December 2022 - Décembre 2022

Happy holidays season to all! Wish you wonderful moments surrounded by your loved ones. Let's remember to take some time for self-care, mindfulness and also be there as a support to our loved ones. We also shall remember all the families and patients that we care for, and I wish them the most beautiful holidays season despite being in the hospital - you are my source of inspiration and strength. Finally, wish to all a happy new year, filled of health, success, joy, happiness and achievements. Thank you for following the NeoCardioLab. I remain open to suggestions to augment the content of this portal in 2023!

Joyeuses fêtes de fin d'année à tous ! Je vous souhaite de merveilleux moments entourés de vos proches. N'oublions pas de prendre du temps pour prendre soins de nous même et nous ressourcer, d'être également là pour soutenir nos proches. Nous nous souvenons également de toutes les familles et des patients dont nous prenons soins, et je leur souhaite le plus beau des temps des fêtes malgré leur hospitalisation - vous êtes ma source d'inspiration et de force. Enfin, je souhaite à tous une bonne et heureuse année, remplie de santé, de réussite, de joie, de bonheur et de réalisations. Merci de suivre le NeoCardioLab. Je reste ouvert aux suggestions pour améliorer le contenu de ce portail en 2023 !

November 2022 - Novembre 2022

Updated content on the Bronchopulmonary Dysplasia - Pulmonary Hypertension section of the website with information regarding evaluation and long-term management. Some teasers of the new content available below. 

Mise à jour du contenu de la section Dysplasie bronchopulmonaire - Hypertension pulmonaire du site Web avec des informations concernant l'évaluation et la prise en charge à long terme. Quelques teasers du nouveau contenu disponibles ci-dessous.

I am now on Mastodon - Follow me. I am also on Twitter. Follow me!

Je suis maintenant sur Mastodon - Suivez-moi. Je suis également sur Twitter. Suivez-moi!

It was a pleasure to be part of the Déjeun'aide Breakfast with Leaders for the Montreal Children's Foundation.  This was organized by the Young Leaders Circles. The new video for the MCH foundation was presented at this breakfast, and we had the pleasure to meet some of the upcoming leaders in the Montreal community, mingling with current leaders. A great philantropy initiative, encouraging community involvement with the MCH at a young start in their career. 

Ce fut un plaisir de faire partie du Déjeuner'aide avec les leaders de la Fondation pour l'enfance de Montréal. Cela a été organisé par le Cercle de la relève. La nouvelle vidéo de la fondation de L'HME a été présentée lors de ce petit-déjeuner, et nous avons eu le plaisir de rencontrer quelques-uns des futurs leaders de la communauté montréalaise, se mêlant aux leaders actuels. Une belle initiative philanthropique, encourageant l'engagement communautaire auprès de L'HME à un jeune début de carrière.

C'est avec plaisir que je présenterai avec ma collègue Dre Audrey Hébert, néonatologiste au CHU de Québec, lors de la Journée provinciale de l'hypertension pulmonaire le 28 novembre 2022. Nous présenterons un portrait de l'hypertension pulmonaire chez les nourrissons prématurés : du nouveau-né à l'adulte. PDF joint ici, plus d'informations ici.

"De 500 g à 50 kg, l’impact cardiovasculaire de la prématurité à l’âge adulte" 

Objectifs : 

1. Se familiariser avec les impacts cardiovasculaires de la prématurité; 

2. Revoir le devenir à l’âge adulte des prématurés; 

3. Comprendre les effets à long terme de la prématurité sur la fonction cardiaque et pulmonaire.

Congratulations to Ms Amanda Ohayon for the presentation of her data on timeliness of fetal echcoardiography for congenital heart block detection in anti-Ro and Anti-La pregnancies at American College of Rheumatology. Her work was selected for an Ignite Talk and for a Press Release. Congratulations! Some pictures and the abstract posted here.

Félicitations à Mlle Amanda Ohayon pour la présentation de ses données sur le moment de l'évaluation par échocardiographie fœtale pour la détection du bloc AV congénital dans les grossesses anti-Ro et anti-La à l'American College of Rheumatology. Son travail a été sélectionné pour un Ignite Talk et pour un communiqué de presse. Toutes nos félicitations! Quelques photos et le résumé posté ici.

I have added a section on important articles for the care of newborns with congenital heart defect. 

J'ai ajouté une section sur des articles importants pour les soins des nouveau-nés atteints de malformation cardiaque congénitale.

October 2022 - Octobre 2022

New section on Neonatal ECMO 

Nouvelle section sur l'ECMO néonatal.

Presentation at SOGC-Quebec on resuscitation before 24 weeks of gestational age (In French)

Présentation à la SOGC-Québec sur la réanimation avant 24 semaines d'âge gestationnel (en français)

The patent ductus arteriosus in prematurity - Is it unethical to administer NSAIDs?

This is the first entry that I have done here that is more « blog-like » in its content. 

Disclaimer – this is only my own opinion, and I truly believe that we are all scientists that try to do the best appraisal of the evidence in order to provide the most optimal care to our vulnerable patient populations. 

After carefully reviewing the literature (some references below - 1 to 7, but there are 100s), I believe there are numerous publications outlining that 1000s of premature infants in randomized control trials have failed to show any benefits from exposing these newborns to prophylactic, early or targeted medications to attempt acceleration of ductal closure. Actually, the preliminary results of the Beneductus trial in Europe (presented at the Pediatric Academic Societies 2021 in Denver by Pr Willem de Boode), has demonstrated that there may even be an increase in harm when exposing extreme premature infants to early ibuprofen (even with a targeted approach). The study was very well done, and there was almost no open-label treatment. 

