The Newton Glassman Charitable Foundation Neonatal Intensive Care Unit at Mount Sinai Hospital is one of the largest tertiary care newborn centres in Canada, catering to a large number of high-risk and premature neonates. The Targeted Neonatal Echocardiography (TNE) program was established in 2011 and follows a consultative service model, where a request for consultation is initiated by the attending clinician on an as-needed basis and involves a comprehensive hemodynamic appraisal of the patient, including a TNE. Specific therapeutic recommendations derived from the clinical integration and interpretation of hemodynamic findings are then provided. Since its inception, this program has grown exponentially. On average, close to 500 neonatal hemodynamic consults are performed annually, including a high proportion of complex cardiopulmonary hemodynamic cases.
Sunnybrook Health Sciences Centre is a tertiary perinatal centre caring for over 150 extremely low birthweight infants annually. Targeted neonatal echocardiography (TNE) is seamlessly integrated within neonatal intensive care for critically ill infants, utilizing state-of-the art ultrasound equipment. This consultative service is provided by a faculty TNE expert and dedicated sonographer and performs approximately 450 TNEs annually.
The TNE program at SickKids is an integrated program involving the Neonatology and Cardiology Divisions. The pediatric echocardiography laboratory at SickKids offers hands-on training in pediatric echocardiography to all TNE trainees before transitioning into the TNE program. Trainees are involved in scanning, reporting and discussing management of hemodynamic problems in the NICU. The program offers hemodynamic rounds and research opportunities. Current research is focused on the development of novel techniques for assessing hemodynamics and cardiac function in newborns.
The neonatal intensive care unit at BC Women’s Hospital in Vancouver is the largest in the province. The NICU has 60 bed and cares for over 1,700 babies per year. Currently, there are two TNE trained neonatologists in our unit. We operate around 200 TNEs per year, with specific database and storage facilities built up in the hospital server. There has been an increasing demand lately for clinical, training and research needs to improve patient outcomes.
Stollery Children’s Hospital NICU, Royal Alexandra Hospital site, is a 69-bed level III NICU serving the large geographical landmass of Northern Alberta and Northern Territories as well as some parts of northern British Columbia. The TNE service was established in 2011 and the training program commenced in collaboration with the Pediatric Cardiology Program. On an average around 350 TNE scans/hemodynamic consults are done every year. Pediatric Cardiology services and TNE service work closely together collaborating in service provision and training.
The NICU at the Children’s Hospital, London Health Sciences Centre is a 47 bed Level 3 tertiary care center. We provide developmentally supportive intensive care to extremely premature, sick and at-risk neonates, and neonates who require surgical services. The clinical TNE program was established in April 2018 and in the last 2 years the program, has completed nearly 250 hemodynamic consults and assisted in guiding clinical care of very sick neonates. The local TNE program has set up an excellent collaborative model with the Division of Pediatric Cardiology.
The Montreal Children’s Hospital NICU is a 52 bed quaternary care unit that admits almost 1000 neonates yearly. The NICU at MCH is at once a perinatal unit and a referral center for the entire province of Quebec and cares for patients with surgical conditions, congenital heart defects, hypoxic ischemic encephalopathy, congenital diaphragmatic hernia and extreme prematurity. The MCH has an antenatal consult service and a transport service and provides fetal therapies, interventions and advanced neonatal care including: ECMO, cardiac surgery, neurosurgery, transplantation, dialysis and hematology-oncology.
The neonatal intensive care unit at CHU de Quebec cares for over 1500 babies per year of whom about 100 are less than 28 weeks. The TNE program was established in 2017 as a collaboration between the divisions of Neonatology and Pediatric Cardiology. Approximately 250 hemodynamics consultations are performed annually various hemodynamic issues such as PDA, pulmonary hypertension and diaphragmatic hernia amongst others.
The IWK Health Center is the largest Perinatal and Pediatric institution in the Atlantic Provinces. It serves as a referral center for complicated cases including cardiac and cardio-surgical patients. The 40-bed tertiary care Neonatal Intensive Care Unit at the IWK Health Centre is the largest NICU in the Maritime Provinces. The TNE Program at the IWK Health Centre was established in 2012 includes diagnosis and treatment of hemodynamically unstable neonates in collaboration with the Cardiology Division and IWK Echocardiography Laboratory.
CHEO is a tertiary care children's hospital that provides pediatric inpatient services in the Ottawa-Carleton region. The NICU at CHEO is a quaternary unit with a 21-bed capacity and approximately 350 admissions per year. All high-risk pregnancies in the region are managed at TOH, which has more than 3,200 births annually. The 27-bed Level III NICU at TOH has 750 admissions annually, of which 80-100 are ELBW. Hemodynamic consultations are provided around the clock in both NICUs in close collaboration with attending staff and trainees.
The CHU Sainte-Justine University Hospital is one of the largest mother-children hospitals in Canada with 65 level III-IV NICU beds and nearly 1200 admissions per year, including neonates with congenital malformation and extreme preterm infants (approximately 100-120 per year). Amongst the 17 neonatologists at CHU Sainte-Justine, two neonatologists with expertise intargeted echocardiography are co-leading clinical protocols and research collaboration in the field of neonatal hemodynamics. The TNE program at CHU Sainte-Justine follows a consultative service model.
The Neonatal Intensive Care Unit at Foothills Medical Centre, Calgary is one of the busiest tertiary care neonatal centres in Canada, with about 1200 admissions per year catering to a large number of high-risk and premature neonates in Southern Alberta. The Targeted Neonatal Echocardiography (TNE) program was started in 2010. The program has grown significantly is last few years with training of staffs and fellows. The TNE team get consultation from the attending physicians on daily basis and we do have 300-400 consultations per year.