Hemodynamics and cardiac physiology

Drs. Amish Jain, Dany Weisz, Luc Mertens, and Bonny Jasani, study cardiac physiology of the newborn infant and refining the use of functional echocardiography in diagnosis and management of cardiovascular problems, particularly for those born preterm specifically, to understand the pathophysiology and identifying best practices for treatment of acute and chronic pulmonary hypertension, shock, and patent ductus arteriosus.

Hemodynamics and brain bunction

Dr. Poorva Deshpande, interested in monitoring the brain function and blood flow of preterm infants at the bedside has  integrated research related to heart function assessment by echocardiography with continuous brain monitoring techniques such as near-infrared spectroscopy (NIRS) and amplitude integrated electroencephalography (aEEG) to identify preterm infants at risk of brain injury.

Hemodynamics in sepsis

Using functional echocardiography, Dr. Ashraf Kharrat is studying neonatal hemodynamics in sepsis and septic shock and also working to integrate cardiopulmonary physiology findings into quality improvement initiatives that identify best care practices

Neonatal Follow-Up
Follow-up programs exist in each of the four centres, led by Dr. Paige Church, with medical leads being, Dr. Edmund Kelly, Dr. Linh Ly and Dr. Ethyl Ying.  As leaders for the Canadian Neonatal Follow-Up Network (CNFUN) which is a national database and is funded by CIHR to study neurodevelopmental outcomes of high-risk infants, they are actively involved in many studies associating care practices with adverse neurodevelopmental outcomes

Cerebral Palsy
Early detection is a key strategy to helping prevent poor neurodevelopmental outcomes resulting from delays in diagnosing CP in infants  born prematurely. Dr. Linh Ly is currently looking at how intervention strategies can be implemented earlier to improve the quality of life of preterm infants who develop CP.

Post-Haemorrhagic Ventricular Disorder
The Toronto Centre for Neonatal health has established an algorithm for initial identification of intraventricular haemorrhage and management plan. In the absence of additional medical co-morbidities (ie. NEC, PDA ligation) which require an immediate transfer, under the leadership of Dr. Linh Ly, the goal is to admit these children to SickKids for neurosurgical evaluation / continuation of care within 72 hours.

Spina bifida
Dr. Paige Church, the physician lead of the Spina Bifida/Spinal Cord injury program at Holland Bloorview Kids Rehabilitation Hospital is actively involved in research with children whose neonatal condition places them at increased risk of long-term neurodevelopmental disability, including preterm and infants with spina bifida.

Coached Coordinated and Enhanced Neonatal Transition (CCENT)
Under the leadership of Dr. Julia Orkin, TCNH neonatologists, Drs. Paige Church, Karel O’Brien and Linh Ly will testing a new CCENT model for neonatal follow-up care  that aims to provide additional support to parents and their babies during their NICU stay as well as their transition home. This study will assess how this new model will affect parental stress, mental health (e.g., postpartum depression), quality of life, child development and health care utilization.

Outcomes Research
A leader in evidence-based medicine, quality improvement, and systematic reviews, Dr. Prakesh Shah is the Director of the Canadian Neonatal Network™ (CNN) and both founder and Director the Canadian Preterm Birth Network (CPTBN), established in 2017, and the International Network for Evaluating Outcomes (iNEO) of neonates, established in 2012. All three neonatal networks collect population-based data on infants admitted to Level 3 NICUs and use the information for outcomes research, benchmarking, and comparative effectiveness research. 

Pain Reduction
An expert in clinical trials and systematic reviews, Dr. Vibhuti Shah is investigating interventions for pain management that minimize infant pain.

Quality Improvement and Health Services Research
The Scientific Director of the Institute of Human Development, Child and Youth Health at the CIHR and founder of the Canadian Neonatal Network™ (CNN) in 1995,  Dr. Shoo Lee has developed and implemented the Evidence-based Practice for Improving Quality (EPIQ) method of quality improvement as an effective way to improve infant outcomes using data from CNN. EPIQ has transformed care in tertiary NICUs across Canada as well as in countries across the world

Improving maternal transfer 
Preterm infants who are born in non-high risk perinatal centers have worse outcomes than those born in a perinatal hospital. Despite recommendations to deliver preterm infants at GA <32 weeks in high risk perinatal centers, more than 28% are outborn. While maternal transfer to high risk centers for some of these cases may not be safely possible, there remains a major opportunity to increase maternal transfers that can lead to an increase in inborn deliveries and improve neonatal outcomes. Dr. Hilary Whyte and Dr. Kyong-Soon Lee are exploring how to increase in-utero transfers of mothers who present at GA <32 weeks to non-tertiary centers in order to decrease neonatal morbidity and mortality.

