics as a specialty. The opportunity to confront complex issues and improve healthcare for both mothers and neonates is a challenge I look forward to embracing as I continue my medical career.

References

  1. Neonatal medicine - sub-specialty (no date) RCPCH. Available at: https://www.rcpch.ac.uk/education-careers/apply-paediatrics/sub-specialties/neonatal-medicine (Accessed: 06 November 2024).
  2. Statistics for babies admitted to neonatal units at full term (no date) Bliss. Available at: https://www.bliss.org.uk/research-campaigns/neonatal-care-statistics/statistics-for-babies-admitted-to-neonatal-units-at-full-term (Accessed: 12 November 2024).
  3. Parsons, L. and Day, S. (1992) ‘Improving obstetric outcomes in ethnic minorities: An evaluation of health advocacy in Hackney’, Journal of Public Health, 14(2), pp. 183–191. doi:10.1093/oxfordjournals.pubmed.a042719.
  4. Shen, Q. et al. (2022) ‘Efficacy and safety of non-pharmacological interventions for neonatal pain: An overview of systematic reviews’, BMJ Open, 12(9). doi:10.1136/bmjopen-2022-062296. 
  5.  Maxwell, L.G., Fraga, M.V. and Malavolta, C.P. (2019) ‘Assessment of pain in the newborn’, Clinics in Perinatology, 46(4), pp. 693–707. doi:10.1016/j.clp.2019.08.005.

Isha Rawat, University of Plymouth

Neonatology is a specialised branch of paediatrics focusing on the health of preterm and term newborns. It covers a spectrum of care, ranging from managing mild conditions to resuscitation and intensive care for critically ill neonates(1).

My introduction to neonatology began during my fourth year when I started hearing stories from my peers about their tier 3 neonatology placement. These accounts varied greatly, from exaggerated anecdotes, such as 'You can’t talk too loudly in NICU, or the babies will desaturate!', to emotionally challenging situations involving palliative care and difficult conversations. The fascination of students with these stories likely stemmed from the unfamiliarity of interacting with newborns and the gravity of intensive care units.

During my one-week placement, I felt nervous and unprepared. The stories I had heard painted NICU as emotionally taxing and academically challenging for students. During ward round, I struggled to answer the consultant’s questions and even felt uncertain when interpreting basic vitals. Neonatal medicine appeared overwhelmingly complex, and I felt out of my depth.

Despite my initial apprehension, I was surprised by the welcoming and supportive environment. The consultant I shadowed was passionate about her work and displayed inspiring empathetic communication with the parents present at bedsides. She introduced herself and the team, remembered each parent’s name and concerns, and approached them with familiarity and genuine kindness. I could see how, in such a high-stress environment, this personal connection helped reassure parents who were otherwise overwhelmed and anxious.
 
I was also excited to encounter congenital conditions, such as duodenal atresia, which I had previously only read about. It was a reminder that abstract conditions I learn about exist and real patients are affected by them. This experience reignited my curiosity and I found myself eager to go into placement every day, wondering what condition I might come across next.

After this initial experience, I applied for a longer placement in my fifth year and was thrilled to secure a five-week rotation. The placement was more challenging than I had anticipated. I witnessed numerous safeguarding concerns, palliative care cases, and difficult outcomes. Even with my previous paediatrics experience, I had not encountered such emotionally taxing situations. Neonatal medicine is unique in that it deals with patients who are incredibly vulnerable, and the stakes feel higher. Nobody expects a newborn to have health concerns, so when they do, the emotional weight of the situation is amplified(2).

At first, I found these cases overwhelming, but what concerned me most was noticing a shift in myself: I was developing compassion fatigue. The exposure to distressing situations seemed to wear me down faster than I expected. In contrast, when discussing these cases with consultants, I was struck by how they remained empathetic despite their years of constant exposure to emotionally challenging situations. It wasn’t that they were immune to the emotional toll, instead, they demonstrated a balance I struggled to achieve. Their ability to engage with families, prioritise the social aspects of care, and look after their teams’ mental well-being was inspiring.

