Neonatology (Neonatal Intensive Care Unit)

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 designated 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, follow 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 900 neonates 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.

What is the NICU?

The Neonatal Intensive Care Unit provides specialized care 24 hours a day to premature or term newborns. At first, many parents find the NICU to be a frightening or stressful place. This is a very normal feeling. Our hope is that you will start to feel a little more comfortable once you have the chance to talk with our team. Feel free to ask questions about how the unit works. We are here to support you.

What can I expect first?

When your baby arrives on the unit, we’ll continue to stabilize him or her. We’ll also start any other treatment your baby might need. You’ll be able to see your child as soon as possible. We’ll give you information about your baby’s condition and what to expect in the next few hours.

What will my baby look like?

Your baby may look different from the healthy, full term newborn you were expecting. Every baby is unique. It can be reassuring for you to understand what the equipment around your baby is used for, and what to expect. Please note that a member of your child’s care team can also answer any questions you may have about equipment and what you can do to help support your child in the hospital setting.

Most babies in the NICU are cared for in an incubator. This is a large plastic-walled bed. The incubator is important to keep your baby warm, and provide humidity (if needed). It puts moisture in the air to protect his or her skin if premature. It also helps protect him or her from environmental noise or excessive light. Your baby may be naked (except for a diaper) inside the incubator. This allows the medical team to watch him closely while keeping him warm. Once the medical team considers your baby ready , he will be moved from the incubator into an open crib. Even if your baby is in the incubator, you will be able to touch him or her. You will also be able to enjoy some skin to skin time, when it’s considered safe to do so by the medical team. The good news is that even small babies that need some respiratory support can still do skin to skin with a parent.

Regardless of your baby’s health status, it’s very important that you expose your baby to quality sounds. We encourage you to speak to your baby, read books and sing songs – this is very important for their language development and will allow him to get to know you better.

Parents can sometimes experience feelings of helplessness when their child is receiving care in the NICU. It’s important to note that as parents or guardians, you are the most important people in your baby’s life and play a very important role in your child’s hospital stay. We encourage you to be with your baby as much as you can and participate in your child’s care as much as possible.

As a parent, you can help support your baby in ways that are completely unique from healthcare professionals on the team. Here are a few examples to help guide you.

Rounds

Every day, our team of health professionals (neonatologists, nurses, nutritionists respiratory therapists, pharmacists, social workers, residents and fellows) gather to have a discussion about each patient on our unit. These meetings are called Rounds. Rounds take place every day from 9:30a.m. to 12:00p.m. As a parent and member of your child’s care team, your participation is welcome and encouraged, though not mandatory. Hence, we recommend that you get some sleep during the night, at home, to promote milk production and allow your mind to be fresh and focused during your participation in the rounds.

Rounds are a nice opportunity to obtain information about the plan for your baby’s care for the day, to ask questions and to contribute to the discussion based on your perspective about how your child is doing. It’s also an opportunity to get to know the health care professionals, their various roles on the team, and to get to know who might be taking care of your baby that day. During Rounds, there is often a teaching component as the Montreal Children's Hospital is an academic institution.

Questions and discussions can also happen at any other time on the unit, as team members are always available to answer your questions and listen to your input.

Breastfeeding

We encourage all mothers whose babies are admitted to the NICU to consider breastfeeding if they can and would like to. The unique nutrients in breast milk are important for your baby’s growth and long-term health. Mother’s milk is definitely the best therapy we can give to baby: it is protective and provides the best nutrition. It’s important to note, however, that if you choose not to breastfeed or are unable to do so for any reason, we will support you in any decision you make and will optimize baby’s nutrition with the input of our expert nutritionist.

Many babies in the NICU will not be able to nurse from the breast right away. It’s important to start expressing your breast milk as soon as possible in order to establish and maintain a good supply.

Once your baby is stable, your breast milk will be given to him either (a) through a feeding tube that passes from his nose/mouth down to his stomach, (b) by nursing at the breast, or (c) by bottle. The way your baby receives your breast milk or formula will depend on a number of factors that your nurse or doctor can discuss with you.

The NICU has electric breast pumps available at every bedside for each baby. Should you need any support with breastfeeding, lactation specialists will come to meet and help you. Our team of lactation consultants are here to listen to your concerns and to support you. Your bedside nurse is also a great resource, and can help answer questions or help orient you as needed.

