Canada is a world leader in neonatal research

One more day of pregnancy can make a big difference in the life of a fetus—especially when there’s a risk of preterm birth.

A pregnancy typically lasts 40 weeks. A baby born before 37 weeks is considered preterm. Preterm birth is the leading cause of infant death in Canada, largely because vital organs have not had time to fully develop.

“Premature babies require a lot of care,” says Dr. Prakesh Shah, researcher and Pediatrician-in-Chief at Mount Sinai Hospital, part of Sinai Health in Toronto. “If they survive, they will need ongoing support for their brain, lungs and heart because those organs did not develop as they would have in the womb.”

Dr. Shah is the former Director of the Canadian Neonatal Network (CNN), one of three major initiatives funded by the Canadian Institutes of Health Research (CIHR) that have helped Canada become a global leader in neonatal research.

CNN was launched in 1995 because Canada was falling behind other developed countries in survival rates for preterm babies and in reducing serious complications such as brain injury, infections and lung disease. At the time, there was no standardized system across Neonatal Intensive Care Units (NICUs) for collecting or comparing data, and outcomes for preterm infants varied significantly between hospitals and provinces. CNN allows NICUs throughout Canada to learn from each other, improve outcomes using real-time data, and set national benchmarks for care.

“Every year, all 32 NICUs meet to share best practices,” says Dr. Shah. At those meetings neonatologists will ask things like: “Why is your infection rate lower? What are you doing differently? What can I take back to my own team to improve our results?”

This approach delivered positive results for Canada. Between 2004 and 2017, survival without major complications for babies born between 23 and 32 weeks increased from 56% to 70%. This improvement did not go unnoticed. As interest in Canada’s model grew, neonatal networks from other countries started reaching out, prompting Dr. Shah to launch the International Network for Evaluating Outcomes of Neonates (iNEO) in 2013. iNeo enables Canada to compare its outcomes with 13 other countries using a standardized data platform.

While iNEO opened the door to international collaboration, Dr. Shah still saw a gap within Canada’s own system. Despite improvements through the Canadian Neonatal Network, outcomes for preemies still varied widely across the country. In 2016 he launched the Canadian Preterm Birth Network (CPTBN). Where CNN focuses on care inside the NICU, CPTBN examines how care before birth, during delivery, and after discharge differs across hospitals and provinces, and how those differences impact babies’ outcomes.

One of CPTBN’s key contributors is Dr. Marc Beltempo, a physician-scientist and neonatologist at the Montreal Children’s Hospital. His research focuses on how small, evidence-based decisions—like when to clamp the umbilical cord after delivery—can have lasting effects on a newborn’s health.

“Tons of data show that when you wait at least 30 seconds, ideally a minute, before clamping, you’re improving the survival of the babies and it offers multiple other benefits,” he explains.” Canada was one of the first countries able to implement that practice widely because of our national network of disseminating, applying and evaluating new evidence in real-world settings.”

Together, CNN, iNEO and CPTBN have positioned Canada as a global leader in neonatal research, especially in data-driven quality improvement and health systems innovation. Their models have been adopted by other countries and cited in international policy reports. Dr. Beltempo attributes Canada’s success to the collaborative nature of the networks.

“When I see that 70% survival without complications, I see NICUs working together,” he says. “I see a country driven to do better for the tiniest humans, our most vulnerable patients, helping them get healthier from birth to discharge, and beyond. And when I’m at our conference of 300 stakeholders, I see all the people in their NICUs behind them, ready to discuss the ideas they bring back and work together to make change. That kind of engagement is the true innovation. And that’s what we’ve exported most.”

At a glance

Issue

Every year, between 25,000 to 30,000 babies in Canada are born too soon; that’s about 1 in every 12 births. Preterm birth is the leading cause of infant death in the country, making it a significant public health concern.

Research

CIHR-funded researchers launched the Canadian Neonatal Network, the International Network for Evaluating Outcomes of Neonates and the Canadian Preterm Birth Network to standardize data collection and share best practices across NICUs. These collaborative networks have significantly improved survival rates and outcomes for preterm babies, positioning Canada as a global leader in neonatal research and quality improvement.