Modules objectives and duration:

Overall Learning Objectives: 

By the end of this Neonatal Neuro-Critical Care program, participants will be equipped to:

 

  1. Assess neonatal brain health using tools such as cranial ultrasound, brain MRI, amplitude-integrated EEG (aEEG), conventional EEG, and near-infrared spectroscopy (NIRS).
  2. Diagnose and manage conditions including post-hemorrhagic ventricular dilatation, neonatal stroke, and hypoxic-ischemic encephalopathy (HIE).
  3. Implement neuroprotective strategies and contribute to quality improvement initiatives in neonatal neurocritical care.
  4. Perform comprehensive neonatal neurological examinations and utilize fetal monitoring techniques to help prevent HIE.
  5. Plan and conduct appropriate follow-up care to support optimal long-term neurodevelopmental outcomes in high-risk neonates.

 

Module 1: Conducting Research and Quality Improvement (estimated time to complete: 8 hours) 

            This course aims to provide a guide to paper writing, basic quality improvement methodology, understanding QI data, how to curate presentations towards your audience, and IVH prevention.  

Lesson 1: A Housewife Guide to Paper Writing 

Speaker: Dr. Susanne Benseler 

By the end of this lesson, participants will be able to:

  1. Apply specific prep-work required to get started on scientific manuscript writing 
  2. Conceptualize and structure the core components of scientific manuscripts
  3. Build transferable, fool-proof recipe for manuscript writing for people with multiple responsibilities 

 

Lesson 2: Basics of Quality improvement methodology 

Speaker: Dr. Stefani Doucette

By the end of this lesson, participants will be able to:

  1. Apply concepts of quality improvement and patient safety 
  2. Contrast QI methodology to that of traditional research 
  3. Identify key measurements used in QI work 

 

Lesson 3: Making sense of QI data 

Speaker: Dr. Ayman Abou Mehrem 

By the end of this lesson, participants will be able to:

  1. Explain the importance of QI data 
  2. Plan QI data collection 
  3. Classify QI data 
  4. Analyze and explain QI data 

Lesson 4:

Presentations “How to capture an audience...”

Presenter: Dr. Amelie Stritzke 

By the end of this lesson, participants will be able to:

  1. Explain how to prepare a scientific talk 
  2. Explain how to deliver a scientific talk effectively

            

 

Module 2: Neonatal Cranial Ultrasonography Online Course (5 hours)

            The overall objective of this module is to standardize point of care ultrasound training for paediatric residents and neonatal-perinatal fellows. To receive the certificate, individuals must complete six lessons. These lessons cover basics of cranial ultrasonography, preterm brain injury classification, ultrasound knobology, and neonatal cranial ultrasonography demonstration. This training is not meant to replace the need for ultrasound technicians and radiologists, it is crucial to retain the support from the radiology department and ultrasound technicians. 

  1. Lesson 1: Basics of cranial ultrasonography video

Speaker: Dr. Khorshid Mohammad 

By the end of this lesson, participants will be able to:

  1. Explain techniques and standard views of cranial ultrasonography 
  2. Recognize pros and cons of cranial ultrasonography 
  3. Explain normal and abnormal findings on cranial ultrasonography 

Lesson 2: Preterm brain injury classification 

Speaker: Dr. James Scott

By the end of this lesson, participants will be able to:

  1. Explain the status and impact of variability in preterm brain injury diagnosis 
  2. Explain common brain injuries identified by Cranial ultrasonography 
  3. Explain uncommon brain injuries and malformation by cranial ultrasound that can mimic common preterm brain injury 

Lesson 3: Ultrasound Knobology 

Speaker: Dr. Khorshid Mohammad 

By the end of this lesson, participants will be able to:

  1. Demonstrate the main machine functionality required to perform cranial ultrasonography 
  2. Explain the differences between types of probes and frequencies in the context of acquiring cranial ultrasound images 

Lesson 4: Neonatal cranial ultrasonography demonstration

Speaker: Dr. Khorshid Mohammad 

By the end of this lesson, participants will be able to:

  1. Demonstrate performing cranial ultrasound study on a live infants
  2. Demonstrate maneuvers to optimize images
  3. Demonstrate ventricular size measurement technique

 

 

 

Module 3: Neurological Examination to Identify Neonates With HIE( 5 hours)

            The goal of this course is to standardize neonatal neurological examination conducted by NICU nurses, RTs, trainees, and bedside physicians. This training is to improve the identification of infants with moderate to server HIE eligible for Therapeutic Hypothermia. This course consists of seven lessons that will improve the identification process.

