Neonatology (Neonatal Intensive Care Unit)

The NICU at the Montreal Children’s Hospital provides ultraspecialized 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 located next door 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 more than 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 ventilatory procedures as well as non-invasive ventilation therapies and equipment for therapeutic hypothermia, hemodialysis and peritoneal dialysis.

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).  In fact, the MCH’s NICU is responsible for the only NNP provincial training program in Canada.  

Vertical Tabs

Our history

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. 

Innovations

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 MCH on a newborn with a neck tumour 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 usehigh-frequency jet ventilation to treat a newborn with a severe lung disease.

Our team

The NICUs rely on several interdisciplinary teams made up of neonatologists, pediatricians, specialized nurse practitioners, clinical nurses, respiratory therapists, pharmacists, nutritionists, social workers, occupational therapists, and other consultants, to treat severely ill newborns (premature or term infants with serious medical or surgical problems). These teams also include students, residents, and research fellows who come to the MCH for clinical and research training.

The Foetal Diagnosis and Treatment Group is a joint initiative of the Montreal Children’s Hospital (MCH), the Royal Victoria Hospital (RVH), and the Jewish General Hospital (JGH). The team provides prenatal care to pregnant women whose fetus has been diagnosed with a congenital defect (cardiac or intestinal malformation, or other birth defect), offering them advice, treatment, and support.

The Neonatal Transport Team (based at the MCH), composed of specially trained nurses and respiratory therapists, transports and treats unstable infants born outside the MCH or RVH who require specialized care.

The Neonatal Clinic provides developmental assessment and long-term follow-up (until school age) of infants who require multidisciplinary care. The liaison team ensures continuity for children who are transferred to a floor but who still require more intensive care.

Department head: 

Dr. Thérèse Perreault, Divison Head

Staff members

  • Dr. Louis Beaumier 
  • Mireille Béchard, Lactation Consultant
  • Dr. Marc Beltempo
  • Lyne Boisvert, Nursing Discharge Coordinator
  • ndréane Pharand,  MUHC nursing coordinator for the Neonatology Program
  • Patricia Grier, Nursing Practice Development Educator
  • Rose Boyle, Neonatal Nurse Practitioner
  • Melinda Di Minno, Social Worker 
  • Martine Claveau, Neonatal Nurse Practitioner
  • Dr. Élise Couture 
  • Dr. Daniel Faucher 
  • Dr. Richard Gosselin 
  • Dr. May Khairy
  • Dr. Louise Koclas
  • Diane Lalonde, Nursing Practice Development Educator, Co-Director, Transport Team
  • Philippe Lamer, Neonatal Nurse Practitioner
  • Marie-Éve Moreau, Neonatal Nurse Practitioner
  • Linda Morneault, Neonatal Nurse Practitioner
  • Dr. François Olivier
  • Dr. Michelle Pepin
  • Nathalie Andraos, Nutritionist
  • Rebecca Chant, Nutritionist
  • Emilie Hébert, Nutritionist
  • Margarida Ribiero da Silva, Neonatal Nurse Practitioner
  • Dr. Patricia Riley : retired
  • Dr. Guilherme Sant' Anna 
  • Marie Laberge, Social Worker
  • Angela Heguy-Johnston, Social Worker
  • Christine Labelle, Occupational Therapist
  • Sarah Milton, Occupational Therapist 
  • Dr. Pia Wintermark 
  • Dr. Wissam Shalish
  • Dr. Gabriel Altit
  • Sarah Asselin, Neonatal Nurse Practitioner
  • Tiffany Mathieu, Neonatal Nurse Practitioner
  • Olga Kazantseva, Neonatal Nurse Practitioner
  • Emilie St-Germain, Neonatal Nurse Practitioner
  • Andréa Martel-Bucci, Neonatal Nurse Practitioner
  • Laila Wazneh, Neonatal Nurse Practitioner
Programs and services

High-risk pregnancies

In a high-risk pregnancy (premature labour, 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 and after delivery. In the case where a birth defect is diagnosed early in the pregnancy, the diagnostic and treatment team 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.

Neonatal transport team

The neonatal transport team treats newborns who are unstable or who need specialized care available only at tertiary care hospitals. The team includes a nurse and a respiratory therapist who have been specially trained for medical transport work; a neonatologist accompanies the team when necessary. The team travels by ambulance as far away as Gatineau, Québec City, La Tuque or Sherbrooke, with all the equipment needed to stabilize a fragile newborn. 

Outreach program

The Outreach program provides training and support to doctors, nurses, and respiratory therapists at referring centres. In addition to helping interested hospitals set up a neonatal resuscitation program (NRP) or a neonatal stabilization program (ACoRN), the Outreach program staff also discusses cases, and provides teaching and support on the implementation of new technologies.

Therapeutic hypothermia

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, 180 patients have been referred to our centre, approximately 40% of whom were treated with body cooling.

 

Training for health professionals

Training for specialized neonatal nurse practitioners (NNP)

In order to provide patients with ultra-specialized care, a centre 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 centre.

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. 