The GMC’s requirement for doctors to maintain empathy and professionalism in emotionally difficult situations is particularly relevant in neonatology(3). I realised that compassion fatigue is not inevitable, however, managing it requires active reflection and resilience (4). Neonatology demands perseverance of compassion, as the journey for these patients and their families with healthcare professionals is only just beginning. A bad healthcare experience could hurt their future relationships with medical care.

My initial apprehension of the speciality was shared by my peers. When talking to my peers about their neonatal placements, I noticed that many of them were put off by neonatology, not because they were disinterested, but because they felt out of their depth. Common themes in student feedback include feelings of anxiety, uncertainty, and inadequacy(5). These emotions can transform even the most fascinating ward rounds into overwhelming and dull experiences. The complexities of neonatal medicine made it difficult for my peers to engage fully or envision themselves as neonatal doctors. This was despite NICU consultants being some of the most enthusiastic teachers I had encountered.

This lack of confidence and engagement may stem from the fact that neonatology is largely overlooked in UK medical education. Despite the increasing demand for neonatal specialists due to shifting obstetric demographics, it remains underpromoted(5). Most universities lack student-led societies for neonatology or teaching specific for neonates.
 
It's unclear whether this truly reflects the experience of all UK medical students. In my research, I could find only one article specifically addressing the subject, which raises questions about the consistency of neonatal education across the country. How much teaching and placement exposure do medical students typically receive, and what are their attitudes toward the specialty? A study of foundation doctors working in neonatology found a decline in interest in pursuing the specialty after their initial weeks working (6). Some attributed this to feeling inadequately prepared during medical school, which negatively impacted their confidence as potential future neonatologists. This highlights the need for some basic neonatal education at the undergraduate level.

Neonatology is a valuable placement for all medical students, even those who do not plan to pursue paediatrics. It strengthens understanding of physiology, fosters attention to detail, introduces the principles of intensive care, and provides exposure to unique pathologies. For me, learning about safeguarding, navigating difficult conversations, and understanding the impact of social determinants of health early in life has been transformative. Highlighting to students that they may learn important transferable skills to other specialities is important. These are universal skills that will benefit any future doctor, regardless of their chosen specialty.

I now recognise neonatology as a specialty I wish to pursue. However, I struggle to find like-minded peers with the same interest. To address this, I aim to create a student-led neonatology society at my medical school. Drawing from successful initiatives in other challenging specialties like paediatrics (7), I will attempt to organise volunteer placements, shadowing opportunities, and teaching sessions to increase exposure and inspire more students.

References

  1. Royal College of Paediatrics and Child Health. Neonatal medicine [Internet]. London: RCPCH; [cited 2024 Dec 18]. Available from: https://www.rcpch.ac.uk/education-careers/apply-paediatrics/sub-specialties/neonatal-medicine
  2. Prentice TM, Gillam L, Davis PG, Janvier A. The use and misuse of moral distress in neonatology. Semin Fetal Neonatal Med. 2018 Feb;23(1):39-43. doi: 10.1016/j.siny.2017.09.007. Epub 2017 Sep 28. PMID: 28964686. 
  3. General Medical Council. Good medical practice [Internet]. London: General Medical Council; 2024. Available from: https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice/about-good-medical-practice
  4. Cavanagh N, Cockett G, Heinrich C, Doig L, Fiest K, Guichon JR, Page S, Mitchell I, Doig CJ. Compassion fatigue in healthcare providers: A systematic review and meta-analysis. Nurs Ethics. 2020 May;27(3):639-665. doi: 10.1177/0969733019889400. Epub 2019 Dec 12. PMID: 31829113.
  5. Thompson R, Jones G, Beardsall K. 'Comfort Club': Student-run volunteering on the neonatal intensive care unit. Clin Teach. 2022 Feb;19(1):59-62. doi: 10.1111/tct.13448. Epub 2022 Jan 20. PMID: 35052012.
  6. Govindarajan S, Macnay K. 1093 Attitude of foundation trainees towards Neonatal Medicine – a cross-sectional survey for quality improvement. Archives of Disease in Childhood 2022;107:A180-A181.
  7. Zaloum SA, Kherati R, Khun SS, Ng AY, Przypasniak Z, Ravimani S, Morrissey B, Minson S. Paediatric shadowing: a student-led initiative to increase medical student interest in paediatric careers. Arch Dis Child Educ Pract Ed. 2024 May 17;109(3):131-136. doi: 10.1136/archdischild-2023-325944. PMID: 38267195. 

