Very preterm babies have an increased risk of ongoing medical complications and neurodevelopmental issues throughout their lifespan. New research suggests that a specially designed epigenetic “clock” can indicate abnormally accelerated molecular aging, which may be associated with these long-term impacts and warrants further study.
I have been working as a clinical neonatologist at C&W since 1984. Over the years my clinical practice has informed my research and my research has informed my clinical practice and my teaching. I have chaired and been a member of various clinical committees in the NICU.
Though my clinical interests encompass many topics pertaining to neonatology in general, my main area of interest is medical ethics. Nationally, I am a member of the Bioethics Committee of the Canadian Paediatric Society (CPS). Internationally, I started the Bioethics Interest Group at the Pediatric Academic Societies (PAS) Meeting in 2000 and I annually organize this group's meetings. I am a member of the Canadian Bioethics Society and the American Society of Bioethics and Humanities. A major aspect of my teaching portfolio is teaching ethics to medical students, residents and neonatal fellows. In July of 2010 I will take over as Director of the Neonatal Fellowship Program.
TACT: Teaching Antenatal Consultations at the Threshold of Viability
The antenatal consultation is a process that takes time and experience to learn and develop. To the best of our knowledge there is no literature evaluating the process of teaching this skill to Clinical Fellows or Subspecialty Residents. Despite the fact that there are clear objectives for adult students training in neonatology, there is no suggested curriculum or teaching strategies by the Royal College of Physicians and Surgeons of Canada or the American Board of Pediatrics.
Evaluation of a Facilitated, Structured NICU Care Conference Process
Care Conferences are a well-accepted forum to discuss challenging medical issues in the NICU. Historically, this venue has been for medical staff only. The model of family-centered care, to facilitate participation of parents in the care of their baby, has been embraced in neonatology. Despite widespread implementation of family-centered care, which has a focus on transparency of care, there are no published studies describing parental involvement in conferences where major issues regarding their baby’s care are being discussed. Moreover, parents often indicate that they wish to participate in care conferences. The purpose of this research is to evaluate whether or not a facilitated, structured Care Conference helps parents and staff in the NICU in their decision-making, and decreases the stress associated with critical decision-making for both parents and staff.
Development of a Fathers Support Scale
This program of research includes a series of three studies which aim to develop a valid and reliable Support Scale for Fathers in the Neonatal Intensive Care Unit (NICU). The first study was qualitative and examined the experiences and stresses of fathers in the NICU. Findings from this study, then informed the development of a scale to help caregivers determine support needs for NICU fathers. The second study established the content validity of the support scale, using experts and small user group of fathers to systematically evaluate the scale. The third and final phase (ongoing) is a large quantitative study which will establish the reliability (internal consistency, test-retest reliability), the concurrent validity and the clinical utility of the scale.
Minimization of Intralipid versus Omegaven
Premature babies often require an intravenously fed solution called Parenteral Nutrition (PN) to provide them with the nutrition they need to grow and develop. However, PN can have side-effects because some babies have difficulty processing certain components of the mixture. One of the side-effects observed from PN is cholestasis (accumulation of bile in the bloodstream) which results in liver damage. One of the reasons this condition may develop might be related to the lipid (fat) portion of the PN, but the problem is that babies, in particular, need fat in their diet. Without fat a baby will become malnourished and will not grow well. Enough fat is important for brain growth and development, but too much can damage the liver. The purpose of this study is to determine the effect of using a novel product, currently unapproved for use in Canada, called Omegaven, a fish-oil based lipid emulsion that may reduce damage to the liver versus minimizing our current soy-based lipid preparation in infants with parenteral nutrition associated liver disease.