Graduate Diploma Nurse Practitioner Neonatology

Contact: Linda Morneault, Neonatal Nurse Practitioner linda.morneault@muhc.mcgill.ca 

Postgraduate Medical Education in Neonatology

Residency program

The McGill training program in neonatology involves the Montreal Children's, the Royal Victoria and the Sir M.B. Davis - Jewish General Hospitals.

Neonatal-perinatal medicine training is offered in the units of the Jewish General and the Royal Victoria Hospitals. Both hospitals deliver nearly 4,000 babies per year and have a very active high-risk antenatal referral program with a catchment area of over 12,000 deliveries for each hospital. The Montreal Children's Hospital provides intensive care experience in all illnesses of the newborn infant, but especially in respiratory care, neonatal surgical problems and congenital heart diseases. It is a postnatal referral centre for many hospitals in Montreal and surrounding communities. 

The two-year program places a major emphasis on clinical and basic science research. Residents and Fellows in the program are expected to develop investigative interests. Areas of particular research activity are developmental pharmacology and perinatal therapeutics, pulmonary physiology and pathophysiology, including longitudinal studies of neonatal intensive care survivors, respiratory muscle function, control of breathing, nutrition, metabolism, management of very low birth weight infants and epidemiology. Residents and Fellows in the joint program are encouraged to seek research mentors either within or outside the division of neonatology.

Neonatal Follow-up Fellowship Program

The program: based at the Montreal Children’s Hospital is designed for physicians who wish to develop clinical expertise in the field of medical and developmental follow-up of high-risk neonates. The program consists of training in clinical, neurodevelopmental evaluations, family support, interdisciplinary approach to care of infants and toddlers with complex medical problems.  Extensive experience with multidisciplinary partners (rehabilitation, specialised developmental disabilities programs) is provided. A short clinical research project or systematic review is completed during the academic year.   For a complete description of this fellowship, please check the following link: Neonatal Follow-up Fellowship Program.

Continuing education

Each year since 2011, we have organized the McGill Neonatal Conference at which a guest speaker lectures to professionals from referring centres throughout the province on an emerging topic.

  • 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.

Other guest speakers who have visited our NICUs since 2009 include also:

  • 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

Nurses: Kathy Randall, Danielle and Kathy Overman

Workshops:

1. Bubble CPAP

2. Neurological exam and aEEG

3. Neonatal global health

4. Simulation / debriefing 

5. Difficult airways

6. Ultrasound workshop

Research

The NICU is part of the Canadian Neonatal Network, whose members can measure their services against those of other tertiary care units across Canada. Its mission is to be a network of researchers who conduct leading multidisciplinary, collaborative research dedicated to the improvement of neonatal-prenatal health in Canada and internationally.

Click here to consult a list of our most recent publications.

Other research activities taking place in the unit include:

Dr. Pia Wintermark

Dr. Pia Wintermark is a pediatrician and neonatologist, with a research interest in neonatal neurology, currently working at the Montreal Children’s Hospital, McGill University.

Dr. Pia Wintermark founded the NeoBrainLab in 2010. Before joining the Montreal Children's Hospital in July 2010, Dr. Pia Wintermark worked at the Children’s Hospital Boston (Harvard Medical School) in Boston, USA, and at the Lausanne University Hospital (University of Lausanne) in Lausanne, Switzerland. She received her MD from the Medical School of the University of Lausanne, in Switzerland.

The NeoBrainLab is devoted to the understanding of the causes and consequences of brain and eyes damages in sick babies. The main goals of the lab are to develop innovative strategies to prevent or repair these brain and eyes damages, and thus to improve the future of these babies. The laboratory uses clinical, basic and translational research to understand mechanisms underlying these brain and eyes damages, and to develop innovative treatments that could lead to decrease brain and eyes damages in sick babies.

We welcome all persons, who are motivated and interested to work in this field.

Dr. Gabriel Altit

  • Medicine (MDCM) - McGill University - Montreal, Canada

  • General Pediatrics Residency (FRCPC) - Université de Montréal - CHU Sainte-Justine
  • Neonatology fellowship (FRCPC) - Université de Montréal - CHU-Sainte-Justine
  • Pediatric Respirology Research / Echocardiography Fellowship – McGill University – McGill University Health Center – Montreal Children’s Hospital
  • Neonatal Echocardiography Research Fellowship - Stanford University - Lucile Packard Children’s Hospital – Palo Alto, California
  • Neonatologist
  • MSc in Clinical Epidemiology – McGill University

His research program is focusing on deformation and rotational analysis by speckle tracking echocardiography (STE) and conventional echocardiography in premature infants with pulmonary hypertension and infants with congenital diaphragmatic hernia. He will also examine markers of end-organ perfusion using echocardiography and near infrared spectroscopy, specifically in neonates with congenital cardiac defects.

Dr. Guilherme Sant’Anna

1.    Study on temperature and cerebral blood flow regulation in hypoxic-ischemic encephalopathy treated by controlled hypothermia.

2.    Study on respiratory and cardiac variability as predictors of the success of extubation.

3.    Study on outcomes for newborns with hypoxic-ischemic encephalopathy who do not qualify for therapeutic hypothermia: a prospective observational study.

