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.