Could these medications be toxic, and not even provide any sort of benefit to these vulnerable infants? Possibly... And likely according to what I am getting from these studies. Is there a subgroup (very limited number of infants) that may benefit from accelerated closure by other means? Some of the studies looking at catheter-based approaches or paracetamol/acetaminophen are ongoing (but will unlikely show any benefits in my biased opinion). 

For all these reasons, I strongly believe that NSAIDs, are not the way to go. Our local practice has been to abandon the use of these toxic medications. They are known to cause systemic vasoconstriction (undifferentiated, reference 8-9, but there are so many articles on this). They are associated with increased spontaneous intestinal perforation, end-organ ischemia and renal dysfunction ( in part due to the renal hypoxic vasoconstriction that is sustained). 

Of course, any care bundles have to be taken into context. We do not just “ignore” the ductus, we have implemented successfully multiple care guidelines for our preterm newborns. We have an extensive golden hour protocol. We have trained all our health care professionals to be expert at the most extreme premature newborns (nurses, nurse practitioners, nutritionists, respiratory therapists, medical trainees, etc.). We have guidelines standardizing the care of our extreme premature population for the first week of life and beyond. We have clinical pathways standardizing ventilation, investigations, caffeine use, nutrition (with a rapid exposure to breastmilk and aiming to get to full feed in the first 7 days), etc. We are aggressive at obtaining breast-milk and promoting early and prolonged skin-to-skin care. Our rate of intubation in the delivery room (DR) is very low, and most of our newborns <29 weeks are brought to the NICU (including those <26 weeks) on bubble CPAP. With bCPAP, it is quite easy to install the cPAP in the delivery room and transport the baby to the unit. It is also a reliable way to sustain adequate peep, avoiding multiple disconnections and loss of FRC. (There is also some data that the frequency of oscillation, which changes with underlying pulmonary compliance, provides some benefits to the infant and more articles showcasing its benefits in the premature population). I have seen a dramatic drop in the need to intubate these infants (especially those born at 26 weeks and more). We even have newborns 23 weeks arriving to the NICU on bCPAP! These infants seem to have a much smoother transition (than what I was used to in my previous practice), as well as optimal recruitment and oxygenation. The drop of PVR occurs possibly more smoothly, allowing for less torrential left to right shunt via the ductus that eventually spontaneously constricts to various degree (until it finally closes at various ages, but often before 36 weeks). I scan almost all the <29 weeks infants in the unit at 10 days and 36 weeks, and it is extremely rare that the ductus is still patent.

We only provide intubation and surfactant in those infants with the most severe respiratory distress syndrome (our protocol has been published, references 10-11). As such, with FiO2 above 50% consistently (or other signs of significant respiratory distress or apneas), these infants get intubated and get surfactant. With a more selected population of infants exposed to surfactant, there is less acute drop in the pulmonary vascular resistance, which makes our rate of pulmonary hemorrhage low (6%) in our extreme premature population (same rate in the <26 weeks newborns). These events of pulmonary hemorrhage often occurs in infants that are outborn, and rarely yield to catastrophic decompensation since they are often these babies that remain intubated and found to have traces of blood upon suction. We do not restrict the total fluid intake (aiming 150-160 mL/kg/day total) and we aim for good nutrition for adequate growth and caloric intake. Patient gets ventilated in volume-guarantee when mechanically-ventilated and extubation occurs after the 72 hours window (in the <27 weeks newborns), once they do get intubated (we are often more rapid at extubating those 27-28 weeks infants, but they so rarely do get intubated in the first place to be honest). Extubation is deemed ready on a pulmonary perspective if FiO2 is <35%, mean airway pressure <10 and drive is present (that is not a set practice guideline). Infants that remain dependent on mechanical ventilation will receive low dose dexamethasone at >14 days (median 21 days of initiation) to get off mechanical ventilation. 

Initially, I was quite skeptical about the absence of medical attempt to close the ductus. It my hemodynamics mind, it did not make sense. I compared the rates of death or BPD of my unit to the ones of another unit and found that there may have been an increase of this rate after the adoption of the policy compared to the status quo in another unit. The other unit, though, had excessively higher rate of death or BPD all throughout the 2 periods (so very hard to increase when your baseline is already 80-90% death or BPD!). The rates of those infants exposed to a no NSAIDs policy, was still dramatically low in terms of death or BPD. Also, the unit adopting the conservative policy, had seen a dramatic increase in the admission of outborn infants 23-24 weeks in the 2015, 2016, 2017 period (following the move to a much bigger single-bed unit, fusing 2 previous units). As we all know, these infants are at the highest risk for death or BPD. The previous EPOCH using NSAIDs had very low numbers of infants born at 23 weeks (most of them being inborn and selected because of their "good profile" to survive). We now care for infants <25 weeks, <600 grams at birth that are born with already very significant medical burden (severe maternal hypertensive or rheumatological conditions, extremes of obesity or diabetes, maternal oncological processes, maternal ECMO, extremely severe growth restriction, twins with TTTS, triplets, etc.). We are the only center in my province that can provide ICU care to the mother with all subspecialty (liver/renal/cardiac/oncology), as well as all array of medical/surgical care to these infants. As such, we do attract some of the most complex cases. Also, as you all know, the association between prematurity-related averse outcomes is logarithmically associated with the degree of immaturity... so I did remain with a doubt in this relative increase in the outcome of death or BPD in the EPOCH 2...

