The Division of Neonatology (Montreal Children's Hospital) regroups twelve neonatologists with various clinical (transport, extremely low birth weight, quality improvement, congenital anomalies, global health), educational (simulation, outreach) and research (respiratory control, pulmonary hypertension, bronchopulmonary dysplasia, long term health outcomes, health economics, neonatal brain repair) interests as well as a full time researcher studying the mechanisms of function and dysfunction in children with neurodevelopmental disorders. The Division is also complemented by five pediatricians with a special interest in the follow up of neonates with special needs and a group of pediatricians that contribute to the care of neonates in the Neonatal Intensive Care Unit (NICU).
Our team uses a multidisciplinary approach that brings together nurses and respiratory therapists, pediatricians, pharmacists, nutritionists, occupational therapists, social workers and Neonatal Nurse Practitioners (NNP) and consultants who treat acutely ill newborn infants (premature infants and term infants with serious medical and surgical disorders). In fact, the Montreal Children's Hospital's NICU is responsible for the only NNP provincial training program in Canada. Patients are transferred from other nurseries across Quebec. In addition, the NICU provides training to many health care professionals and physicians originating from many countries such as Brazil, Thailand, Lebanon and Rwanda under the umbrella of the Neonatal-Perinatal Medicine Residency Program at McGill, the Neonatal Follow-Up Fellowship Program and the International Neonatal Medicine Program.
History and Milestones
The Neonatal Intensive Care Unit (NICU) at the Montreal Children’s Hospital (MCH) was founded in 1957. It later expanded and gained a reputation for its research into and treatment of respiratory diseases in newborns under the guidance of Dr. Mary Ellen Avery, Chief of Pediatrics in the 1970s. In 1958, Dr. Robert Usher, then Director of the Intensive Care Unit at the Royal Victoria Hospital (RVH), invented a needle to administer fluids to very tiny babies. Since then, these two units have collaborated on a number of therapeutic advances, such as the use of surfactant and nitric oxide, neonatal transport, extracorporeal membrane oxygenation, high-frequency ventilation, and body cooling, all of which changed the face of neonatology. In fact, the Montreal Children’s Hospital is where these technologies were first introduced in Québec.
Since the move and the amalgamation of the MCH and RVH NICUs in 2015, the Neonatal Intensive Care Unit (NICU) at the Montreal Children’s Hospital provides ultra-specialized intensive care to both mothers and babies. The unit has 52 beds, all single rooms with 4 twin rooms allowing neonates to receive care in a quiet environment that reduces the spread of infection, while ensuring families’ privacy.
The NICU is at once a perinatal unit and a referral center for the entire province of Quebec. The Maternal-Fetal Medicine physicians at the Royal Victoria Hospital, which is adjacent to the Children’s, treat a high proportion of high risk pregnancies requiring immediate attention at birth by neonatologists and other pediatric medical or surgical specialists.
The MCH NICU is also a reference center for neonates with a variety of conditions at birth. These neonates are transported by a specialized transport team. The NICU admits close to 900 neonates per year and the Royal Victoria Hospital counts 3,000 deliveries per year.
The MCH's NICU is equipped with the most recent technologies for invasive ventilation, including high frequency oscillatory ventilators and Jet ventilators as well as non-invasive ventilation therapies and equipment for therapeutic hypothermia, hemodialysis and peritoneal dialysis.
1990: Creation of the first neonatal transport team in Québec, dedicated to the ground transportation of unstable newborns.
1991: Start of the provincial extracorporeal membrane oxygenation program intended to assist newborns in severe respiratory distress who do not respond to conventional treatments.
1994: Start of the specialized neonatal nurse practitioners pilot project designed to provide advanced care to newborns in an interdisciplinary setting. This project led to the 2006 creation of the provincial training program for specialized neonatal nurse practitioners.
1995: First hospital in Québec to use nitric oxide to treat pulmonary hypertension and to use high-frequency ventilation to treat severe respiratory distress.
2000: First EXIT (ex-utero intrapartum treatment) procedure performed at the Montreal Children's Hospital on a newborn with a neck tumor compressing the airway.
2008: Start of the therapeutic hypothermia program to treat infants born with perinatal asphyxia after 36 weeks of gestation.
2010: Start of magnetic resonance imaging (MRI) scans without sedation.
2011: First hospital in Québec to use high-frequency jet ventilation to treat a newborn with a severe lung disease.