Kangaroo care

Kangaroo care is the practice of holding your baby on your bare chest skin-to-skin. We encourage both mothers and fathers to do this with their babies. It is a good way to be close to your baby and it can help him in many ways. Kangaroo care can help baby’s body temperature, heart rate, breathing, and can even help weight gain. It also allows for the transfer of protective bacteria (called the “microbiome”) from your skin to baby’s. This practice can help extend periods of deep sleep, or a quiet alert state, and lessen crying. Kangaroo care also helps to improve breast milk production. Talk to your baby’s nurse about the kangaroo care position that would be best for your baby.

Reading to your baby

We encourage you to read books to your baby. Many books! Reading to your newborn will help you feel more involved with your baby’s care, will help him know that you are there and will help him with his development. It is one of the most important interventions to promote language development in babies admitted to the NICU. We know that during pregnancy, babies will constantly listen to their environment (which includes mom’s voice and other surrounding people speaking). Hearing your voice outside the womb is therefore very comforting to your baby.

The hospital has a “Books for Babies” program and offers a free book to every family on the unit during their stay. You are also welcome to bring books from home, from you childhood and in your mother tongue.

Bring things in from home

You can bring your own baby blanket, pyjamas, small toys and pictures of your family. Avoid bringing any stuffed toys (for infection control). You can ask your baby’s nurse if ever you have questions about additional items you’d like to bring into the unit.

Bathing

We encourage you participate in this part of your baby’s routine. Your nurse will guide you in order to help you feel comfortable, by showing you how to safely give your baby a bath (the different steps, where to find what you need, etc.). Bath time is a great way for you and your baby to spend time together and get to know each other even more.

Where is the NICU located?

The NICU is located in Bloc B, on the 6 th floor of the Montreal Children’s Hospital. The hospital address is 1001 Décarie boulevard, Montreal, QC H4A 3J1. The hospital is accessible by bus, train, metro, car bike and foot. Parking is also available on site.

Visiting

We encourage you to visit your baby often. Please refer to our Visiting Policy for more information about when visiting is permitted on the unit.

1.     When you arrive:

• Press the button outside the NICU door (B6S) and state who you are and the name of your baby. A staff member will promptly open the door.
• Hang up your coat and boots in the waiting room. Lockers are available if you wish to keep your items locked. Please bring your own lock.
• During the winter season, please bring a pair of indoor shoes to wear on the unit.

2.     Wash your hands:

• Remove all jewelry below your elbows (including your watch) Wash your hands with soap and water for 20 seconds, and wipe with the paper towel provided.
• Throughout your visit, use the alcohol solution outside every patient room to wash your hands: before and after you touch your baby, when you enter your child’s room and when you exit the room.

3.     Disinfect your cell phone with the wipes provided in the waiting room and place it in a clear plastic bag provided near the sink. Wipe the bag before re-entering your baby’s room.

Family lounges and rooms

We have two family lounges available for parents. These common spaces are for parents of all babies in the NICU, so we ask that you please share the space and keep it clean. You will find: coffee machine, fridge, microwave and a bathroom, as well as a television. No food is allowed on the unit, but you can eat snacks, lunch and other meals in these rooms.

Child Life Services

Because many of our patients are born prematurely, many families remain with us for weeks or months at a time. Our Child Life Services team offers weekly and monthly activities for families to help normalize the hospital experience and to offer parents an opportunity to meet other families experiencing the same things. Activities range from coffee hours to arts and crafts and are always focused on creating memories of this time period.

Medical team

A neonatologist is in charge of your baby’s treatment plan and works in collaboration with residents and fellows (these are doctors training to become pediatricians or neonatologists) and nurse practitioners. The medical team includes medical fellows, residents and students. Depending on your baby’s unique needs, the neonatologist may consult with other specialists and team members.

There is always a member of the medical team available to answer your questions.

Nursing team

There is also always a nurse available to answer your questions. A nurse will be assigned to your baby’s care, 24 hours a day. A typical nursing shift may vary between 8 and 12 hours during the day or night time period.