As such, humble to dig more into the question, I recently published the updated follow-up data of our approach (adding the numbers of 2018 and 2019) since we moved to this new unit (single room). Our BPD rates kept on declining and they were actually were very good despite the high admission rate of infants 23-24 weeks that was maintained through the years. We had a 32% death or BPD in those <29 weeks… Further, we only had 7% of infants <26 weeks that had Grade 3 BPD as per the new NICHD classification! Looking at national rates, we have one of the lowest rate of mortality in this high risk population (despite those factors that I have exposed earlier regarding the complexity of the population we care for). These are amongst the best reported outcomes of this particularly vulnerable population in Canada. Our NEC rates are also consistently very low in this population as per our annual report. Our IVH rates are within national average (disclaimer: many of the <26 weeks outborn infants in our catchment area are re-routed to our centre, and as such, close to 20% of the <26 weeks admitted are outborns). The majority (>90%) of these infants underwent spontaneous closure. Since 2015, we have had only 1 premature infant (born <29 weeks) requiring a tracheostomy (and we have admitted since that time: 400 babies <29 weeks, out of which there are 40 infants <24 weeks, 50 at 24 weeks, and 60 born at 25 weeks). Further, we recently reported on our population with pulmonary hypertension, and compared to previous reports, our mortality rate within this subgroup was extremely low. There were only 24 infants with >2/3 systemic pulmonary pressure estimates at the 36 weeks echocardiography (out of a source sample of 387 infants, 8%). Reported literature quotes that mortality can be up to 25% in this subgroup, while only 3 infants did not survive among these 24...

For some reason, the PDA debate is very emotional for many. My physiological mind tells me that the left to right shunt through the ductus is probably not great for these infants with such vulnerable status in the post-natal setting. However, the attempt at accelerating its closure (with invasive methods, or with potentially toxic medications) does not confer an advantage and seem to be at their detriment. I am now quite confident about the approach of not using NSAIDS in this population. With all the studies out there, it is time to accept the null hypothesis and stop loosing so much resources, time, energy, money on studying yet-again NSAIDS that have been shown in countless well designed randomized studies to not benefit these babies! No matter how much we would like these medications to benefit them. At this point, one may argue that it is unethical to expose a patient to such medication. It is also not a judicious use of scarce research resources to try to enrol infants in yet another study that was already done, to replicate negative results (or worst, increase harm)

Regarding cath-closure, I am worried that we will be intervening on very small infants that are transitioning, potentially exposing them to interventional complications for no benefits. I hope to be wrong... I have seen some infants post-embolization of the occluder (not good)... I have also seen some premature infants loosing a limb due to vascular injury when attempting ductal closure at early age. I have heard some centres with mortality and low output from valvular injury, atrial rupture and sustained arrhythmia... 

These are my humble opinions, that will certainly trigger many disagreements ;). I more than welcome more discussion - My Twitter: @CardioNeo

After a little hiatus of a few weeks, here are some news of the NeoCardioLab.  

New resource available in English in the Families section:

• Birth Injury Center: A lot of resources regarding cerebral palsy, brachial plexus injury and other delivery complications - for families.  Would like to thank Rebecca Wilde Director of Outreach | Birth Injury Center, for bringing up to my attention this great resource for families!

Will be presenting at the Neonatal Hemodynamics webinar series on October 19th, 2022 on Congenital Diaphragmatic Hernia: Phenotyping Cardiovascular Profile to Provide Precision Management. To register here.

Congratulations to Justine Morin, Sam Amar and Daniela Villegas Martinez who represented the NeoCardioLab at the Congrès de la recherche Mère-Enfants!

September 2022 - Septembre 2022

Congratulations to Ms Amanda Ohayon for getting her abstract accepted to the American College of Rheumatology . Her abstract entitled “Timeliness of Fetal Echocardiography for Congenital Heart Block Detection in Anti-Ro/La-Positive Pregnancies” has been chosen by the ACR Communications and Marketing Committee to be highlighted in a press conference during ACR Convergence 2022, which will be held in Philadelphia, PA and virtually this year. Her Ignite Poster Session will occur on Sunday, November 13 from 10:25 AM - 10:30 AM. Abstract ID: 1290756. She will also have a Virtual Poster on Sunday, November 13 from 9:00 to 10:30 AM. Work co-supervised with Dr E. Vinet.

Félicitations à Mlle Amanda Ohayon pour l'acceptation de son abrégé à l'American College of Rheumatology. Son résumé intitulé "Timeliness of Fetal Echocardiography for Congenital Heart Block Detection in Anti-Ro/La-Positive Pregnancies" a été choisi par le comité des communications et du marketing de l'ACR pour être mis en évidence lors d'une conférence de presse lors de l'ACR Convergence 2022, qui se tiendra à Philadelphie, et virtuellement cette année. Sa session d'affiches Ignite aura lieu le dimanche 13 novembre de 10h25 à 10h30. Numéro du résumé : 1290756. Elle aura également une affiche virtuelle le dimanche 13 novembre de 9 h 00 à 10 h 30. Travail co-supervisé avec Dr E. Vinet.

Congratulations to Dr Marina Mir who got her abstract "Congenital heart defect newborns with diastolic steal have altered cerebral arterial Doppler profile during the transitional period" accepted for poster display during the 11th Annual Scientific Sessions of the Cardiac Neurodevelopmental Outcome Collaborative. Her Poster (#3) will be presented on Wednesday, October 26 from 5:45 pm – 7:00 pm during the Wine & Wisdom Walkaround Poster Session.

Félicitations à la Dre Marina Mir qui a vu son abrégé accepté "Congenital heart defect newborns with diastolic steal have altered cerebral arterial Doppler profile during the transitional period" pour la 11e session scientifique annuelle du Cardiac Neurodevelopmental Outcome Collaborative. Son affiche (#3) sera présentée le mercredi 26 octobre de 17 h 45 à 19 h 00 lors de la séance d'affiches Wine & Wisdom Walkaround.