Dr. Wissam Shalish

Dr. Shalish graduated from medical school at McGill University and completed his pediatric residency at the Montreal Children’s Hospital from 2008-2011. After completing his fellowship in Neonatal-Perinatal Medicine at the Hospital for Sick Children in Toronto, he returned in 2013 as physician in the division of Neonatology at the Montreal Children’s Hospital. At the same time, he has been pursuing a PhD in Experimental Medicine at McGill University, looking at the use of automated analyses of cardiorespiratory signals for the prediction of extubation readiness in extremely preterm infants. He was the recipient of the Richard and Edith Strauss Fellowship in clinical medicine from 2013 to 2015, and has been awarded the FRQS doctorate award since 2015. His research interests include weaning from mechanical ventilation, prediction of extubation readiness and biomedical signal analysis.

Dr. François Olivier

  • Pediatrician, Neonatologist 
  • Education:
  • Pediatric Residency: Université Laval, Québec 
  • Neonatal-Perinatal Medicine fellowship: Université Laval, Québec
  • Clinical Scientist residency: Université Laval, Québec 
  • Master in Clinical Epidemiology, Université Laval, Québec 

Interest in quality improvement and clinical research. 

Dr. Marc Beltempo, MD, MSc, FRCPC

  • Medical Degree, Université de Montréal
  • Pediatric Residency, Université Laval
  • Neonatal fellowship, Université Laval
  • Masters in Health Administration, Université de Montréal
  • Research fellowship, Maternal-Infant Research Centre, University of Toronto

National collaborations

-          Site investigator, Evidence-based Practice for Quality improvement (EPIQ)

-          Site Investigator, Canadian Neonatal Follow up Network (CNFUN)

Research interests

-          Neonatal health outcome research

-          Health system and organizational analysis

-          Quality improvement

The Neonatal health-care services research program [Dr Beltempo] focuses on evaluating how the organization of work affects outcomes of infants in the NICU. Using clinical and administrative databases, we are studying the effects of different health-care delivery models, team composition and resource allocation on quality of care and efficiency in the NICU. Further, collaborative research with the Canadian Neonatal Network (CNN) addresses better understanding predictors of neonatal outcomes and quality improvement in the NICU.

Recent publications

Beltempo M, Lacroix G, Cabot M, Piedboeuf B. Factors and costs associated with the use of registered nurse overtime in the neonatal intensive care unit. Pediatr Neonatal Nurs Open J. 2016; 3(2): 43-49.

Beltempo M, Blais R, Lacroix G, Cabot M, Piedboeuf B.Association of Nursing Overtime, Nurse Staffing and Unit Occupancy with the Risk of Healthcare-Associated Infections in The NICU. American Journal of Perinatology, 2017 Apr 4

Beltempo M, Platt R, Piedboeuf B, Bizgu V, Barrington K, Shah P and the Canadian Neonatal Network. Association of resident duty hour reform and neonatal outcomes of very preterm infants. American Journal of Perinatology, In Press

Referrals

Newborns admitted to the Montreal Children’s Hospital can also be born elsewhere and transported to our centre for specialized treatment by the transport team. Referring centres can call 514 934-4425 or 888 590-1617 (toll-free) to speak to a neonatologist.  Doctors at referring centres can contact the on-call obstetrician at 514 934-4400, ext. 35006 or 31599, for a consultation in maternal-fetal medicine or to request a transfer for a woman experiencing premature labour.

What to expect

In order to make informed decisions and participate actively in their child’s care, families need access to complete and accurate information. The way in which this information is communicated to families depends on their personal preferences and knowledge level. The care team also includes social workers and a psychologist who are standing by to support families.

Literacy program

Families are encouraged to participate in their child’s care, and since the latest research suggests that literacy is a determining factor in brain development, the Montreal Children’s Hospital and the Québec Centre for Literacy have decided to team up with healthcare professionals to encourage families to read to their newborns. To this end, the Books for Babies program gives books to parents of infants hospitalized in the NICU.

Breastfeeding

Breast milk is the preferred nutrition for preterm or sick babies admitted to the MCH and RVH NICUs, where team members encourage mothers to pump their milk for their babies. New mothers can also practice skin-to-skin contact (kangaroo care) to promote bonding and stimulate lactation. Of course, when the babies are healthy enough, mothers can breastfeed them directly. Both NICUs are equipped with a breastfeeding room and electric pumps that mothers can use during their time in the units. During their babies’ hospital stay, these woman can rely on the support of lactation consultants to assist them with latching, and with pumping their milk in the hospital and at home.  

In 2012, the MCH’s NICU innovated by inaugurating a breast milk management program whose mission is to enrich the breast milk and prepare the feedings for all the babies in the unit. The RVH set up a similar program in 2013.

Developmental careprogram

Developmental care is a new individualized care approach that places newborns and their families at the centre of the neonatal care experience. In other words, this care is aimed at reducing stress in sick or premature newborns and creating optimal conditions for their development.

Volunteers read to, play with, sing to and rock the babies to provide them with comfort, companionship and stimulation.

Refer a patient 
  • Room number : B 06.1124, Glen site
  • Telephone : 514-412-4452
  • Fax : 514-412-4356