Neonatology (Neonatal Intensive Care Unit)

The MCH’s NICU mainly treats infants presenting with congenital heart, intestinal, kidney or other defects; and complications of prematurity, such as necrotizing enterocolitis, ductus arteriosus, bronchopulmonary dysplasia, severe respiratory distress with pulmonary hypertension requiring high-frequency ventilation and/or nitric oxide, neonatal asphyxia, or other conditions requiring the attention of pediatric or surgical sub-specialities. This means, for example, that an infant who is diagnosed with a heart defect before or after birth will have immediate access to pediatric cardiologists, cardiovascular surgeons, and neonatologists; the same applies for other medical and surgical specialties.

Our partners in the NICU at the Royal Victoria Hospital (RVH) primarily treat preterm infants born at the RVH to mothers with high‑risk pregnancies. Invasive and non-invasive ventilation, and high-frequency ventilation are some of the technologies available at the RVH’s NICU. The MCH’s NICU also offers high‑frequency jet ventilation, therapeutic hypothermia, hemodialysis, peritoneal dialysis, and pre- and post-operative support for newborns requiring surgery.

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.

1995: First hospital in Québec 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 
  • Andréane 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 
  • Lynn Lauzon, Nurse Manager 
  • Nathalie Andraos, Nutritionist 
  • Rebecca Chant, Nutritionist
  • Emilie Hébert, Nutritionist
  • Margarida Ribiero da Silva, Neonatal Nurse Practitioner
  • 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
Where the care happens

The MCH’s NICU is located in a pediatric hospital that offers a full range of pediatric and surgical subspecialties. Each year, approximately 400 newborns are admitted to the MCH and 600 are transported by the transport team. The RVH’s NICU is combined with a maternity unit that provides obstetric critical care, and follow-up of in vitro fertilization procedures. Approximately 400 patients are admitted to the RVH’s NICU every year, and most of the newborns admitted are born there. The MCH’s Neonatal Follow-up Program oversees at-risk newborns at both hospitals.

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.

Our new hospital

When the new hospital opens on the Glen campus in 2015, the NICUs at the MCH and the RVH will be merged into one 52-bed unit that will provide ultra-specialized care to mothers and their unborn babies. Moreover, all infants born at the Glen campus will have immediate access to ultra-specialized tests and procedures (surgery, cardiology, imaging), without the need to be transferred, thus ensuring rapid treatment and eliminating the risks related to transport. The care environment will also be profoundly transformed since all newborns will have a private room. This layout will foster a quieter, more private environment that is better suited to the new technologies and much safer in terms of controlling infections. Twins will be given special treatment, with rooms designed to accommodate them and their parents.

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. For more information, visit the McGill Neonatology Fellowship website

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 centresthroughout the province on an emerging topic.

  • 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. Abbott 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, VanderbiltUniversity; and Dr. Pablo Sanchez, University of Texas Southwestern.

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; and Dr. Roger Soll, University of Vermont College of Medicine, Burlington, VT.

Research

The two NICUs are 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 two units include:

Dr. Pia Wintermark

1.      Cerebral MRI perfusion studiesin newborns with hypoxic-ischemic encephalopathy (principal investigator, Sick Kids Foundation).

2.      Role of angiogenesis in the repair process of a brain affected by hypoxic-ischemic encephalopathy (principal investigator, Montreal Children’s Hospital Research Institute).

3.      NeuroDevNET: Study on protecting the preterm infant brain: preeclampsia and magnesium sulfate (co-investigator, CIHR).

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. Robert T. Brouillette

1.       National Curriculum Director, Canadian Child Health Clinician Scientist Program

2.       Director of Clinical Research

3.       Director of the Sleep Laboratory

Dr. Patricia Riley    

1.      Provincial monitoring of extremely preterm infants (< 25 weeks) at 18, 36 and 60 months in collaboration with other tertiary care centres in Québec.

2.      CIHR MiCare team; EPIQ II project (co-investigator at the MUHC site).

3.      Canadian Neonatal Follow-up Network (CNFUN); coordinator at the MUHC site (CIHR).

4.      Determinants of physical activity in youth recreational activities (co-investigator, CIHR).

5.      Study (SCREEN-ROP) of conclusive data on screening preterm infants for retinopathy of prematurity (co-investigator, CIHR). 

The McGill Obstetrics and Neonatal Database (MOND) is an electronic database of all births at the Royal Victoria Hospital since 1978. This database, the only one of its kind in Canada, is the basis for several studies, for example, measuring the impact of folic acid in preventing neural tube defects (…), measuring the impact of breastfeeding on the frequency of gastrointestinal infections and eczema in the PROBIT study (Dr. Michael Kramer), assessing the frequency of birth defects with in vitro fertilization (Dr. S.L. Tan), measuring the effect of body weight and ethnicity on the incidence of gestational diabetes, assessing the impact of maternal age on the risk of premature labour and the impact of obstetric history on subsequent pregnancies (Dr. Robert Platt). 

Dr. Romain Mandel

1.  CIHR MiCare team; EPIQ II project (co-investigator at the MUHC site)

Referrals

Newborns admitted to the Montreal Children’s Hospital are all born elsewhere and are 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.

Babies are admitted to the Royal Victoria Hospital’s NICU either because:

  • they are delivered preterm, due to a birth defect or because the mother has a medical condition that presents a risk to herself or her child; or
  • they are unstable at birth.

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