Congratulations to Pierre Elias who got his abstract "Left ventricular dimensions and function by three-dimensional echocardiography are associated with brain injury in neonatal encephalopathy" accepted for poster display during the 11th Annual Scientific Sessions of the Cardiac Neurodevelopmental Outcome Collaborative. Her Poster (#3) will be presented on Wednesday, October 26 from 5:45 pm – 7:00 pm during the Wine & Wisdom Walkaround Poster Session.

Félicitations à Pierre Elias qui a vu son abrégé accepté "Left ventricular dimensions and function by three-dimensional echocardiography are associated with brain injury in neonatal encephalopathy" accepté pour présentation par affiche lors de la 11e session scientifique annuelle du Cardiac Neurodevelopmental Outcome Collaborative. Son affiche (#3) sera présentée le mercredi 26 octobre de 17 h 45 à 19 h 00 lors de la séance d'affiches Wine & Wisdom Walkaround.

I want to thank the Society of Obstetrician and Gynecology of Canada for inviting me to present on the extreme of prematurity at their next conference in Mont-Tremblant, on October 7th, 2022. I will be presenting on "Réanimation au limite de la viabilité et avant 24 semaines - une perspective néonatale"

Je tiens à remercier la Société des obstétriciens et gynécologues du Canada de m'avoir invité à présenter sur l'extrême prématurité lors de leur prochaine conférence à Mont-Tremblant, le 7 octobre 2022. Je présenterai sur "Réanimation au limite de la viabilité et avant 24 semaines - une perspective néonatale"

Congratulations to Dr Wael Abdelmageed who submitted his thesis in Experimental Medicine on the outcomes of extremely premature infants exposed to maternal hypertension (co-supervised with Dr Natalie Dayan).

Félicitations au Dr Wael Abdelmageed qui a soumis sa thèse en médecine expérimentale sur le devenir des grands prématurés exposés à l'hypertension maternelle (co-supervisée avec le Dr Natalie Dayan).

August 2022 - Aout 2022

Article fresh off the press: "The biventricular contribution to chronic pulmonary hypertension of the extremely premature infant". In this publication, post-doctoral student Dr Gabriela Nunes, describes how infants with BPD-associated pulmonary hypertension have altered right and left ventricular function at around 36 weeks of post-menstrual age. As such, contrary to many other forms of pulmonary hypertension, it does not seem to be an isolated RV disease (at least at the initial stages). Full article here: https://rdcu.be/cUkmB 

Learn more on the ongoing projects at the NeoCardioLab by click here. The NORDIC Program: Neonatal Outcomes Related to the early Discover of Impaired Cardiac function is composed of 3 multi-centric prospective research projects, over a 4 year period:

1. NORDIC-PREM: Pulmonary Hypertension Rate in Extreme preterm and the identification of its early cardiovascular Modifiers

2. NORDIC-SPEC: Surveillance of Postnatal steroids Effects on Cardiac function in extremely preterm infants with evolving lung disease

3. NORDIC-CDH: Exploratory Observational ECHO Prospective Study in CDH

En savoir plus sur les projets en cours au NeoCardioLab en cliquant ici. Le programme NORDIC : Issues néonatales liées à la découverte précoce d'une dysfonction cardiaque est composé de 3 projets de recherche prospectifs multicentriques, sur une période de 4 ans :

1. NORDIC-PREM : Taux d'hypertension pulmonaire chez les grands prématurés et identification de ses modificateurs cardiovasculaires précoces

2. NORDIC-SPEC : Surveillance des effets postnataux des stéroïdes sur la fonction cardiaque chez les nourrissons extrêmement prématurés atteints d'une maladie pulmonaire évolutive

3. NORDIC-CDH : Étude prospective observationnelle exploratoire d'échocardiographie dans l'hernie diaphragmatique congénitale 

July 2022 - Juillet 2022

I participated today to the Incubator Podcast! The podcast will be posted next week. I will be speaking about my upcoming presentation at NeoHeart 2022 - Neonatal Hemodynamics scientific year- in-review. If you have not checked out Incubator Podcast - now is the time! What they do is truly phenomenal. Their aim is to "improve access to evidence based practices, create connections within our community and provide frameworks for mental wellness for our colleagues and the families we serve". And they truly succeed at their mission! It was a real pleasure to participate with Dr. Daphna Yasova Barbeau, Dr. Rune Toms and Dr. Ben Courchia. You can also access the Podcasts on Apple Podcast here and on Spotify here. Check out their Twitter account for the last news about their upcoming podcasts.

J'ai participé aujourd'hui au "Podcast de l'incubateur" (Incubator Podcast) ! Le podcast sera mis en ligne la semaine prochaine. Je parlerai de ma prochaine présentation à NeoHeart 2022 - Bilan scientifique de l'année en hémodynamie néonatale. Si vous n'avez pas visité le site de "Incubator Podcast" - c'est le moment ! Ce qu'ils font est vraiment phénoménal. Leur objectif est "d'améliorer l'accès aux pratiques fondées sur des preuves scientifiques, de créer des liens au sein de notre communauté et de fournir un cadre de bien-être à nos collègues et aux familles que nous servons". Et ils réussissent vraiment leur mission ! Ce fut un réel plaisir de participer avec la Dre Daphna Yasova Barbeau, le Dr Rune Toms et le Dr Ben Courchia. Vous pouvez également accéder aux podcasts sur Apple Podcast ici et sur Spotify ici. Consultez leur compte Twitter pour les dernières nouvelles sur leurs prochains podcasts.

3D evaluation by 3D echocardiography in a premature newborn. More in the 3D section.

Some Echocardiographic Doppler Examples of ductal steal from the systemic to the pulmonary circulation. You may find these under the PDA section. 

