Abstract
<title>Abstract</title> <p>Objective: To describe how Neonatal-Perinatal Medicine (NPM) fellowship programs structure training and care for extremely preterm patients (EPPs), define fellow roles, and identify educational challenges within evolving EPP care models. Study Design: All U.S. NPM programs were surveyed regarding EPP care structures, fellow involvement, and perceived challenges with one response per program. Quantitative data were analyzed descriptively, and free-text responses underwent thematic qualitative analysis. Results: Ninety-seven fellowship programs participated (91% response); all provided EPP care, and 56% utilized dedicated EPP teams. Frontline EPP care was most commonly provided by advanced practice providers (85%), followed by fellows (60%), residents (43%), and hospitalists (10%). Fellows contribute through prenatal counseling, resuscitation, procedural care, and supervision. Common challenges included ambiguous team roles, procedural competition, communication barriers, and the need to balance educational opportunities with clinical care demands. Conclusion: Fellows remain integral to EPP care. Structured team models, graduated autonomy, and clear interdisciplinary communication may optimize both fellow education and patient care.</p>