Establishing a Standardized Process for Evaluation and Management of Postoperative Pain
The purpose of this quality improvement project is to implement a standardized process for evaluation and treatment of postoperative pain  for all infants in the neonatal intensive care unit (NICU). Studies in preterm infants show that repeated painful stimuli early in life have short and long term consequences including physiologic instability, altered brain development and abnormal stress response systems that persist  into childhood. Pharmacologic management of pain in infants must be balanced with the adverse effects of opioids on the developing brain. 
Optimal pain management is a vital component of high-quality neonatal care. The use of a pain assessment tool provides a common  language to allow multidisciplinary teams to discuss an appropriate pain plan.

Pulmonary vascular resistance
With a primary research interest focused on the pulmonary vascular smooth muscle and the control of pulmonary vascular resistance during development and following pulmonary hypertension, Dr. Jaques Belik and his team have been actively studying the biophysical and biochemical changes in pulmonary vascular smooth muscle contractile and relaxant properties and their impact on the control of pulmonary vascular resistance for the past 20 years. They utilize several animal models of pulmonary hypertension to evaluate the signaling pathways responsible for the age-related and pulmonary hypertension-induced changes in lung vascular resistance. More recently Belik’s team uncovered evidence for a cross-talk between the airway epithelium and pulmonary arterial muscle that appears to play a major physiological role in the regulation of pulmonary vascular resistance during development. Current studies in his laboratory are geared at evaluating the factors involved in this cross-talk.

Inflammation and oxidative lung injury
Dr. Gauda’s research focuses on the discovery of novel mechanisms to prevent the development of lung injury in premature infants; specifically she is conducting pre-clinical studies in her laboratory to determine whether exogenous adiponectin or upregulation of endogenous adiponectin will prevent inflammatory and oxidative lung injury leading to bronchopulmonary dysplasia. She is also conducting observational studies in human infants to determine the association between plasma adiponectin levels and biomarkers of inflammation and oxidative stress in extremely premature infants.  In addition, her research portfolio includes studies designed to identify mechanisms that control breathing during development with a focus on maturation of the carotid body and its effects on breathing instability in premature infants and in newborn models.

Point-of-Care Technologies
Dr. Adel Mohammed and Dr. Yenge Diambomba are working to use lung ultrasound severity scoring as a diagnostic tool for the early prediction of bronchopulmonary dysplasia. In addition, they developed a lung ultrasound workshop to train clinicians across Canada how to use lung ultrasound. They are also studying the lung ultrasound implementation process and evaluating
lung ultrasound training methods.

Neonatal Resuscitation and Simulation Training

Dr. Douglas Campbell, a simulation co-lead, at the University of Toronto’s Division of Neonatal-Perinatal Medicine and Medical Director of the Allan Waters Family Simulation Centre at St. Michael’s Hospital, is involved in research and quality improvement using simulation to prepare for neonatal resuscitation team-training and patient care situations in the emergency/trauma, operating room or inpatient ward environments.

Simulation has become an essential asset. Dr. Emer Finan and Dr. Kin Fan Young Tai, along with Carol Chang, RN, at Mount Sinai conduct research on NRP procedures and ways to improve teaching of NRP including use of simulation techniques.

The SickKids ACTS team, under the direction of Dr. Hilary Whyte, also uses high fidelity simulation equipment for quality improvement and education for new learners and for all professionals rotating through the transport service. A weekly learning lab is provided for residents and NICU departmental fellows, and on an as needed basis, for skills and ventilation continuing education of all. 

Use of Gentle Synchronized Negative Pressure in Helping Babies Breathe (Neovest).
The NeoVest delivery device is a wearable vest/shell that surrounds the infant’s abdomen developed by Dr. Douglas Campbell and his colleagues using serial body measurements of infants. It gently pulls on the abdomen by applying negative pressure, thereby displacing the diaphragm. The materials used for the NeoVest are lightweight and suitable for the infants’ sensitive skin. The aim of this

Read more here: https://clinicaltrials.gov/ct2/show/NCT03510169?term=NCT03510169&rank=1