2 news cases of echocardiographic examples of ALCAPA - Anomalous Left Coronary Artery from the Pulmonary Artery

2 nouveaux cas d'exemples échocardiographiques d'ALCAPA - L'anomalie de naissance de la coronaire gauche à partir de l'artère pulmonaire

I would like to highlight other important collaborations. 

A) With Dr Isabelle Malhamée and her team from the MUHC-RI (SARABI study on the impact of maternal preeclampsia on maternal and neonatal cardiovascular function)

B) With Dr Evelyne Vinet and her team from the  MUHC-RI (At Heart Matters - study on the impact of maternal lupus on maternal and neonatal cardiovascular function)

C) With Dr Maria V Fraga and her team from Children's Hospital of Philadelphia (Lung ultrasound in congenital diaphragmatic hernia).

D) The team of the RESETPDA study - P.I. Dr Dany Weisz at Sunnybrooke Hospital - University of Toronto. 

E) The team of the Comparative Effectiveness Trial on Dopamine vs Norepinephrine in neonatal sepsis (P.I. Dr Amish Jain, Dr Prakesh Shah, Dr Ashraf Kharrat).

F) The entre TnECHO Quebec Collaborative that is very involved in all the research collaborations in Quebec: Dr Audrey Hébert, Dr Anie Lapointe, Dr Andréanne Villeneuve, Dr Nina Nouraeyan, Dr Brahim Bensouda.

G) My collaborations with other Quebec sites and other researchers at the Montreal Children's Hospital. Other sites: CHU Sainte-Justine, Jewish General Hospital, Royal Victoria Hospital, Hôpital Maisonneuve Rosemont.

H) With Dr Marilyn Aita (Neuro-NQi project)

Juste de l'information importante concernant une de nos collaborations avec la Dre Natalie Dayan. Nous collaborons ensemble depuis quelques années sur un sujet important : la santé des femmes enceintes souffrant d'hypertension. Vous pouvez visiter le site de she MATTERS en cliquant sur le lien et en savoir plus sur mes autres collaborations ici.

« she MATTERS »: Améliorer la santé cardiovasculaire des nouvelles mères. Le projet « she MATTERS » (pour iMproving cArdiovascular healTh in new moThERS, soit améliorer la santé cardiovasculaire chez les nouvelles mères) vise à comprendre si une intervention liée à l’allaitement peut améliorer la pression artérielle et les marqueurs de risque métabolique chez les femmes ayant été récemment atteintes de troubles hypertensifs de la grossesse (THG). Les complications liées à la grossesse sont des facteurs de risque des maladies cardiovasculaires prématurées et des accidents vasculaires cérébraux spécifiques aux femmes. L’allaitement peut protéger contre le développement de l’hypertension et du syndrome métabolique. L’information découlant de ce programme établira les bases des approches personnalisées spécifiques au sexe et au genre dans la gestion de risque des THG.

All the publications of the NeoCardioLab are now available on PDF in the section Publications. 

Toutes les publications du NeoCardioLab sont désormais disponibles en PDF dans la rubrique Publications.

June 2022 - Juin 2022

Celebration at NeoCardioLab. Some of the students celebrating the graduation of Dr Shiran Moore! Thank you to Amanda Ohayon for the great cupcakes. You can see the team of students at NeoCardioLab here. 

Célébration au NeoCardioLab. Quelques-uns des étudiants célébrant la remise des diplômes du Dre Shiran Moore ! Merci à Amanda Ohayon pour les supers cupcakes. Vous pouvez voir l'équipe d'étudiants de NeoCardioLab ici.

May 2022 - Mai 2022

New section on probe position for acquisition of echocardiography standard views. Thanks to Dr Shiran Moore (neonatal hemodynamics fellow) and Pierre Elias (medical student). 

Nouvelle section sur la position de la sonde pour l'acquisition des vues standard d'échocardiographie. Merci au Dr Shiran Moore (fellow en hémodynamie néonatale) et Pierre Elias (étudiant en médecine).

The 11th McGill Neonatal Conference on Neonatal Cardiac Issues is now finished. You can find the slide decks and the recordings here. Thank you for attending!

La 11e Conférence néonatale de McGill sur les atteintes cardiovasculaires du nouveau-né est maintenant terminée. Vous pouvez trouver les diapositives et les enregistrements ici. Merci d'avoir participé!

New section for the families on Gastroschisis

Nouvelle section pour les familles sur le Gastroschisis

Case of May - Ex-premature infant found to have significant pulmonary hypertension at term corrected age. 

New section on pulmonary venous stenosis in the context of prematurity. Some images showcasing the appearance of acquired pulmonary veins stenosis by echocardiography and its assessment by Doppler (when not complete atresia). This section can be found under the tab of TnECHO. There is an increasing recognition of this entity which is severe and challenging to diagnose, prognosticate and manage. 

Nouvelle rubrique sur la sténose veineuse pulmonaire en contexte de prématurité. Quelques images montrant l'apparition d'une sténose acquise des veines pulmonaires par échocardiographie et son évaluation par Doppler (lorsqu'il n'y a pas d'atrésie complète). Cette section se trouve sous l'onglet TnECHO. Il y a une reconnaissance croissante de cette entité qui est grave et difficile à diagnostiquer, à pronostiquer et à gérer.

The recording of the recent webinar on The Future of Neonatal NIRS - Panel Discussion by the Neonatal NIRS Consortium is now available here. 

L'enregistrement du récent webinaire sur "The Future of Neonatal NIRS - Panel Discussion" par le Neonatal NIRS Consortium est maintenant disponible ici.

Two new publications by the NeoCardioLab: 

• "Early echocardiography predicts intervention need in antenatal suspicion of coarctation of the aorta" from Punnanee Wutthigate, Jessica Simoneau, Claudia Renaud and Gabriel Altit, published in "CJC Pediatric and Congenital Heart Disease". Available here.