Lesson 1: Normal full neonatal neurological examination 

Speaker: Leah Foster, paediatric neuro-critical care nurse practitioner 

By the end of this lesson, participants will be able to:

  1. List  the components of the neonatal neurological examination 
  2. Demonstrate the components of the neonatal neurological examination

Lesson 2: Normal targeted neonatal neurological examination 

Speaker: Leah Foster, pediatric neuro-critical care nurse practitioner 

By the end of this lesson, participants will be able to:

1. Demonstrate normal targeted neonatal neurological examination

Lesson 3: Abnormal targeted neonatal neurological examination 

Speaker: Leah Foster, paediatric neuro-critical care nurse practitioner 

By the end of this lesson, participants will be able to:

1. Demonstrate abnormal targeted neonatal neurological examination

Lesson 4: Targeted neonatal neurological examination and other criteria to identify infants with HIE 

Speaker: Dr. Prashanth Murthy. Jeanne Scotland, Neonatal Nurse Practitioner  

By the end of this lesson, participants will be able to:

1. Explain therapeutic hypothermia eligibility criteria 

      2.Demonstrate eligible and ineligible cases 

 

Module 4: Neonatal Follow Up Essentials (4 hours)

            This course covers essential concepts in the neonatal follow up program. This module consists of three lessons that will improve clinical assessment of the essential concepts in the neonatal follow up program. 

Lesson 1: Principles of Neonatal Follow-Up 

Speaker: Dr. Leonora Hendson 

By the end of this lesson, participants will be able to:

  1. Describe key activities of a Neonatal Follow-Up Clinic 
    1. Clinical, audit, research, teaching
    2. Long term studies internationally 
  2. Describe a Canadian (Calgary, Alberta) context of neonatal follow up 

Lesson 2: Cerebral Palsy Essentials: diagnosis and treatment

Speaker: Dr. Amina Benlamri 

By the end of this lesson, participants will be able to:

  1. State the definition of CP and its risk factors
  2. Summarize pathway of diagnosis including early diagnosis of CP tools
  3. Explain principles of management of CP 

Lesson 3: Neurodevelopmental profile of children born extremely premature

Speaker: Dr. Elsa Fiedrich

By the end of this lesson, participants will be able to:

  1. Summarize historical context of prematurity & neonatal follow up 
  2. Examine Canadian neurodevelopmental outcomes of children born extremely premature
  3. Discuss Calgary Neonatal follow up clinic & outcome data
  4. Explore Preemie neurodevelopmental phenotype
  5. Acknowledge the family’s perspective on meaningful outcomes

 

Module 5: Neonatal Brain MRI Teaching Module (8 hours)

            The goal of this course is to familiarize individuals with common brain MRI abnormalities in neonates and develop a systematic approach to MRI interpretation. This module consists eight lessons that allow for the improvement of identification in common brain MRI abnormalities. This course does not replace the need for neuroradiology consultation and interpretation. 

Lesson1: Introduction to Neonatal Brain MRI

Speaker: Dr. Zarina Assis 

By the end of this lesson, participants will be able to:

  1. Summarize indications for neonatal brain MRI  
  2. Summarize RI imaging protocols 
  3. Explain different MRI sequences in relation to brain development, malformation and injury 

Lecture 2: Neuroimaging in Neonatal HIE and Stroke Lecture

Speaker: Dr. Xing-Chang Wei  

By the end of this lesson, participants will be able to:

  1. Recognize MRI patterns of neonatal hypoxic-ischemic encephalopathy
  2. Describe the prognostication value of MRI changes in HIE 
  3. List diseases mimicking HIE on neonatal MRI 

