Understanding the history of neonatal intensive care at HSC is necessary in order to get a complete history of women’s and maternal health. Neonatal care was part of Health Sciences Centre long before the official Intensive Care Nursery first opened at the Children’s Hospital in 1972. Although newborn care was not studied until the 1940s, neonatal intensive care operated out of the maternity wards as early as the mid-1910s. The opening of the Maternity Pavilion (later the Women’s Hospital), brought with it new methods and technology for the care of newborn babies before the majority of the work transferred to the Children’s Hospital in 1956. As of 2019, neonatal intensive care is distributed between Children’s Hospital, Thorlakson Building, and Women’s Hospital – a quarter mile apart – and special equipment is required to transfer newborn babies from one to the other. The present NICU structure will be amalgamating all of its resources into a new and expanded Neonatal ICU and Intermediate Care Nursery in the new HSC Women’s Hospital.
Also see our exhibit: History of Intensive Care at HSC.
Newborn Service/ Premature Nursery (predecessor to Neonatalogy), 1947
In the 1940s, Winnipeg General Hospital was handling several thousand obstetrical and gynecological cases each year. Newborn care was a new science; there were few incubators until 1949 and intravenous feeding was non-existent.
The Newborn Service Department was formed in 1947 under the direction of the Pediatrician and the Pediatric Staff; all newborn babies in the Obstetrical Department would benefit from their services. This change signified the beginnings of a long standing collaborative and supportive relationship between the Obstetrical nursing service and the Department of Pediatrics. The Department took on the responsibility of caring for premature and full-term babies requiring special care. Neonatal care was provided as early as 1949 through the use of oxygen hoods and incubators.
When the Maternity Pavilion opened in 1950, full-term and premature infants from the Maternity wards were transferred to a Premature Nursery. The Premature Nursery provided special care to infants weighing less than 5.5 pounds at birth. Although this unit was not officially an intensive care unit, the Premature Nursery provided specialized treatment to infants requiring extra care, usually as a result of blood sugar issues, problems with feeding, or prematurity.
At the same time, a special care unit for babies was operating at the old Children’s Hospital. In 1956, the Children’s Hospital moved to 685 Sherbrook Street and featured a Newborn Observation Room. This unit provided ventilation and intravenous therapy to infants. By the late 1960s, the unit was able to provide respiratory support for infants, as well as intravenous fluids and medications, and tube feeding. Around this time, the unit also began to be referred to as the Intensive Care Newborn Nursery. A tunnel served as a key link between the Children’s Hospital and Maternity Pavilion. Because care was provided in both institutions, many critically-ill babies were transferred by incubator from the Maternity Pavilion to the Intensive Care Nursery at Children’s Hospital.
The difference between the two areas was in the intensity of care required. The nursery at the Women’s Pavilion looked after healthy newborns, premature, or sick babies born in the Pavilion who were under observation or needing special care – for example Rh babies. The Intensive Care Nursery at Children’s provided sophisticated intensive care on a one-to-one basis to very sick babies throughout the province who required special therapy, blood work, x-ray, or micro-biochemistry.
Although the Premature Nursery at the Pavilion and Intensive Care Nursery in Children’s Hospital were physically separated, there was much cooperation and collaboration with the Department of Pediatrics in Children’s Hospital and the Department of Obstetrics and Gynecology. Traditionally, obstetricians looked after the newborns, and pediatricians were called upon in the event of a serious illness of a child. Now obstetricians, pediatricians, and neonatologists work together to manage newborn problems early in pregnancy.
Third and fourth year medical students were studying neonatal mortality and diseases of the newborn at Winnipeg General Hospital early in the 1950s. It was believed that more teaching regarding newborn babies was done at Winnipeg General Hospital than in any other hospital in Canada. In 1954, the Department of Pediatrics reported the lowest rate of neonatal deaths in their history – Dr. Medovy attributed this to the cooperation of the members of the Department of Obstetrics, Obstetrical nursing staff, attending pediatrics staff, and the senior residents who rotated from Children’s Hospital.