• Yan ES, Chock VY, Bonifacio SL, Dahlen A, Guimaraes CV, Altit G, Bhombal S, Van Meurs K. Association between multi-organ dysfunction and adverse outcome in infants with hypoxic ischemic encephalopathy. J Perinatol. 2022 May 16. doi: 10.1038/s41372-022-01413-6. Epub ahead of print. PMID: 35578019.

REMINDER: You are invited to our XI Neonatal Conference of McGill University

We are pleased to announce our 11th McGill University Neonatal Conference.

Date:            Wednesday June 1, 2022

Title:             Neonatal Cardiac Issues

Time:            08:00 - 17:00

Venue:          Virtual  

Cost:             Free (without credits) or $50.00 per person (non-reimbursable) to obtain credits (Continuing medical education) along with a completed returned evaluation

Please click on our conference webpage for the program information: https://www.mcgillmchneonatalconference.com/

Please share the link of our website to your colleagues in the department/division such as the Pediatricians, Nurses, Respiratory Therapists, Residents, Fellows, Obstetrics-Gynecologists (nursery, ante/post-partum, delivery), Family Medicine doctors, Cardiologists, Pharmacists, trainees and anyone who would be interested in the current theme of the Conference.

To participate in this conference, please complete the registration form on the following website (please allow 5-10 seconds for the page to fully load) :

https://www.mcgillmchneonatalconference.com/inscription-registration

To be added to the conference mailing list: Click here

RAPPEL: Vous êtes invité à notre XI Conférence Néonatale à McGill

Nous sommes heureux d’annoncer notre 11ième conférence néonatale de l'Université McGill. Cette année, exceptionnellement, notre conférence sera virtuelle.

Date :            Mercredi, le 1 juin, 2022

Titre :            Problèmes cardiaques du nouveau-né

Heure :          8:00 - 17:00

Endroit :        Virtuelle 

Coût :            Gratuit (sans obtention de crédit) ou $50.00 par personne (non-remboursable) pour avoir des des crédits de formation continue avec une évaluation qu'il faudra soumettre

Veuillez cliquer sur le site web de notre conférence pour obtenir les informations sur le programme de la journée : https://www.mcgillmchneonatalconference.com/

Nous vous prions de partager ce site-web à vos collègues de votre département (ou de votre division) tel que les pédiatres, les infirmières, les inhalothérapeutes, les résidents, les cardiologues, les fellows / moniteurs cliniques, les apprenants, les technologues en imagerie cardiaque, les obstétriciens-gynécologues (pouponnière, ante/postpartum), les médecins de famille, les infirmiers et infirmières practiciennes, les pharmaciens et à tous ceux qui pourraient être intéressés par le thème de la conférence 2022. 

Afin de participer à cette conférence, veuillez remplir le formulaire d'inscription à la page suivante (SVP patientez de 5 à 10 secondes pour que la page se charge complètement): https://www.mcgillmchneonatalconference.com/inscription-registration. 

Pour être rajouté à la liste de distribution de la conférence: Cliquer ici

Please save the date for our next Neonatal NIRS Consortium webinar on Wednesday, May 18, at 10 am (Pacific)/ 12pm (Central)/ 1 pm (Eastern). The topic will be a panel discussion and open forum about the current state of neonatal NIRS monitoring and future directions for the field. To guide our discussions, please fill out this VERY BRIEF 6-question survey by clicking here. We hope you can join us for this opportunity to explore the state of neonatal NIRS monitoring and share your experiences, questions, and ideas with other leaders in the field of neonatal NIRS. We welcome additional input. Please find the Zoom invitation for the May webinar here.  Hope you all can join! 

Register in advance for this meeting: 

https://stanford.zoom.us/meeting/register/tJcudO2upjosEtfN48Z81HeMFuIDRLS_ERp0  

After registering, you will receive a confirmation email containing information about joining the meeting. 

Best regards, 

Valerie Chock and Zachary Vesoulis

April 2022 - Avril 2022

New section with cases in the congenital diaphragmatic hernia section, on LV hypoplasia and dysfunction in CDH

Nouvelle section avec des cas cliniques dans la section des hernies diaphragmatiques congénitales, sur l'hypoplasie du VG et la dysfonction cardiaque dans l'hernie diaphragmatique.

Join us for an amazing conference on congenital diaphragmatic hernia: https://www.cdh2022.com/ 

Joignez nous pour une conférence fantastique sur l'hernie diaphragmatique: https://www.cdh2022.com/ 

We have expanded the section of Tricuspid atresia.

Nous avons rajouté du matériel à notre section sur l'atrésie tricuspidienne.

You can see some of the Posters of the NeoCardioLab for PAS 2022 here. 

Vous pouvez voir certaines des affiches du NeoCardioLab pour le PAS 2022 ici.

April is Hypoxic Ischemic Encephalopathy awareness month! You can find more information here.

Avril est le mois de la sensibilisation à l'encéphalopathie hypoxique ischémique ! Vous pouvez trouver plus d'informations ici.

March 2022 - Mars 2022

The section on hypertrophy is now updated, and a case was added. 

La section sur l'hypertrophie est maintenant mise à jour et un cas a été ajouté.

Now a section dedicated specifically for our families going through therapeutic hypothermia for hypoxic ischemic encephalopathy (cooling), or with a diagnosis of congenital heart defect - for specific family-oriented resources.

Maintenant, une section dédiée spécifiquement à nos familles qui ont un enfant qui nécessitent un refroidissement thérapeutique ou avec un diagnostic de malformation cardiaque congénitale - pour des ressources spécifiques axées sur la famille.