Programs and Services
In a high-risk pregnancy (premature labor, congenital fetal abnormality, or health problem in the mother posing a risk to herself or the fetus), the family is followed by a team of obstetricians and neonatologists who provide advice, treatment and follow-up during pregnancy and after delivery. When a birth defect is diagnosed early in the pregnancy, the Fetal Diagnostic and Treatment Group (FDTG) works closely with the parents to provide them with information about the diagnosis, prognosis, treatments, and possible procedures during the pregnancy or after the birth. This team is comprised of geneticists, surgeons, maternal-fetal medicine specialists, neonatologists, cardiologists, nephrologists, and nurses, who meet regularly to discuss the various cases.
The neonatal transport team of the Montreal Children’s Hospital involved a group of nurses and respiratory therapists who have advanced training in neonatal transport medicine. They are working in collaboration with consulting MDs at the Montreal Children’s Hospital's NICU and they are covering the transport services 24/7. More than 400 babies are transported annually for emergent stabilization and consultation from more than 50 centers in Quebec. The transport admissions to the NICU represent 40% of all NICU admissions at the MCH. The transport team utilizes state of the art equipment specially designed for neonatal transport, mirroring the standards of care found in neonatal critical care units as well as national and international recommendations for neonatal transport. When a patient’s transport is requested from a referring center, the team is mobilized as fast as possible. The medical team from the NICU is also available to answer questions or to provide assistance regarding patient management.
The MCH Neonatal Transport Program is a participating member of the Canadian Neonatal Transport Network (CNTN) which integrates comparative data and benchmarking from many transport programs across Canada. The objective is to improve neonatal transport outcomes through sharing evidence based practice within the Canadian Neonatal Network (CNN).
The Neonatal Outreach Program provides training and support to physicians, nurses, and respiratory therapists at referring centres. In addition to helping interested hospitals establish a neonatal resuscitation program (NRP) and reviewing pertinent referred cases, there is also a didactic teaching curriculum about common neonatal presentations and emergencies. The Neonatal Outreach Program will also be adding in-site simulations within interested sites to augment learning.
The Neonatal Outreach Program was created to address the growing number of requests from referring centres for advice and education. Activities include implementation of the neonatal resuscitation program (NRP), case discussions, didactic learning about neonatal morbidities and emergencies, and soon, on site simulations to facilitate learning about the care of unstable neonates.
Since 2008, the MCH has offered therapeutic hypothermia to newborns born after 36 weeks with asphyxia who meet the eligibility criteria based on their neurological exam or their brain activity as seen on amplitude-integrated electroencephalography (aEEG). Since 2008, 1,054 patients have been referred to our centre, approximately 33% of whom were treated with body cooling.
Education and Training
Each year since 2011 the McGill Neonatal Conference is held, at which a guest speaker lectures to professionals from referring centers throughout the province on an emerging topic.
2019: Neonatal Respiratory Care. Guest speakers: Dr Jen-Tien Wung, New Jersey, USA; Dr Hany Aly, Ohio, USA.
2018: Neonatal Hematological Problems. Guest speakers: Dr. Robert Christensen, Utah, USA; Dr Anthony Chan, Ontario, Canada.
2017: Perinatal Problems. Guest speakers: Dr. Nestor Vain, Argentina; Dr. Abbot Laptook, Rhode Island, USA; Dr. François Luks, Rhode Island, USA; Dr. Nicholas Embleton, New Castle, England and Dr. Monique De Paepe, Rhode Island, USA.
2016: Neonatal Infectious Problems. Guests speakers: Dr. Bosco Paes and Dr. Pablo Sanchez
2015: Neonatal Surgical Problems.
2014: Neonatal Cardiorespiratory Problems. Guest speaker: Dr. Martin Keszler, Brown University, Rhode Island
2013: Neonatal nutrition. Guest speaker: Dr. Josef Neu, Gainesville, Florida
2012: Extremely preterm neonates: From conception to childhood. Guest speaker: Dr. Peter Davis, Melbourne, Australia
2011: Therapeutic hypothermia. Guest speaker: Dr. Abbot Laptook, Brown University, Rhode Island
Each year, we also host a keynote speaker as part of the Dr. Robert Usher Lecture. This lecture is named after Dr. Usher: a pioneer in the field of neonatology. These have included Dr. Peter M. Dunn, University of Bristol; Dr. Eduardo Bancalari, Miami University; Dr. Joseph Volpe, Harvard Medical School; Dr. Saroj Saigal, McMaster University; Dr. Judy L. Aschner, Vanderbilt University; Dr. Pablo Sanchez, University of Texas Southwestern, TX; Dr. Wally Carlo, University of Birmingham, Alabama; Dr. Vinod Bhutani, Stanford University; Dr. Alan Jobe, Cincinnati, OH.