Lesson 3: Imaging in Neuroinfections and metabolic disorders in newborns 

Speaker: Dr. Zarina Assis 

By the end of this lesson, participants will be able to:

  1. Identify important features of imaging in neuro-infections in newborns
  2. Identify important features of imaging in neurometabolic disorders in newborns 

Lesson 4: Neonatal Brain MRI: A Practical Approach

Speaker: Dr. Khorshid Mohammad

By the end of this lesson, participants will be able to:

  1. Develop practical approach for neuroimaging in HIE 
  2. Develop practical approach for neuroimaging in neonatal stroke 
  3. Develop practical approach for neuroimaging in brain malformation
  4. Develop practical approach for neuroimaging in large ventricles

 

 

Module 6: Neonatal Brain Monitoring Teaching Module (9 hours)

            This course will allow individuals to familiarize themselves with the main available and clinically relevant Neonatal Brain Monitoring modalities. The eight lessons cover the basics of neonatal EEG, aEEG, EEG trends in newborn infants, neonatal seizure diagnosis and management, and neonatal cerebral NIRS application. 

Lesson1: Basics of Neonatal EEG Lecture

Speaker: Dr. Alice Ho 

By the end of this lesson, participants will be able to:

  1. Demonstrate the technique in recording of the neonatal EEG  
  2. Describe the principles of visual analysis of the neonatal EEG 
  3. Demonstrate the ontology of neonatal EEG from 26 to 42 weeks conceptual age 

Lesson 2: aEEG Basic and Beyond

Speaker: Norma Oliver  

By the end of this lesson, participants will be able to:

  1. Identify normal and abnormal aEEG background patterns for term infants 
  2. Identify features of electrographic seizures on aEEG
  3. Identify sources of aEEG artifacts  

Lesson 3: EEG trends in the newborn infant 

Speaker: Dr. Juan Pablo Appendino 

By the end of this lesson, participants will be able to:

  1. Describe advantages of EEG trends 
  2. Recognize limitations of EEG trends
  3. Recognize  normal and abnormal backgrounds on EEG trends 
  4. Recognize seizure diagnosis on EEG trends  

Lesson 4: Neonatal seizure diagnosis and management: a clinical perspective 

Speaker: Dr. Khorshid Mohammad

By the end of this lesson, participants will be able to:

  1. Describe  the pathophysiological mechanisms of neonatal seizure  
  2. Distinguish  the different clinical types of neonatal seizure  
  3. Describe  seizure-like events and be able to differentiate them from neonatal seizure
  4. State general principles of neonatal seizure management 
  5. Describe  the indications. Mechanism of action, usage of common anti-seizure medications 

 

 

 

Lesson 5: Neonatal electrographic seizure diagnosis

Speaker: Dr. Luis Bello Espinoza

By the end of this lesson, participants will be able to:

  1. Summarize key definitions and challenges of neonatal electrographic seizure   
  2. Summarize general aspects on the role of EEG in prediction of neonatal outcome  
  3. Discuss inter-rater reliability in neonatal electrographic seizure diagnosis 
  4. Describe  features of EEG only seizures 

Lesson 6: The Management of Neonatal status epilepticus 

Speaker: Dr. Eric Payne 

By the end of this lesson, participants will be able to:

  1. summarize neonatal status epilepticus definitions and epidemiology
  2. Recognize the need for continuous EEG monitoring and predictors of seizures  
  3. Discuss neonatal status epilepticus treatment evidence

Lesson 7: Seizures in the preterm brain

Speaker: Dr. Julia Jacobs-LeVan 

By the end of this lesson, participants will be able to:

  1. Describe how EEG reflects brain maturation in premature infants
  2. Identify pitfalls in premature EEG
  3. Indicate why seizures are less commonly recognized in premature than term infants
  4. Identify EEG patterns for seizure in premature infants 
  5. Discuss treatment and outcome of seizures in preterm infants 

Lesson 8: Neonatal cerebral NIRS application 

Speaker: Norma Oliver 

By the end of this lesson, participants will be able to:

  1. Describe Near Infra-Red Spectroscopy 
  2. Describe NIRS indications and applications in the NICU 

 

 

Module 7: Nursing Care of Infants with HIE Certification Module (10 hours)

            The overall objective of this course is to certify NICU nurses in providing comprehensive care to infants with hypoxia ischemic encephalopathy. This course reviews priorities and principles of managing patients undergoing therapeutic hypothermia and monitoring by means of amplitude integrated EEG and NIRS. 

