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Dr Estelle Gauda - Division Head
The Neonatal Intensive Care Unit (NICU) at SickKids is an outborn unit which admits a broad spectrum of premature and mature neonatal patients with medical and surgical diagnoses requiring tertiary or quaternary care. The emphasis in the NICUs at Mount Sinai and Women's College Hospitals is on antenatal diagnosis and counselling as well as the care of inborn patients resulting from high-risk pregnancies.
The University of Toronto Neonatal/Perinatal Fellowship Training Program is a Royal College of Physicians and Surgeons of Canada accredited program without certification.
The research activities of the Division of Neonatology include a laboratory focus on lung development and injury, clinical studies of brain, lung and gut diseases specific to the newborn and various epidemiological aspects of the factors which contribute to, and outcomes of, neonatal disease.
History of Neonatology at SickKids
1915-1960: The first Babies Ward at the Hospital for Sick Children (SickKids), modelled on one in the Pasteur Hospital in Paris, opened in 1915 and had 28 glass cubicles to allow isolation and to minimize cross-infection. This coincided with the appointment of Dr. Alan Brown as Attending Physician in the Infant's Department. His approaches to limiting malnutrition and infection were generally adopted throughout Ontario, and were a major contributor to the reduction in infant mortality from 155 to 85/1000 between 1915 and 1919. A notable first for SickKids was Dr. Alfred P. Hart's first published report, in 1925, of the use of exchange transfusion to treat severe neonatal jaundice. This practice was rapidly adopted worldwide and by the mid-1950s some 500-600 exchange transfusions were performed each year at SickKids. An early emphasis on nutritional research led to the development by Drs. Fred Tisdall and Theo Drake, in the 1930s of Pablum weaning food and Sunwheat biscuits which benefited infants both directly and indirectly through royalties used by SickKids to fund research. The first Fellow in Neonatology was Dr. Alice Goodfellow in 1953, followed in 1954 by Dr. Paul Swyer, later to become Division Chief and internationally renowned for his contributions to the development of neonatal intensive care, including the first textbook on Neonatal Intenstive Care published in 1975.
1960-1995:Neonatal intensive care came of age at SickKids in 1961 with the appearance of the first NICU cubicle and with the first trials in Canada, and perhaps North America, of positive pressure ventilation for the neonatal respiratory distress syndrome. These studies were conducted by Dr. Swyer with two Fellows, Drs. Maria Delivora-Papadopoulos and Henry Levison who both went on to have distinguished academic careers in neonatology at Philadelphia and in respiratory medicine at SickKids respectively. Almost 200 Fellows, from all corners of the world, have now passed through our NICU, which is currently part of the University of Toronto Training Programme in Neonatal/Perinatal Medicine. A focus on innovative approaches to neonatal ventilation persisted, and included the development and application of high frequency oscillation techniques to infants with respiratory distress syndrome by Dr. Charles Bryan's research group in the SickKids Research Institute's Division of Respiratory Physiology. During the 1970's, Dr. Graham Chance was able to research, organize and validate an SickKids-based transport service for neonates which was initially staffed by physicians. Currently, some 600 neonatal transports occur each year by ambulance, helicopter or fixed-wing aircraft, of which 95 per cent are conducted by a specifically trained and highly skilled group of transport nurses. During the 1980's and 1990's, there has also been an evolving recognition of the important role for clinical nurse specialists/nurse practitioners trained in neonatology, and this group currently shoulder a significant load of direct patient care. Under the successive leaderships of Drs. Pamela Fitzhardinge, Karen Pape, Hilary Whyte and Karel O'Brien the combined SickKids and Mount Sinai Hospital follow-up clinic has repeatedly made significant contributions to our understanding of outcomes in sick neonates. Following Dr. Swyer's retirement in 1986, Dr. Barry Smith was recruited as Division Head and Dr. Martin Post as Head of Neonatal Research, both from Harvard University, to bring in research expertise in lung cell and molecular biology. This was further expanded by the recruitment of Dr. Keith Tanswell from the University of Western Ontario in 1989, who subsequently became the inaugural holder of the first University of Toronto Chair in Neonatal Medicine endowed in 1996 by SickKids' Womens' Auxiliary.
1996-Present:Dr. Barry Smith left SickKids to take up the position as Dean of Medicine at Queen's University, and Dr. Tanswell took over as Head. The current neonatologists in the NICU are Drs. Jaques Belik, Jonathan Hellmann, Jae Kim, Andrew James, Aideen Moore, Christine Newman, Boriana Parvez, Rosemary Moodie, Hilary Whyte and Patrick McNamara. In addition, neonatologists from Mount Sinai Hospital share equally in the joint follow-up clinic. The NICU remains busy, with some 800-1000 admissions/year. In 2003, the role of the Neonatal Transport Team was expanded to include transport of infants of up to two years of age.
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