Other guest speakers who have visited our NICUs since 2009 include:
Dr. Colin Morley, Melbourne University, Australia
Dr. J. T. Wung, Columbia University, NY
Dr. Jeffrey Ferranti, Duke University, NC
Dr. Patrick McNamara, University of Toronto, ON
Dr. Brian Simmons, University of Toronto, ON
Dr. Roger Soll, University of Vermont College of Medicine, Burlington, VT
Dr. Robin Steinhorn, UC Davis, CA
Dr. Richard Martin, UH Cleveland Medical Center
Dr. Abbot Laptook, Brown University, RI
Dr. Lina Chalak, University of Texas Southwestern, Dallas, TX
Dr. George Little, Dartmouth, NH
Dr. Hannah Glass, UCSF
Dr. Richard Martin – Rainbow Babies, Cleveland
Dr. Emily Tan – Hospital for Sick Children, Toronto
Dr. Hany Aly - George Washington
Dr. Seetha Shankaran - Wayne State University
Dr. Jack Sinclair - McMaster University
Dr. Lex Doyle – University of Melbourne, Australia
Dr. Page Church - Hospital for Sick Children, Toronto
Dr. Brian Simmons – Sunnybrook, Toronto
Dr. Prakesh Shah – Mont-Sinai, Toronto
Dr. Bosco Paes – McMaster University
Dr. Ronald Clyman - UCSF
Dr. Jennifer Beck – St-Michael’s Hospital, Toronto
Dr. Cristopher Synderby - Toronto
Dr. Neil Finer - San Diego
Dr. Jacques Belik - Toronto
Dr. Summesh - McMaster - US course
Dr. Prashanth - McMaster - US course
Dr. Michael-Andrew Assad – Calgary
Dr. John Profit – Stanford
Dr. Kevin Dysart - CHOP, Pennsylvania
Nurses: Kathy Randall, Danielle and Kathy Overman
- Bubble CPAP
- Neurological exam and aEEG
- Neonatal global health
- Simulation / debriefing
- Difficult airways
- Ultrasound workshop
For more information about the Division of Neonatology's subspecialty residency or fellowship programs please visit Education and Training.
Graduate Diploma Nurse Practitioner Neonatology
Training for specialized neonatal nurse practitioners (NNP). In order to provide patients with ultra-specialized care, a center must have highly efficient interdisciplinary teams in place, hence the specialized neonatal nurse practitioners pilot program managed by Dr. Eugene Outerbridge, which led to the creation of the McGill University-affiliated provincial training center.
The MUHC’s two NICUs are home to the provincial training program for specialized neonatal nurse practitioners (NNP), affiliated with McGill University. These specialized nurse practitioners care for newborns and their families at the various stages of the neonatal period. They are trained to:
- assist with prenatal counselling;
- assist with stabilizing the newborn in the delivery room;
- assist the attending physician in treating preterm or term infants who present with complications at birth;
- follow infants in the neonatal intensive or intermediary care units;
- treat term newborns in the mother-child unit who are presenting with signs of complications or deterioration.
Their tasks mainly include resuscitating and stabilizing neonates, prescribing drugs and other substances, prescribing diagnostic tests and performing invasive or risky diagnostic procedures, prescribing medical treatments, performing invasive medical procedures, providing prenatal counselling, and making in-house calls.
To qualify, NNPs must complete graduate level courses and clinical internships. We have trained 10 NNPs to date and four are almost finished their training; in order to meet provincial needs, we are aiming to train 65 NNPs in the next few years.
Contact: philippe.lamer2 [at] mcgill.ca (Philippe Lamer) and elizabeth.hailu [at] mcgill.ca (Dr. Elizabeth Hailu)
Dr. Gabriel Altit
Dr. Marc Beltempo
Dr. Jessica Duby
Dr. Daniel Faucher, Associate Division Director
Dr. Jarred Garfinkle
Dr. Richard Gosselin, Director of MUHC Division of Neonatology
Dr. Elizabeth Hailu
Dr. Francois Olivier
Dr. Katryn Paquette
Dr. Michelle Pepin
Dr. Michelle Ryan
Dr. Bayane Sabsabi
Dr. Guilherme Sant’Anna
Dr. Wissam Shalish
Dr. Pia Wintermark
Neonatal Follow-Up Clinic
Dr. Elise Couture, Fellowship Program Director
Dr. Andreea Gorgos
Dr. May Khairy
Dr. Louise Koclas
Dr. Michelle Pepin
Nurse Clinicians, Neonatal Follow-Up Clinic
Neonatal Nurse Practitioners - NICU
Margarida Ribeiro da Silva
Nursing Leadership Team
Sharon Taylor-Ducharme, Nurse Manager
Cassandre Marthone, Assistant Nurse Manager
Bao Tran Dang, Assistant Nurse Manager
Natasha Doulis, Assistant Nurse Manager Interim
Lyne Boisvert, Nursing Discharge Coordinator
Sophie Fournier; Co-Director of the Transport Team