Sally Balfourth, The University of the West of England

As a Student Midwife, it’s hard for me to think about Neonatology without thinking about pregnancy and the many extraordinary changes that take place during those weeks. Babies have a shorter window in our care, often only their first few hours or days. We assist their journey from water to land; the foetus becomes the neonate and in the case of Neonatology, becomes the patient. For these babies, transitioning to life on land can take considerable time. 

Each baby’s story is as unique as the person who carried them. Sometimes concerns over their health have already been picked up antenatally but some complications do not emerge until the postnatal period. Though Midwives are highly skilled at anticipating and recognising deviations from the normal, when further care is required, this is escalated to the Neonatologists - experts at the medical care of newborns that are unwell, preterm or requiring additional attention. In some cases, babies are swiftly whisked away to the Neonatal Intensive Care Unit (NICU) not long after they are born.

Though I’ve had many visits to NICU, without having a clear role, I feel out of place there, like a tourist or uncomfortably voyeuristic. My experience of NICU is mostly through the perspective of the parents and caregivers in the early postnatal days. They are the ones frequently absent from their rooms on the bustling postnatal ward, busy visiting their babies on dark and quiet NICU. Care is made to ensure these parents aren’t sharing rooms with those who have newborns. We discuss the importance of bonding, skin to skin and hand expressing - breast milk is a potent elixir especially for preterm babies(1). The mother continues to be under our care until both parties feel they are ready to leave. 

Midwives do not just support physiological health but consider the whole landscape of the person and their psychological, social, cultural and spiritual situations(2). Perinatal mental health is an increasingly common concern and increases with NICU admissions(3). This can be a highly stressful time for parents. Even after leaving our care, for many parents it’s just the beginning of the journey- they may have many months ahead of them as their newborn gets better. But sadly that's not always the case. A day spent working with a compassionate and wise Bereavement Midwife illuminated the reality of the babies who don’t make it and how to care for the families they leave behind.

Sometimes I wonder what the experience is like for the baby in NICU. They exist in the liminal space: beyond the womb but before being discharged home. Familiar smells, voices and skin coexist with strange sounds and sensations. In utero, they are inherently supported by the pregnant body that carries them. In NICU, infants are dependent on a whole team of people for support- although I don’t think the multidisciplinary team is what they mean when they say it takes a village to raise a child.

Though my current experience of Neonatology is modest, I’d like to learn more. In my third year I’ll have a full week placement on NICU to gather some of the pieces together. For now I remain curious, getting glimpses where I can.

References

  1. La Leche League: Successfully breastfeeding your premature baby [online] Available at: https://laleche.org.uk/successfully-breastfeeding-premature-baby/ [Accessed 16.12.2024]
  2. Nursing and Midwifery Council (NMC) (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. [online] Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed 16.12.2024]
  3. Malouf, Reem et al. Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis eClinicalMedicine, Volume 43, 101233 [online] Available at: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00514-9/fulltext [Accessed 16.12.2024]

Peter Latchem,  University of Southampton

To many medical students, paediatrics and neonatology are daunting placements to begin. They seem immensely specialist, so different from the other areas of adult medicine that the student may have experienced. However, most students have been silently prepared in a surprising way. Any medical student starting a placement in perinatal medicine who has had experience in Older Person’s Medicine (OPM) may be surprised to learn that, paradoxically, neonatology is very much like geriatrics. Humans at the start and end of their lives are not as different as one may imagine, sharing wide differentials, practical challenges and issues with communication, consent, and capacity, as well as shared vulnerability and increased care needs. Differences in care and treatment aims vary, but recognising these differences is of great educational importance. Here I explore my experience as a medical student of both specialities highlighting similarities and differences.