Research into newborn health began in earnest in the early 1950s with a Perinatal Mortality Study – completed in 1954 – which resulted in better care and diagnosis of neonatal illness. The study attracted attention within Canada and enhanced the excellent reputation of the Maternity Pavilion.
In the 1960s, Dr. Victor Chernick, Pediatrician-in-Chief and Head of the Respiratory Service, worked with a local respiratory company, Harco, to develop ways to monitor heart rate and body temperature of children and newborns. They also rigged a pediatric ventilator with a smaller circuit in order to provide ventilation to newborns. The Intensive Care Unit on 3 South of Children’s Hospital was used for any patient, pediatric or newborn, who needed assisted-ventilation. As early as 1958 they were able to measure arterial oxygen levels using the “Riley bubble” technique. In spite of these innovations the mortality rate for newborns needing assisted-ventilation was still 80-90%. A special team of physicians cared for all of the ventilated patients. This team included Dr. Chernick (respirologist), Dr. Gordon Cummings (cardiologist), and Joe Hyakawa (Anaesthetist).
In the early 1970s, a Neonatal Respiratory Control lab was built in the Women’s Centre (Maternity Pavilion/ Women’s Hospital) beside the Premature Nursery (Intensive Care Newborn Unit), specifically to investigate the control of the respiratory system during the neonatal period. Dr. Henrique Rigatto was the lead researcher, studying problems such as the relationship between period breathing, apneaic spells – where premature infants would stop breathing – and sudden infant death (SID) during the early months of life. It was hoped by doing research into the control of the respiratory system during the neonatal period, apneaic spells could be prevented.
Neonatal Intensive Care
Despite opening the Observation Room at the Children’s Hospital in 1956, neonatal intensive care did not officially begin until 1972, when the designated Intensive Care Nursery (ICN) was opened across the hall from the original observation room. The new ICN was a ten-bed unit with the capability of ventilating newborns.
The following year, in 1973, the Winnipeg Police Union donated newborn intensive care equipment to the unit, including four incubators and two negative pressure respirators. The respirators, developed by Dr. Chernick, were designed to assist the breathing of premature infants with Hyaline Membrane disease. Prior to the development of these respirators in 1971, the only method of treating infants with this disease was by positive pressure ventilation (blowing air into the lungs). Dr. Chernick’s new method used special respirators to provide continuous suction on the infant’s chest and allowed the deflated lungs to fill by normal respiration; it increased the survival rates of infants with this disease from 25% to 75%.
The High Risk Newborn Resuscitation Room on the Labour and Delivery unit was developed so newborns could be stabilized during the “Golden Hour” (the first hour after birth) before being moved to either the Children’s Hospital Intensive Care Nursery or the Intermediate Care Nursery in Women’s Hospital.
In 1984 the ICN expanded into an adjacent room to add two more beds to the unit. On 2 September 1986, a new Neonatal Intensive Care Unit (NICU) at Children’s Hospital officially opened. The Unit opened on the fourth floor of the old Children’s Hospital, and consisted of a 2,443 sq. ft. space with a capacity for eight isolettes (newborn incubators) and ten radiant warmer beds with overhead heater unit. These open beds allowed for several medical staff to attend to a baby at the same time. Arrangements were also made to ensure that the space was fully capable of computerized patient monitoring systems, to be installed at a later date.
The Unit also opened with 3,067 sq. ft. of support service space, which included a parent lounge, and mother-baby bonding room, a doctor’s call room, a 24-hour satellite pharmacy, a respiratory technology work station, a multi-purpose room, storage rooms, and patient/security call system. The new Unit replaced a 915 sq. ft. area that no longer provided optimal care for newborns.
