Shoo Lee

Shoo Lee
Mount Sinai Hospital
Appointment Status Cross-Appointed
Cross-appointed: Paediatrics
Research Interests
Health Economics, Health Services Research, Illness Severity, NICU, Outcomes Variations

Dr. Shoo Lee is a neonatologist and health economist. He is Scientific Director of the Institute of Human Development, Child and Youth Health (IHDCYH) at the Canadian Institutes of Health Research; Professor of Paediatrics, Obstetrics & Gynaecology and Public Health; Paediatrician-in-Chief and Director of the Maternal-Infant Care (MICare) Research Centre at Mt. Sinai Hospital and Associate Member of the Samuel Lunenfeld Research Institute.

Dr. Lee received his medical degree from the University of Singapore, completed his paediatric training at the Janeway Children's Hospital in Newfoundland and neonatal fellowship training at Boston’s Children’s Hospital, and received his PhD in Health Policy (Economics) from Harvard University.

As the founder and Director of the Canadian Neonatal NetworkTM and the International Neonatal Collaboration, Dr Lee fosters collaborative research, and he leads the CIHR Team in Maternal-Infant Care. His research focuses on improving quality of care, patient outcomes and health care services delivery.

Awards for his work include the CIHR Knowledge Translation Award, the Aventis Pasteur Research Award and the Distinguished Neonatologist Award from the Canadian Paediatric Society, and the Premier Member of Honour Award from the Sociedad Iberoamericana de Neonatologia and Magnolia Award from the Shanghai government.


Research Synopsis

Canadian Neonatal Network (CNN)

In 1995, I founded the Canadian Neonatal Network, which now includes all 29 tertiary level NICUs from across Canada. The objective of the network is to foster national collaborative research into neonatal care. Since 1995, more than 100 researchers and trainees from across Canada have participated in research projects through the Network, and international research collaborations have been formed wth researchers in the US and Australia. CNN is now recognized  as the prime organization for neonatal research in Canada. The network has successfully obtained research operating grants from federal and provincial granting agencies totalling over $20 million, and published over 100 manuscripts and 150 abstracts in peer-review journals. The Network has become a leader in neonatal clinical and policy research and is a recognized research entity both in Canada and internationally. In 2004, the Canadian Neonatal Network received the Knowledge Translation Award from the Canadian Institutes of Health Research. In 2012, I stepped down as Director and became Chair of the Governing Board, following my appointment as Scientific Director of the Institute of Human Development, Child and Youth Health at the Canadian Institutes of Health Research.

CIHR Team in Maternal-Infant Care (MiCARE)

Following the success of the Canadian Neonatal Network, I worked with colleagues in other disciplines to establish the Canadian Perinatal Surveillance Network, and to link its database with the Canadian Perinatal Network, Canadian Neonatal Network, Canadian Pediatric Surgery Network, Canadian Pediatric Pain Network, and the Canadian Neonatal Follow-Up Network. The networks collaboratively established and maintain linked national databases that now track 85% of pregnancies in Canada, every high risk pregnancy admitted for tertiary perinatal care, every baby admitted to a neonatal intensive care unit, every baby needing surgery for selected conditions, and the neurodevelopmental outcomes of every high risk baby across Canada. This is the most comprehensive database of its kind in the world, and forms the basis of the Maternal-Infant Care (MICare) Network, which groups these networks together for research.

Evidence-based Practice for Improving Quality (EPIQ) for quality of care improvement

I led a national effort in Canada to develop a new Evidence-based Practice for Improving Quality (EPIQ) approach and demonstrated that it could reduce nosocomial infection rates by 44% and bronchopulmonary dysplasia by 15% in a multi-center trial at 12 Canadian NICUs. Following this, we extended EPIQ-2 to 26 NICUs across Canada, and demonstrated significant improvement in Canadian NICU outcomes (including 8% increase in survival without morbidity, 23% decrease in nosocomial infection, 23% decrease in retinopathy of prematurity, and 20% decrease in necrotizing enterocolitis). We are now conducting EPIQ-3 to further improve neonatal outcomes and transform neonatal care in Canada and internationally. The EPIQ method has now been adopted by over 100 NICUs in Europe, USA, Latin America, China, India and Malaysia.

Family Integrated Care (FiCARE)

I pioneered a new paradigm of care for the NICU called Family Integrated Care. Traditionally, nurses provide primary care for infants admitted to the NICU and although parents are encouraged to participate in care, they play a mainly supportive role. In FiCARE, parents become an integral part of the care team and provide all cares for the infant except for intravenous administration and procedures. They give reports during ward rounds, write medical charts and participate in daily patient management decision making. Nurses become teachers and counsellors for the parents instead of primary care givers. I led a pilot trial at Mount Sinai Hospital that demonstrated siginficant improvement in infant weight gain and breastfeeding rates, reduction in nosocomial infection, necrotizing enterocolitis and retinopathy of prematurity rates, and reduction in parent anxiety. I am now leading a multi-center trial in 30 NICUs in Canada, Australia and New Zealand. If the results are also positive, FiCARE will become the new standard of care in NICUs. I am also collaborating on additional trials in China and the US. The goal of this initiative is to shift the paradigm by embracing and empowering the family in care of patients. It may be that this philosophy can be extended beyond the NICU to other areas of health care and result in improved outcomes and reduced costs.