Lesson 1: introduction to HIE

  • Speaker: Norma Oliver, Nurse Clinician and nursing co-lead of neonatal neuro-Critical Care program, Alberta Children’s Hospital,Jan Lind, Nurse Clinician and nursing co-lead of neonatal neuro-Critical Care program, Alberta Children’s Hospital

By the end of this lesson, participants will be able to:

  1. Identify the phases of energy failure leading to neuronal damage in the brain 
  2. Discuss the importance of prompt intervention within the therapeutic window
  3. Discuss the priorities of neuroprotective care
  4. Summarize current therapies and diagnostic tools for infants with HIE

Lesson 2: aEEG Basics and Beyond

Speaker: Norma Oliver, Nurse Clinician and nursing co-lead of neonatal neuro-Critical Care program, Alberta Children’s Hospital

By the end of this lesson, participants will be able to:

  1. To identify normal and abnormal background patterns for term infants
  2. To identify features of electrographic seizures on aEEG
  3. To identify sources of aEEG artifacts

Lesson 3:NIRS in the NICU

Speaker:Norma Oliver, Nurse Clinician and nursing co-lead of neonatal neuro-Critical Care program, Alberta Children’s Hospital

By the end of this lesson, participants will be able to:

  1. Describe Near Infra-Red Spectroscopy
  2. Summarize NIRS indications and applications in the NICU

Lesson4:Neuroprotective Nursing Care, More Than Just a Cool Cub

Speaker: Jan Lind, Nurse Clinician and nursing co-lead of neonatal neuro-Critical Care program, Alberta Children’s Hospital

By the end of this lesson, participants will be able to:

  1. Describe he concept of neuroprotection
  2. Identify the components of the HIBERNATION protocol
  3. Recognize the impact that nursing care can have on improved outcomes

 

 

 

Module 8: Post Hemorrhagic Ventricular Dilatation Diagnosis and Management( 3 hours) 

            This course will teach individuals about the diagnosis and management of PHVD, reservoir insertion, tapping, and post tapping care. This will be accomplished through five in depth lessons that are key to developing these skills.

Lesson1:  Preterm Brain Injury Lecture

Speaker: Dr. Hussein Zein

By the end of this lesson, participants will be able to:

  1. Explain the normal brain anatomy on ultrasound 
  2. Explain the classic preterm brain injury on ultrasound 

Lesson 2: Post Hemorrhagic Ventricular Dilatation in Preterm Infants 

Speaker: Dr. Lara Leijser 

By the end of this lesson, participants will be able to:

  1. Explain different methods and definitions of ventricular dilatation  
  2. Explain different approaches to PHVD 

Lesson 3: Reservoir tapping video:

By the end of this lesson, participants will be able to:

  1. Demonstrate the correct technique of Reservoir tapping   

 

Module 9: Neonatal Stroke Teaching Module by Dr. Adam Kirton ( 2 hours to )

 

By the end of this module, participants will be able to:

 

  1. Identify and diagnose acute stroke syndromes in the newborn.
  2. Outline and demonstrate strategies for neuroprotection in the newborn with acute stroke.
  3. Describe and apply interventions that can improve outcomes from perinatal stroke.

 

Questions

 

The most likely cause of neonatal arterial ischemic stroke is:

 

  1. Thrombophilia
  2. Placental embolism
  3. Congenital heart disease
  4. Birth trauma

Reference to correct answer: minute 5 in the lecture 

 

An immediately treatable cause of neonatal arterial ischemic stroke is:

 

  1. Congenital heart disease
  2. Hypoxic ischemic encephalopathy
  3. Bacterial meningitis
  4. Prothrombotic disorders

Reference to correct answer is minute 18 of the lecture 

 

An otherwise stable term newborn has focal seizures at 14 hours of life and you suspect stroke. Choose the optimal imaging you would request:

 

  1. Cranial ultrasound
  2. CT head
  3. CT head with contrast CTA/CTV
  4. MRI brain with addition of MRA and/or MRV if focal diffusion lesions are found

Reference to correct answer is minute 08:12

 

The presence of intracranial blood is an absolute contraindication to anticoagulation in neonatal CSVT.