In 2005 the Intermediate Care Nursery expanded to a third area in the Thorlakson Building in order to accommodate the growing number of babies requiring supportive care. This area consisted of two rooms which were formerly the Children’s Day Surgery Unit. Some renovations were required to allow for eleven newborn spaces which could support ventilators if needed. Soon after, all three neonatal areas were renamed to reflect the administrative changes. All three were now managed within the Child Health Program and became Neonatal Intensive Care Units with zones: Yellow Deer in Children’s Hospital CS4, Orange Bison in Thorlakson Building MS3, and 735 Notre Dame in Women’s Hospital WT1.
Neonatal Transport Program
Because of the separate buildings for neonatal care, HSC had to become experts in care and transport of newborns. Neonatal Transport Program was founded in 1981 by Dr. Henrique Rigatto, Director of the Neonatal Intensive Care Unit since 1972, and based out of HSC. The program was required to aid in the transportation of sick babies in and outside of the hospital, and developed equipment that was specially designed to do so.
The Program was established through provincial funding and implemented in two phases: Phase I began in July 1981 as ground transport serving an 80 mile (128 km) radius of Winnipeg. This distance was expanded to 100 miles (150 km) in February 1989. Phase II rolled out in May 1986, with the introduction of aircraft (Lifeflight–Manitoba Air Ambulance) and a back-up team, which included a list of physicians, nurses, and respiratory therapists who were willing to go on transports should the need arise. The ground transport team also picked up babies at the Winnipeg airport and other hospitals.
Originally, the transport team consisted of a physician and a nurse. With the advent of air transports in 1986 and the fact that the majority of transported newborns had respiratory problems, a registered respiratory therapist was added to the team. Nurses alone would support babies for return transports of stable, growing, premature infants to the facility of origin.
Within the first ten years of operation – after many stages of growth – it developed into a provincial program that benefits sick newborns from Manitoba, Northwestern Ontario, and Nunavut.
The Neonatal Transport team is often sent to isolated areas, sometimes having to travel by boat or snowmobile in order to reach the sick newborns requiring stabilization and transport to intensive care nurseries at HSC and St. Boniface General Hospital.
The Program has a long history of outreach: beginning in 1984, the Program sought to improve communication and rapport between itself and referring facilities, including onsite visits by the transport medical director and nurse coordinator, and participating in annual presentations on relevant topics in neonatology.
In 1998, staff developed a new ground transport incubator system to facilitate movement of newborns between sites within the hospital. The transport incubator has gone through a series of upgrades over the years, but is still essential for keeping newborn babies safe on their travels.
In the first 25 years of operation, the Team made 5,790 transports, which averages to about four to five transports per week. The Program implements outreach initiatives and training for hospitals in rural Manitoba to ensure care runs smoothly.
Health and Research
There have been many breakthroughs in neonatal health over its 80 year history. At the Winnipeg Rh Laboratory, Dr. Bruce Chown and his laboratory technician, Marion Lewis, conducted life-altering research on Rh blood antibodies, which contributed to the elimination of this threat by showing that the immune system was sensitized by the fetus bleeding into the mother. Individuals travelled from all over the world to get fetal treatment and neonatal management. In the 1960s, Dr. John Bowman and Chown helped to develop and test a vaccine: WinRho SDF. Chown was the first Manitoban to complete landmark research that led to the commercialization of a major new drug – work that ultimately laid the foundation for all research in the province to follow.
As noted above, in the early 1970s, Dr. Henrique Rigatto managed research into neonatal respiratory issues at the Neonatal Respiratory Control Lab. Rigatto studied the relationship between period breathing, apneaic spells, and Sudden Infant Death (SID) during the early months of life, so death and long-term ill-effects could be prevented. Research into neonate respiratory health continued in and outside of HSC. NICU staff continually strive to remain up-to-date on new theories and procedures to support newborn health.