Institute of Human Development, Child and Youth Health, Canadian Institutes of Health Research

In 2012, I became the third Scientific Director of the Institute of Human Development, Child and Youth Health at the Canadian Institutes of Health Research. During the past two years, I oversaw the development of a new IHDCYH strategic plan that was developed through a national consultation with over 1,000 stakeholders. I am also leading the development of new major funding initiatives including an international cohort registry, a Signature Initiative in environmental health, a Strategy for Patient Oriented Research Network in Primary and Integrated Health Care, and an Innovating Childrens’ and Families’ Health Conference to promote child and family health research in Canada. I am also working to mobilize both CIHR and partnered funding for the IHDCYH strategic plan going forward.



CIHR Training Grant in Health Law, Ethics and Policy, Canadian Institutes of Health Research, 2001-2015, $3,700,000 (Co-I)

Canadian Child and Youth Health Research Clinician-Scientist Development Program, Canadian Institutes of Health Research, 2002-2015, $4,000,000 (Co-I)

MiTY Trial, Canadian Institutes of Health Research, 2010-2015, $1,580,000 (Co-I)

EPIQ-II, Canadian Institutes of Health Research, 2012-2016, $6,000,000 (PI)

Institute Support Grant, Canadian Institutes of Health Research, 2012-2015, $4,000,000 (PI)

Research Development Grant, Canadian Institutes of Health Research, 2012-2015, $600,000 (PI)

Family Integrated Care – Development and Introduction in Level II Hospitals, AHSC AFP Innovation Fund, $200,000 (Co-I)

Family Integrated Care in China, China Medical Foundation, 2014-2017, $135,000 (Co-I)


Publications and Awards

View PubMed search of this faculty member's recent publications.

Recent Publications

Lee SK, Canadian Neonatal Network EPIQ Study Group. Improving the quality of care in neonates - a cluster randomized controlled trial. CMAJ 2009. DOI 10.1503/cmaj.081727

Lee SK, Aziz K, Dunn M, Clarke M, Kovacs L, Ye XY. Transport risk index of physiologic stability, version II (TRIPS-II): A simple and practical neonatal illness severity score. Am J Perinatol. 2013;30:395-400

O’Brien K,  Bracht M, Macdonell K, McBride T, Robson K, O’Leary L, Christie K, Galarza M, Dicky T, Levin A, Lee SK. A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy and Childbirth 2013 DOI 10.1186/1471-2393-13-S1-S12
Bracht M, O’Leary L, Lee SK, O’Brien K. Implementing family integrated care in the NICU: A parent education and support program. Adv Neonatal Care 2013;13(2):115-125

Ko G, Shah P, Kovacs L, Ojah C, Riley P, Lee SK, Canadian Neonatal Network. Neighbourhood income level and outcomes of extremely preterm neonates: Protection conferred by a universal health care system. Can J Public Health 2012;103(6):443-47.

Bassil KL, Shah PS, Shah V, Ye XY, Lee SK, Jefferies AL, Canadian Neonatal Network. Impact of Late Preterm and Early Term Infants on Canadian Neonatal Intensive Care Units. Am J Obstet Gynecol 2013; DOI 10.1055/s-0033-1347364. ISSN 0735-1631.

Zhou Q, Cao Y, Lee SK, Cai XD, Chen C, Hu XJ, Huang CQ. Distribution and antibiotic sensitivity of pathogens in neonates with ventilator associated pneumonia. Chin J Perinal Med 2012;15(8):462-8

Qi Z, Cao Y, Jiang SY, Chen C, Hu XJ, Wang CQ, Lee SK. Efficacy of an Infection Control Programme in Reducing Ventilator-associated Pneumonia in a Chinese NICU. Am J Infect Control. 2013 Nov;41(11):1059-64. doi: 10.1016/j.ajic.2013.06.007. Epub 2013 Sep 1

Lee SK. O’Brien K. Innovation: Parents as primary care-givers for their infants in the neonatal intensive care unit. CMAJ cmaj.130818; April 7, 2014,doi:10.1503/cmaj.130818

Lee SK, Shah P, Singhal N, Aziz K, Synnes A, McMillan DD, Seshia M, Canadian Neonatal Network EPIQ Study Group. Association of a quality improvement program with neonatal outcomes in extremely preterm infants: A prospective cohort study. CMAJ 2014:DOI 10.1503/cmaj.140399

Lee SK, Aziz K, Singhal N, Cronin CM, Canadian Neonatal Network Partnerships for Health System Improvement (PHSI) Study Group. An Evidence-based Practice for Improving Quality (EPIQ) program has greater impact on improvement of outcomes than the use of clinical practice guidelines in neonatal intensive care units. Pediatr Child Health (in press)