You can now support the mission of the NeoCardioLab through a donation to the Montreal Children's Foundation by clicking here. 

Vous pouvez maintenant soutenir la mission du NeoCardioLab en faisant un don à la Fondation de l'hôpital de Montréal pour enfants en cliquant ici.

Fill our survey here.

Répondez à notre sondage ici. 

You can now register here for the McGill University - XIth Neonatal conference on Neonatal Cardiac Issues that will take place virtually on June 1st, 2022. The registration is free of charge, but there are registration fees for those requesting medical education credits.

Vous pouvez maintenant vous inscrire ici pour la XIe Conférence néonatale de l'Université McGill sur problèmes cardiaques du nouveau-né qui aura lieu virtuellement le 1er juin 2022. L'inscription est gratuite, mais il y a des frais d'inscription pour ceux qui réclament des crédits de formation continue.

New material on fetal congenital heart block, fetal supraventricular tachycardia, fetal cardiomyopathy with hypertrophy/pleural effusions/ascites in the fetal echocardiography section. 

Nouveau matériel sur le bloc auriculo-ventriculaire complet congénital detecté durant la vie fœtale, la tachycardie supraventriculaire fœtale, la cardiomyopathie fœtale avec hypertrophie/épanchement pleural/ascite dans la section d'échocardiographie fœtale.

We have updated our Disclaimer section. Please take the time to read it. 

Nous avons mis à jour notre section "Avis de non-responsabilité". Merci de prendre le temps de la lire.

We have now expanded our content on brain ultrasound in the POCUS section. 

Nous avons maintenant élargi notre contenu sur l'échographie cérébrale dans la section POCUS.

New section dedicated to Fetal Echocardiography now available. We have now posted an Atlas of a normal fetal echocardiography by views with clips and explanations. More to come on pathologies detected by fetal echocardiography. 

Nouvelle section déstinée à l'échocardiographie fœtale disponible. Nous avons maintenant mis en ligne un les vues pour une échocardiographie fœtale normale par vues avec extraits et explications. Plus à venir sur les pathologies détectées par échocardiographie fœtale.

New section on sketches of the echocardiography views. These sketches are also integrated in the section on normal neonatal echocardiography in the respective views.

Nouvelle section sur les croquis des vues d'échocardiographies. Ces croquis sont également intégrés dans la section sur l'échocardiographie néonatale normale, dans la description des vues respectives.

Join us at PAS-2022. Here are the abstracts - posters that will be presented by members of the NeoCardioLab team and collaborations. Posters will soon be posted here.

Abstract Title: Thrombocytopenia and neonatal outcomes among extremely premature infants exposed to maternal hypertension

Abstract ID: 1177473

Session Title: Neonatal Hematology & Bilirubin Metabolism I

Session Type: Poster Session

Session Date: Friday April 22, 2022

Poster Session Time: 6:15 PM - 8:45 PM

Abstract Title: Hemodynamic profile of neonates receiving sildenafil in addition to therapeutic hypothermia for neonatal encephalopathy

Abstract ID: 1176697

Session Title: Neonatal Cardiac Physiology/Pathophysiology/ Pulmonary Hypertension I

Session Type: Poster Session

Session Date: Saturday April 23, 2022

Poster Session Time: 3:30 PM - 6:00 PM

Abstract Title: Neonatal Cardiac and Intestinal Complications Associated with Diazoxide

Abstract ID: 1165537

Session Title: Neonatal Cardiac Physiology/Pathophysiology/ Pulmonary Hypertension I

Session Type: Poster Session

Session Date: Saturday April 23, 2022

Poster Session Time: 3:30 PM - 6:00 PM

Abstract Title: Non-interventional approach to PDA in preterm infants: time to look at the chronic pulmonary hypertension outcome

Abstract ID: 1163667

Session Title: Neonatal Cardiac Physiology/Pathophysiology/ Pulmonary Hypertension I

Session Type: Poster Session

Session Date: Saturday April 23, 2022

Poster Session Time: 3:30 PM - 6:00 PM

Abstract Title: Creatine Kinase Predicts Low Cardiac Output in Neonatal Hypoxic-Ischemic Encephalopathy

Abstract ID: 1175844

Session Title: Neonatal Cardiac Physiology/Pathophysiology/ Pulmonary Hypertension II

Session Type: Poster Session

Session Date: Saturday April 23, 2022

Poster Session Time: 3:30 PM - 6:00 PM

Abstract Title: Early Cardiac Function and Pulmonary Hypertension are Associated with Adverse Cardio-Respiratory Outcomes in Extreme Preterms

Abstract ID: 1177456

Session Title: Neonatal Cardiac Physiology/Pathophysiology/ Pulmonary Hypertension II

Session Type: Poster Session

Session Date: Saturday April 23, 2022

Poster Session Time: 3:30 PM - 6:00 PM

Abstract Title: Congenital heart defect newborns with diastolic steal have altered cerebral arterial doppler profile during the transitional period

Abstract ID: 1177173

Session Title: Neonatal Cardiac Physiology/Pathophysiology/ Pulmonary Hypertension III

Session Type: Poster Session

Session Date: Saturday April 23, 2022

Poster Session Time: 3:30 PM - 6:00 PM

Abstract Title: Reliability of echocardiography indices for patent ductus arteriosus evaluation among extremely preterm neonates by neonatologist experts in a national network

Abstract ID: 1175780

Session Title: Neonatal Cardiac Physiology/Pathophysiology/ Pulmonary Hypertension III

Session Type: Poster Session

Session Date: Saturday April 23, 2022

Poster Session Time: 3:30 PM - 6:00 PM

Abstract Title: Sildenafil administration to treat neonatal encephalopathy (SANE-01) and repair brain injury secondary to birth asphyxia: A randomized, double-blind, placebo-controlled pilot phase Ib study