The maxim of medical education: ‘it’s all in the history’, is important in both neonatology and geriatrics, but they do come with differing twists. The use of collateral histories is essential in both,  from the parents of a newborn or from the carers and family of an older person with confusion. Impaired communication of symptoms, and physiologies ramping up or slowing down can dispose to numerous pathologies, with both patient groups having a seemingly infinite list of differential diagnoses. Risk factors remain of great importance in both groups, interestingly due to the opposite ends of time lived. Neonates may have only had exposure to a risk factor for a small period of time (think a few week’s exposure to teratogens), but this may constitute a large, embryologically crucial portion of their whole existence. An older patient may have had multiple and long exposures to risk factors (a 30 a day smoking habit and occupational exposure to asbestos perhaps). In either case, thorough history taking is crucial to narrow the field of differentials.

As with all other areas of medicine, once a thorough history has informed thinking, examination to confirm or exclude suspicions is essential. Younger and older patients often present similar challenges in examination. Agitated newborns, young children and confused older persons are likely to disturbed by examination. Distraction and opportunism are essential skills. Long practiced OSCE structures and patters are abandoned to listen to temporarily quiet lungs, and shuffle more disturbing tests and examinations toward the end. Extremes of physiology in neonates still forming, can challenge expected ‘norms’ and an awareness of what should be expected to change, sometimes day by day, at each age is essential. Similarly, it is important to be aware that an older person’s 5/5 knee flexion power is going to be very different to a young man’s 5/5 power. The more normal corneal arcus you see in an older person, the more normal soft systolic murmur you hear in an infant, the more confident of your population’s baseline you become.

Macroscopic and microscopic fragility are marked in both groups of patients. Those who have struggled in vain to cannulate the only available, highly mobile and friable vein in a falls patient in an older person’s assessment unit will recognise the same difficulties whilst watching (in awe!) an umbilical vein catheter being placed. In older people, completing a challenging procedure is a test of not only dexterity, but of ability to win a patient’s confidence and trust. In neonates, a small amount of sucrose gel on a gloved finger to gently suck provides excellent pacification (and perfect demonstration of an infant’s newborn reflexes) in completing an Echocardiogram.

An essential part of both paediatrics and OPM is the understanding of the legal frameworks governing patient’s rights and protections. Students in paediatrics more broadly must gain a thorough understanding of the rights of children, and the principles of paramountcy and Gillick competency. Students in OPM must understand the importance of capacity, best interest decisions (currently including deprivation of liberty safeguards), Advance Directives and Lasting Power of Attorney. Common to both groups, where life expectancy is limited, the ethical and legal grounds for withdrawal of medical intervention is a constant area of discussion both within the profession and in the public eye, evidenced by the media coverage of Charlie Gard’s case and discussions surrounding the Assisted Dying Bill. The often complex network of guidance, laws, and ethics surrounding the most vulnerable in our society, advocated for vociferously by both population’s patient groups, makes for high stakes clinical practice and illustrates the importance of continuing honest conversations about care.

It is easy to think that neonates all have many years of life ahead and conversely in older person’s medicine that years are closing in. There are always exceptions. Sadly many neonates will not survive infancy, and death’s timeline is famously difficult to predict in even the frailest. Both specialties therefore highlight the priority of quality of life, over and above days or decades lived, with ample opportunity for open and honest discussions.
 
There is a sad difference though that I have noted between the two specialties. The atmosphere in paediatrics and neonates, even with the darkest clinical cases, is one of optimism. There is a palpable weight for clinicians thinking of their patient’s future years of life ahead that presses on all to go the extra mile for their patients. This is not unexpected, the prettiest wards, the best entertainment, the most funds, the quickest scans go straight to the sick child. 

Whilst I do not wish this to be different, I do see a juxtaposition between this and many older persons’ wards. There is sometimes a tendency to forget about its patients as people with a life to live. A weekly game of bingo being the most engaged I have personally seen patients on an otherwise drab older persons ward. I have of course seen exemplary care of the elderly; however I would like to see the same resource, enthusiasm, and care go to the elderly by default as I see with paediatrics – after all, are we so different at either ends of life?

British Association of Perinatal Medicine (BAPM) is registered in England & Wales under charity number 1199712 at 5-11 Theobalds Road, London, WC1X 8SH.
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