 

  1. True
  2. False

Reference to correct answer is minute 12:00 in the lecture 

 

Intraventricular hemorrhage in a term newborn is most likely secondary to:

 

  1. Deep CSVT
  2. Germinal matrix hemorrhage
  3. Arteriovenous malformation
  4. Bleeding diathesis

Reference to correct answer minute 10:11 minute in the lecture

Neonatal hemorrhagic stroke is often secondary to birth trauma:

 

  1. True
  2. False

Reference to correct answer minute 15:50 minute in the lecture

 

Which of the following is NOT a neuroprotective strategy for acute neonatal stroke?

 

  1. Seizure monitoring and treatment with antiseizure medication
  2. Treatment of fever and infection including normothermia
  3. Normoglycemia
  4. Hypothermia

Reference to correct answer minute 16:48-19:00 minute in the lecture

 

When considering the continuation of antiseizure medication at the time of discharge in a newborn with neonatal stroke, which of the following is true:

 

  1. Medications should be continued due to high risk of early recurrence
  2. EEG can predict recurrence and should determine the need for ongoing medication
  3. Antiseizure medication should usually be discontinued as early recurrence is rare 
  4. Antiseizure medicines do not complicate parental care of a newborn with stroke

Reference to correct answer minute 19:20 minute in the lecture

 

Which of the following is NOT true regarding long term mental health morbidities for the entire family after neonatal stroke:

 

  1. Mom’s will often carry misplaced guilt regarding causation of their child’s neonatal stroke
  2. Post-traumatic stress disorder is a common adverse outcome for parents
  3. Most cases of neonatal stroke are preventable and medicolegal action can facilitate closure and understanding for parents 
  4. Perinatal stroke affects the entire family and rates of anxiety, depression, and marital discord are increased 

 

Reference to correct answer minute 23:30 minute in the lecture

 

 

 

 

 

 

 

 

 

 

Module 9: Neonatal Stroke Teaching Module by Dr. Adam Kirton ( 2 hours to )

 

By the end of this module, participants will be able to:

 

  1. Identify and diagnose acute stroke syndromes in the newborn.
  2. Outline and demonstrate strategies for neuroprotection in the newborn with acute stroke.
  3. Describe and apply interventions that can improve outcomes from perinatal stroke.

 

Questions

 

The most likely cause of neonatal arterial ischemic stroke is:

 

  1. Thrombophilia
  2. Placental embolism
  3. Congenital heart disease
  4. Birth trauma

Reference to correct answer: minute 5 in the lecture 

 

An immediately treatable cause of neonatal arterial ischemic stroke is:

 

  1. Congenital heart disease
  2. Hypoxic ischemic encephalopathy
  3. Bacterial meningitis
  4. Prothrombotic disorders

Reference to correct answer is minute 18 of the lecture 

 

An otherwise stable term newborn has focal seizures at 14 hours of life and you suspect stroke. Choose the optimal imaging you would request:

 

  1. Cranial ultrasound
  2. CT head
  3. CT head with contrast CTA/CTV
  4. MRI brain with addition of MRA and/or MRV if focal diffusion lesions are found

Reference to correct answer is minute 08:12

 

The presence of intracranial blood is an absolute contraindication to anticoagulation in neonatal CSVT.

 

  1. True
  2. False

Reference to correct answer is minute 12:00 in the lecture 

 

Intraventricular hemorrhage in a term newborn is most likely secondary to:

 

  1. Deep CSVT
  2. Germinal matrix hemorrhage
  3. Arteriovenous malformation
  4. Bleeding diathesis

Reference to correct answer minute 10:11 minute in the lecture

Neonatal hemorrhagic stroke is often secondary to birth trauma:

 

  1. True
  2. False

Reference to correct answer minute 15:50 minute in the lecture

 

Which of the following is NOT a neuroprotective strategy for acute neonatal stroke?