Abstract ID: 1176761

Session Title: Neonatal Clinical Trials I

Session Type: Poster Session

Session Date: Saturday April 23, 2022

Poster Session Time: 3:30 PM - 6:00 PM

February 2022 - Février 2022

Free virtual course: "Echo-Morphology Correlations and Use in Surgical Decision-Making in Congenital Heart Disease" hosted by the SickKids Labatt Family Heart Centre from Friday, May 6 to Sunday, May 8, 2022. Register here.  ​

Cours virtuel gratuit : "Echo-Morphology Correlations and Use in Surgical Decision-Making in Congenital Heart Disease" animé par le SickKids Labatt Family Heart Center du vendredi 6 mai au dimanche 8 mai 2022. Inscrivez-vous ici.​ (En anglais seulement)

A great resource for families of newborns with a congenital heart defect (in english only for now): CHD Care Compass

Une excellente ressource pour les familles de nouveau-nés atteints d'une malformation cardiaque congénitale (en anglais seulement pour l'instant) : CHD Care Compass

Important new data on neurodevelopmental outcomes in children with congenital diaphragmatic hernia. Congratulations to Dr Pramod Puligandla (senior author and supervisor of this work), as well as Dr Mahdi Hassan (first author) and the entire collaboration of the multidisciplinary CDH clinic of the Montreal Children's Hospital. More manuscripts coming soon on this population of vulnerable children from this incredible collaboration at the MCH. 

Article: Hassan M, Patel D, LaRusso K, Koclas L, Smith-Morin Ot M, Shapiro AJ, Sant'Anna A, Altit G, Beauseigle S, Puligandla PS. Risk stratification helps identify congenital diaphragmatic hernia (CDH) infants in need of formal neurodevelopmental assessment: Observations from a structured, interdisciplinary long-term follow-up clinic. J Pediatr Surg. 2022 Jan 13:S0022-3468(22)00033-1. doi: 10.1016/j.jpedsurg.2021.12.048. 

Nouvelles données importantes sur les résultats neurodéveloppementaux chez les enfants atteints d'hernie diaphragmatique congénitale. Félicitations au Dr Pramod Puligandla (auteur et superviseur de ce travail), ainsi qu'au Dr Mahdi Hassan (premier auteur) et à toute la collaboration de la clinique multidisciplinaire CDH de l'Hôpital de Montréal pour enfants. D'autres manuscrits à venir sur cette population d'enfants vulnérables issus de cette incroyable collaboration à L'HME.

January 2022 - Janvier 2022

Updated section on Coarctation, on Truncus Arteriosus, on pulmonary atresia with intact ventricular septum and on double inlet left ventricle with new images. New congenital heart defect showcased: Right pulmonary artery originating from the Aorta.

Mise à jour de la section sur la coarctation, le tronc artériel commun, l'atrésie pulmonaire à septum intact et sur le ventricule gauche à double entrée avec de nouvelles images. Nouvelle malformation cardiaque congénitale présentée : artère pulmonaire droite issue de l'aorte.

New section on Bronchopulmonary Dysplasia - associated Pulmonary Hypertension now available. 

Nouvelle section sur l'hypertension pulmonaire associée à la dysplasie bronchopulmonaire maintenant disponible.

English:

Happy new year to all! A lot of exciting things in the pipeline for the NeoCardioLab upcoming in 2022. 

New ECG module here.

Please do not forget to subscribe to our Mailing List if you want the last news!

I would like to thank Dr Clara Song (@songMD on Twitter; Associate Physician, Neonatal Intensivist, Southern California Permanente Medical Group; Chair Elect at  the American Academy of Pediatrics, Section on Neonatal-Perinatal Medicine) for inviting me to present at the California Association of Neonatologists on January 11th, 2022 on the NeoCardioLab. 

Dr Shiran Moore will be presenting the site presentation at the Neonatal Hemodynamics Research Center - representing the Montreal Children's Hospital on 07/27/2022! She will be presenting on cardiac biomarkers in HIE - a project in collaboration with Dr Pia Wintermark and Dr Anie Lapointe. More information to come.

Really great workshop available online via the "Association des cardiologues du Québec" by Dr Jean-Marc Côté (CHU de Québec) and Dr Anne Fournier (CHU Sainte-Justine) on the Interactive interpretation of pediatric ECG tracings. This workshop is in French only. 

Français:

Bonne année à tous! Beaucoup de choses sont en préparation pour le NeoCardioLab pour 2022. 

Nouvelle section sur l'ECG

N'oubliez pas de vous abonner à notre liste de diffusion si vous voulez les dernières nouvelles !

Je tiens à remercier la Dre Clara Song (@songMD sur Twitter ; médecin associé, intensiviste néonatal, Southern California Permanente Medical Group; chair à l'American Academy of Pediatrics, Section on Neonatal-Perinatal Medicine) pour m'avoir invité à présenter à la California Association of Neonatologists le 11 janvier 2022 sur le NeoCardioLab.

Dr Shiran Moore présentera une conférence au Neonatal Hemodynamics Research Center - représentant l'hôpital de Montréal pour enfants, le 27/07/2022! Elle présentera sur les biomarqueurs cardiaques chez le nouveau-né avec hypoxie ischémie - un projet en collaboration avec Dre Pia Wintermark et Dre Anie Lapointe. Plus d'informations à venir.

Vraiment super atelier disponible en ligne via l'Association des cardiologues du Québec par Dr Jean-Marc Côté (CHU de Québec) et Dre Anne Fournier (CHU Sainte-Justine) sur l'Interprétation interactive des tracés ECG pédiatriques. Cet atelier est en français seulement.