The MCH Neonatology Program: Open, Responsive, Collaborative

Wednesday, March 9, 2011 - 10:37
The birth of a baby is supposed to be joyous, but unfortunately the joy is cut short for some parents when their baby is born in distress or diagnosed with a life-threatening condition. To compound the worry and fear of parents, the baby is immediately transferred to a neonatal intensive care unit (NICU) like the one at The Montreal Children’s Hospital. It can be a harrowing experience when a new parent walks in to an NICU for the first time. The sights and sounds are far from comforting and the first glimpse of their newborn hooked up to various machines, tubes and monitors is often terrifying. Their anxiety is moderately eased when they learn about the highly-skilled health care team fighting to save their child’s life.
 
The NICU at The Montreal Children’s Hospital serves the entire province of Quebec. It provides state-of-the-art, comprehensive specialty care to newborn infants with a wide range of congenital and acquired conditions. The team cares for extremely premature infants as early as 23 weeks gestation and also cares for term infants who require intervention from various specialties such as general surgery, cardiac or neurosurgery, genetics, gastroenterology or respirology. The team provides care for over 380 seriously-ill newborns per year in its 28-bed Neonatal Intensive Care Unit. The Neonatal Follow-up Clinic monitors the development of these children up to school age. There is also a highly-trained Neonatal Transport Team that provides neonatal outreach teaching to health professionals.
 
The NICU team
 
The MCH NICU’s interdisciplinary team comprises a team of 12 neonatologists, 70 nurses, including 6 nurse practitioners, several respiratory therapists and other health professionals to diagnose and treat newborns in need of highly-specialized critical care. 
 
The MCH does not impose mandatory overtime on its nurses: team members do overtime on a voluntary basis.
 
Neonatal Transport Team
 
The ‘’green’’ phone in the NICU is never ignored, and calls to that line never go to voice mail. This is a dedicated phone line for health care professionals working in any of Quebec’s 20 birthing centres. A specialist from the MCH is on the other end of the phone 24/7 to answer questions and provide advice when a baby is born in distress. As well, specially trained members of a neonatal transport team can be dispatched to help stabilize the sick newborn, provide preliminary care and transfer the child to the MCH. Over 500 transports are done yearly.
 
Neonatal Outreach Teaching Program
 
Some eight years ago, in response to requests from referring nurseries, the MCH started offering on-site training to better enable local health professionals to stabilize acutely ill newborns and learn how to care for these infants once they return from the MCH’s NICU. The Neonatal Outreach Teaching Program offers professionals from referring hospitals a curriculum that includes basic science, clinical science and technical skills. The training is inter-disciplinary with doctors, nurses and inhalation therapists in the same room. The MCH can also create a program designed to meet the specific needs of the requesting team. The training is provided at no charge thanks to a grant from The Montreal Children’s Hospital Foundation.
 
Neonatal Follow-up Program and Neonatal Clinic
 
Unlike some centres, the health professionals who work in the MCH Neonatal Follow-up Program and Neonatal Clinic also work in the NICU. There are many benefits to working in unison rather than silos; the key advantage is continuity of care. The health professionals in the Neonatal Follow-up Clinic know exactly what type of care the baby received while in the NICU. In addition, after the baby is discharged, the team in the NICU gets feedback on the child’s progress allowing them to adjust their protocols and improve care. There is also a tremendous benefit to parents who enjoy a long-term relationship with their child’s doctor from birth right up until their child reaches school age.
 
The MCH integrated Neonatal Follow-up Clinic provides developmental assessment and long-term follow-up of infants who require comprehensive coordination of care. These patients have potential developmental and medical sequelae due to illness in the newborn period. It holds six clinics per week and follows 1,000 patients per year. 
 
Neonatal research
 
Several members of the Division of Newborn Medicine are actively involved in research. Dr. Robert Brouillette is the Director of Clinical Research at the Montreal Children’s Hospital, Director of the Sleep Laboratory and has a major interest in control of breathing. Dr. Guilherme Sant’Anna is working on developing predictors of successful weaning from ventilator in extremely low birth weight infants. He is also interested in thermogenic response and changes of cerebral blood flow during therapeutic hypothermia in neonates with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). The MCH recently recruited Dr. Pia Wintermark from Boston Children’s Hospital. She is focusing her neonatal research on brain injury in asphyxiated newborns. Dr. Wintermark is using the MCH’s new 3-Teslor MRI to monitor the brain perfusion of infants with HIE who receive therapeutic hypothermia. Her goal is to improve current therapy to decrease brain injury and improve neurodevelopmental outcome.
 
Medical firsts
 
The MCH NICU is proud of its history of innovative care. The MCH is often the first hospital in Quebec to pioneer new treatments, services and programs. For example:
  • Neonatal transport team founded in 1990
  • ECMO founded in 1991
  • Nitric Oxide Program for pulmonary hypertension founded in 1994
  • High-frequency ventilation for severe respiratory distress started in 1995
  • Neonatal Educational Outreach Program started in 2004
  • Nurse Practitioners Training Program, training site in Quebec for NPs (pilot project started in 1990, training program started in 2008)
  • Hypothermia Program started in 2008
The Future – Quebec’s only full-service Mother-Child Care Centre
 
Currently all the newborns treated at the MCH are out-born, that is, they are delivered at birthing centres across much of Quebec (from Gatineau, to northern Quebec, the greater Montreal Area and as far east as Quebec City). However, the MCH NICU and the The Royal Victoria Hospital NICU are merging. The neonatologists at both units currently provide cross-site care, and the merger will happen when the two facilities are eventually located side-by-side on the MUHC Glen Campus. The new NICU at the Glen Campus will feature a 52-bed (private rooms) level 2-3 NICU. In addition, it will be the only health centre in Quebec equipped and trained to provide full-service Mother-Child Care, which means that when a pregnant woman requires care in an ICU, a fully-trained, highly specialized medical team will be at her side to provide care. The same scenario is true for a sick newborn. Both mother and child will receive the care they need under the same roof. The MUHC will be the only hospital in Quebec able to provide this level of care for both mother and child.
 
To contact the Newborn Medicine Service, please call 514-412-4452. 
 
For consultation or transport contact the Neonatal Transport Team at 514-934-4425 or 1-888-590-1617 to reach the neonatologist on call.
 
For additional information on the Neonatal Outreach Program please call Dr. Louis Beaumier or Diane Lalonde, NPDE, at 514-412-4452.
 
To reach the Neonatal Follow-up Program call 514-412-4302.