 

  1. Seizure monitoring and treatment with antiseizure medication
  2. Treatment of fever and infection including normothermia
  3. Normoglycemia
  4. Hypothermia

Reference to correct answer minute 16:48-19:00 minute in the lecture

 

When considering the continuation of antiseizure medication at the time of discharge in a newborn with neonatal stroke, which of the following is true:

 

  1. Medications should be continued due to high risk of early recurrence
  2. EEG can predict recurrence and should determine the need for ongoing medication
  3. Antiseizure medication should usually be discontinued as early recurrence is rare 
  4. Antiseizure medicines do not complicate parental care of a newborn with stroke

Reference to correct answer minute 19:20 minute in the lecture

 

Which of the following is NOT true regarding long term mental health morbidities for the entire family after neonatal stroke:

 

  1. Mom’s will often carry misplaced guilt regarding causation of their child’s neonatal stroke
  2. Post-traumatic stress disorder is a common adverse outcome for parents
  3. Most cases of neonatal stroke are preventable and medicolegal action can facilitate closure and understanding for parents 
  4. Perinatal stroke affects the entire family and rates of anxiety, depression, and marital discord are increased 

 

Reference to correct answer minute 23:30 minute in the lecture

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Module 10: Fetal monitoring to prevent HIE ( duration 6 hours):

 

This course will teach individuals about the perinatal asphyxia diagnosis pre and perinatally to better predict and prevent hypoxic ischemic encephalopathy 

Lesson1:  Basics of Fetal doppler changes Lecture

Speaker: Dr. Nancy Soliman

By the end of this lesson, participants will be able to:

  1. Describe the basic principles of fetal Doppler ultrasound and its role in assessing fetal hemodynamics and placental function.

 

  1. Interpret key fetal Doppler parameters including the umbilical artery, middle cerebral artery, and ductus venosus waveforms in common obstetrical scenarios.
  2. Recognize abnormal Doppler findings and understand their clinical significance in the context of fetal growth restriction and perinatal risk.
  3. Apply Doppler findings to guide timing of delivery and management decisions in high-risk pregnancies.

Lesson2 Basics of Fetal heart rate monitoring lecture

Speaker: Dr. Nancy Soliman  

By the end of this module, participants will be able to:

  1. Describe the components of a fetal heart rate tracing, including baseline rate, variability, accelerations, decelerations, and uterine activity.
  2. Differentiate between reassuring, indeterminate, and abnormal fetal heart rate patterns using a systematic interpretation approach.
  3. Recognize common causes of non-reassuring fetal heart rate patterns and their implications for fetal well-being. 

Lesson 3: Fetal Heart Rate Patterns and Perinatal Asphyxia by Dr. Barry Schifrin.

By the end of this module, participants will be able to:

  1. Explain the pathophysiologic relationship between fetal heart rate patterns and various stages of perinatal asphyxia.

 

  1. Critically assess the limitations of current fetal heart rate classification systems and their impact on clinical interpretation.
  2. Differentiate between normal and abnormal fetal heart rate responses to hypoxic stress using real-case tracings and physiologic context.

Lesson 4: Cord PH interpretation by Dr. Thierry Daboval

By the end of this module, participants will be able to:

  1. Describe the physiological principles behind cord blood gas values, including arterial vs venous pH, pCO₂, and base excess.
  2. Interpret cord pH results in the context of identifying perinatal hypoxia, acidosis, and potential neonatal compromise.
  3. Differentiate between respiratory and metabolic acidosis using cord gas parameters and understand their clinical implications.

 

Lesson 5: Understanding placental histopathological changes by Dr. Marie-Anne Brundler

By the end of this module, participants will be able to:

  1. Describe the key histopathological features of the placenta using the Amsterdam Classification, including maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), inflammatory lesions, and villous maturation disorders.

 

  1. Interpret placental pathology reports within the framework of the Amsterdam Classification to better understand the timing and potential causes of perinatal injury.
  2. Correlate classified placental findings with antenatal events, intrapartum factors, and neonatal outcomes to guide postnatal investigations and future pregnancy counseling.