In the early 2000s, the Association of Women’s Health, Obstetric and Neonatal Nurses, an organization of 22,000 health care professionals, developed a resource for the identification, treatment, and management of hyperbilirubinemia in newborns. Hyperbilirubinemia is a condition in which there is too much bilirubin in the blood. Bilirubin builds up in the blood and tissues in babies, who cannot easily rid themselves of it, resulting in jaundice. Nursing and staff at NICU learned and utilized this resource to mitigate risks in newborn babies.
Other research and management has been implemented for: Meconium Aspiration Syndrome (babies born in meconium-stained amniotic fluid who have meconium in their lungs), persistent pulmonary hypertension (where limited oxygen is sent to the brain and organs), postasphyxial pulmonary edema (accumulation of fluid in the tissues of the lungs), nutrition, neonatal sepsis (bacteria in the blood stream), and many more.
Neonatal Family Support Program
The Neonatal Family Support program began in October 2005. The program was developed by the Neonatal Developmental and Family-Centered Care Committee with the support of the Winnipeg Foundation. The program was created to provide peer support and connect parents whose babies are in the neonatal intensive care unit (NICU) with volunteers who have gone through the same experience. The volunteers can relate to what parents are experiencing and help them with whatever they need.
When the program began, the volunteer parents attended a workshop that provided them with training in helping parents cope. The training included teaching parent volunteers how to talk to people, listening skills, and respect for alternative care methods. Support was primarily provided over the phone, in person, or through email.
The program included weekly parent group meetings led by the Neonatal Clinical Nurse Specialist and one of the NICU social workers. These group meetings provided parents with opportunities to learn about infant care and ask questions. Often neonatologists, respiratory therapists, dietitians, physiotherapists, and occupational therapists attended to provide education and support. Families also interacted with each other and provided informal peer support.
The program operated in all of Manitoba’s NICUs: HSC Children’s Hospital, St. Boniface General Hospital, and Brandon Regional Health Care Centre. The volunteer parent aspect of the program continued until 2008, when funding was no longer available for a program coordinator. The weekly parent group meetings continued.
In 2018, funding for a coordinator was once more available, and the parent volunteer / veteran parent program began again. The focus has expanded to offer parents a specific “buddy”, or to interact with veteran parents who visit the unit and act as parent ambassadors. The veteran parents also organize special events and family group meetings. The program is offered at HSC and St. Boniface Hospital.
The New HSC Women’s Hospital
With the opening of the new HSC Women’s Hospital, the present NICU in Blue Dr. Goodbear, Yellow Deer, and 735 Notre Dame Avenue will be amalgamating all of their current neonatal resources into a new and expanded Neonatal ICU and Intermediate Care Nursery. This means that a convalescing mother and her newborn requiring special attention will be cared for in the same building, rather than in three separate buildings. Care units will feature private rooms and rooms to accommodate multiple births.
Doris Sawatzky-Dickson, Clinical Nurse Specialist in Neonatology and Clinical Lead for the new NICU in HSC Women’s Hospital, worked with the Nursing Leadership Team and helped the Project Management Team, architects, and design team for the new HSC Women’s Hospital before her retirement in 2018.
In total, there will be sixty beds organized around five pods. Each pod will have eight private neonatal rooms and two double rooms intended for twins, and its own supply and equipment storage areas for clean linen, supplies, respiratory, and other equipment. Each room will have observation windows and a live-feed camera for nurses to more easily monitor the babies. The pods will have a central team station with a med prep zone, DI station, and access to an emergency cart. The NICU will also include a pharmacy and infant nutrition prep area. The new NICU has made accommodations for families staying long-term, with a “family zone” featuring a kitchen, sleep area, and resource room. A brightly lit hallway, with several private areas and seating, brings in sunshine while keeping parents nearby. Private meeting spaces will also be available for consultative and educational purposes.
With the opening of the new HSC Women’s Hospital, the future of neonatal care has never looked brighter. Thanks to the enduring efforts of staff at HSC, neonates and their families will continue to receive the best care now and in future.