In addition to staff nurses, you may meet other specialized nurses:

• Lactation consultants are also part of the nursing team. They are available to help with breastfeeding, expressing your milk through a pump, etc.
• Neonatal nurse practitioners are nurses specializing in neonatology and can prescribe certain medications and treatments for your baby.
• Clinical nurse specialists and nurse educators are nurses who act as consultants and expert clinicians to help the unit use the latest research and practices.
• Nurse managers help oversee the entire unit.

Respiratory therapists

Respiratory Therapists (RTs) have expertise in airway and lung management. Our team has ultra-specialized RTs who have received extensive training in the management and transport of term and premature infants. They use and train with the latest technologies and are always seeking to implement better ways to provide respiratory support to our patients. 

Social workers

Social workers are part of the NICU team to help support families navigate parking, transportation and lodging issues that can accompany a premature infant’s hospitalization. They can also advise families about certain allocations they are entitled to, and can help guide them to resources that can be beneficial depending on their situation.

Department head: 

• Dr. Richard Gosselin , Director
• Dr. Daniel Faucher, Assistant Director

Staff members:

• Dr. Gabriel Altit
• Dr. Marc Beltempo
• Dr Jessica Duby
• Dr. Jarred Garfinkle
• Dr. Elizabeth Hailu
• Dr. François Olivier
• Dr. Katryn Paquette
• Dr. Michelle Ryan
• Dr. Guilherme Sant' Anna 
• Dr. Wissam Shalish
• Dr. Pia Wintermark 

• Sharon Taylor-Ducharme, Nurse Manager
• Cassandre Marthone, Assistant Nurse Manager
• Bao Tran Dang, Assistant Nurse Manager
• Natasha Doulis, Assistant Nurse Manager Interim
• Florence Casuar, Assistant Nurse Manager (interim)
• Lyne Boisvert, Nursing Discharge Coordinator
• Sophie Fournier, Nursing Practice Development Educator; Co-Director of the Transport Team
• Elissa Remmer, Nursing Practice Development Educator
• Stephanie Mardakis, Nursing Practice Development Educator

  My Language Passport: An early language development guide for parents and preemies

This video is available in other languages:

• English
• French
• Arabic
• Farsi
• Hebrew
• Mandarin
• Romanian
• Spanish
• Tamil
• Bulgarian

• Talk to someone. This may be a spouse, family member, social worker, mental health professional or your baby’s caregivers. Many new parents find it helpful to speak with other parents who have “been there”. Support groups are available. Ask your nurse or social worker about more information.
• Ask lots of questions.Get involved in your child’s care as early and as much as possible.
• Give yourself permission to adjust and cope. Having a sick baby is likely one of the most stressful events you’ve ever experienced.Ask for help.
• Make time for self-care.Read stories, speak and sing to your child.

For consultation or transfer, call 514-934-4425 or 1-888-590-1617 to reach the neonatologist on call. For additional information on the Neonatal Outreach program please contact Dr. Michelle Ryan at 514-412-4452.

The Neonatal Transport Team is composed of specially trained nurses and respiratory therapists working in collaboration with the neonatologists. During the initial call, a first evaluation is done and recommendations are given to the referring physician. Video consultation is also offered if needed. The transport team is rapidly mobilized. They carry state-of-the-art equipment and all required medications to support the care of unstable neonates. The team can offer advance therapy during transport, such as therapeutic hypothermia for neonate who have suffered from perinatal asphyxia to lessen brain injury.

In response to a growing number of requests for advice from referring centres, the Outreach Teaching Program was created to support medical, nursing and respiratory therapy staff. Activities include consultation for the care of unstable neonates, on-site teaching, case discussion and conferences on congenital heart disease, respiratory distress, etc.

Staff:

• Dr. François Olivier, Medical Director of the Transport Team
• Dr. Michelle Ryan, Medical Director of NRP and Outreach and Co-lead for NICU Simulation Program
• Sophie Fournier, Assistant Nurse Manager, Coordinator of the Transport and Resus Team
• Helen Seremetis, RT, Technical Coordinator Respiratory Therapy

The Montreal Children’s Hospital Fetal Diagnosis and Treatment Group (FDTG) includes specialists from different departments at the hospital who work as a team to provide prenatal diagnosis and treatment of fetal abnormalities.

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.

The Neonatal Clinic provides developmental assessment and long-term follow-up until school age of infants who require comprehensive, multidisciplinary coordination of care. These patients have potential neuro-developmental and medical sequelae associated with specific conditions that happened during the newborn period.

Residency program

• Length: 2 years
• Program Director (interim): Dr Nina Nouraeyan
• Tel: (514) 412-4452
• Fax: (514) 412-4356, e-mail: pd-neonatology.med@mcgill.ca

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 NPM residents 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 NPM residents in the joint program are encouraged to seek research mentors either within or outside the division of neonatology.

Neonatal Hemodynamics Clinical Research Fellowship

• Length: 1 or 2 years
• Program Director: Dr Gabriel Altit
• Tel: (514) 412-4452
• Fax: (514 412-4356, email: gabriel.altit@mcgill.ca 

Neonatology is probably one of the youngest yet most advanced fields in Pediatrics. The numerous discoveries made through research has led to the most advanced and innovative treatments allowing preterm babies as young as 23 weeks gestation to survive and thrive. A graduating Neonatal Perinatal Medicine resident should be given the opportunity to obtain advanced training in neonatal echocardiography research methods, if he/she shows enthusiasm for neonatal cardiovascular research. In the recent years, the evaluation of cardiovascular growth and adaptation to extra-uterine life has led to many discoveries and improved the care of newborns admitted to the neonatal intensive care unit. Targeted neonatal echocardiography is an area of focused competence that is in the process of approval for certification through the Royal College of Physicians and Surgeons.

Neonatal hemodynamics research describes the use of echocardiography (conventional and advanced) for research in the cardiovascular performance of the neonate and of previous graduate of the NICU. Echocardiography has a central role in neonatal hemodynamics research. Echocardiography can be used to assess cardiac function (left and right sided), pulmonary pressures, intracardiac and extracardiac shunts (e.g. atrial septal defect, ventricular septal defect, patent ductus arteriosus), central line position, assessment of pericardial fluid and structural defects.

Training in neonatal echocardiography by neonatologists has been actively done in neonatal units in Australia, Canada, and across Europe. Multiple guidelines for Neonatologist-performed echocardiography training have been published (1-4). However, few programs offer training for neonatologists in neonatologist-performed echocardiography that follow these recommendations.

The trainee will participate in a longitudinal program of training centered around a scholar project in neonatal echocardiography/hemodynamics.

The Neonatal Hemodynamics Clinical Research Fellowship Program is designed to be flexible to accommodate interests and timelines of good research projects in neonatal echocardiography/hemodynamics.

Neonatal Perinatal Medicine Scholar Fellowship

• Length: 1 or 2 years (depending on research project planned)
• Program Director: Dr Marc Beltempo
• Tel: (514) 412-4452
• Fax: (514 412-4356, email: marc.beltempo@mcgill.ca 

Neonatology is probably one of the youngest and one of the most advanced fields in Pediatrics. The numerous discoveries made through research has led to the most advanced and innovative treatments allowing preterm babies as young as 23 weeks gestation to survive and thrive. A graduating Neonatal Perinatal Medicine resident should be given the opportunity to obtain advanced training in research methods, if they show enthusiasm for neonatal research. These skills will not only lead to a genuine ability to study and appraise new interventions/treatments, it will also lead to better teachers of future clinicians and scientists. This fellowship is designed to be flexible so as to accommodate interests and timelines of good research projects.

The purpose of the Neonatal Perinatal Medicine Scholar Fellowship is to provide the Neonatal trainee with additional knowledge, skills and experience needed to begin training toward a potential career as an independent investigator.

Neonatal Follow-up Fellowship Program

• Length: 12 months
• Fellowship Director: Dr. Elise Couture, Training Coordinator
• Tel: (514) 412-4302
   e-mail:  elise.couture@muhc.mcgill.ca

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.

NeoConnect

Your presence is a priceless gift to your baby. We can help you connect with your baby and the care team, even if you can’t be physically present on the unit through voice recordings and videoconferencing. Ask a member of our team to learn more.

NeoConnect Recording Device Instructions (PDF)

Popular Lullaby Lyrics (PDF)

NeoConnect: Instructions on how to download WhatsApp (PDF)