TORONTO
RESIDENT’S
HANDBOOK OF
NEONATOLOGY
FOR RESIDENTS BY RESIDENTS
FIRST EDITION
KATHERINE A. BOONE ◈ MAYA E. DAHAN ◈ ELISE M. HALPERN
MELISSA K. LORENZO ◈ DOUGLAS M. CAMPBELL
,Acknowledgements
We are grateful to the many contributors to this handbook including content experts, fellows, and
residents. We also acknowledge the tremendous neonatal expertise that exists within Canada outside
of our contributors and are grateful to the creators of Canadian paediatric guidelines that form the
foundation of this handbook. We would also like to thank the Toronto Centre for Neonatal Health for
supporting the free access and distribution of this handbook so that all Canadian residents and
paediatric practitioners can access this resource.
We would like to acknowledge the land on which the contributors to this handbook live and work.
For thousands of years it has been the traditional land of the Huron-Wendat and Petun First Nations,
the Seneca, and most recently, the Mississaugas of the Credit River. Today, Toronto is home to
Indigenous Peoples from across Turtle Island. Indigenous Peoples on the land now-called Canada
face social and political barriers to health related to systemic discrimination, both current and
historical. As a result, Indigenous Peoples have unique healthcare needs and can face challenges
related to healthcare resources. Resources related to Indigenous health, cultural safety,
reconciliation, and Jordan’s Principle can be found on the Canadian Paediatric Society website.
Preface
The Toronto Resident’s Handbook of Neonatology was created for residents, by residents. It is the
culmination of 2 years of work (2020 to 2022) by 27 residents, and 18 content experts based in
Toronto, Canada. It is meant to be used as a quick on-call reference for residents, study guide for final
year residents, and clinical resource for general paediatricians. The content is broadly applicable to
any Canadian context where neonates are cared for. Canadian Paediatric Society position statements
form the foundation of the content. In the absence of CPS statements, national / international
guidelines, hospital-specific guidelines, and expert opinion were used. Content references can be
found at the end of each chapter. The chapters represent an overview of common clinical neonatal
problems and are not meant to be in-depth detailed reviews. We endeavor to update the chapters
every 5 years.
Back to Table of Contents Page 2 of 212
,Table of Contents
Published 2022
Author Expert Reviewer
Common NICU Abbreviations Dr. Elise M. Halpern
Chapter 1 – Routine Newborn Care Dr. Erin Landau-Crangle Dr. Brian Simmons
Dr. Elise M. Halpern
Chapter 2 – Maternal Medical Dr. Norah MacMillan Dr. Rudaina Banihani
Illness
Chapter 3 – Antenatal Care Dr. Alessia Gallipoli Dr. Paige T. Church
Chapter 4 – Neonatal Dr. Dayae Jeong Dr. Emer Finan
Resuscitation and Procedures
Chapter 5 – Common Dr. Tanvi Agarwal Dr. Douglas M. Campbell
Neonatal Consults Dr. Celine Conforti
Dr. Katherine A. Boone
Chapter 6 – Routine Preterm Care Dr. Maya Dahan Dr. Eugene Ng
Dr. Mirriam Mikhail
Dr. Yolanda Scoleri
Chapter 7 – Fluid, Electrolytes, Jordan Mann, RD Dr. Christopher Tomlinson
and Nutrition Dr. Usamah Mohammed
Chapter 8 – Neurology Dr. Harry Chandrakumaran Dr. Vann Chau
Chapter 9 – Respirology Dr. Maya Dahan Dr. Michael S. Dunn
and Ventilation Dr. Alexandra Kilian
Chapter 10 – Cardiology Dr. Herman Bami Dr. Lynne E. Nield
Dr. Ali Lootah Dr. Dany Weisz
Dr. Elise M. Halpern Dr. Anica Bulic
Chapter 11 - General Surgery Dr. Ashna Asim Dr. Sharifa Himidan
Dr. Sasha Ayoubzadeh Dr. Christopher Tomlinson
Dr. Carlos Zozaya
Dr. Joshua Ramjist
Chapter 12 - Gastroenterology Dr. Carlos Zozaya Dr. Christopher Tomlinson
Dr. Joshua Ramjist
Dr. Melissa Lorenzo
Chapter 13 – Nephrology Dr. Priya Saini Dr. Seetha Radhakrishnan
Dr. Elise M. Halpern
Chapter 14 – Endocrinology Dr. Joshua Stanley Dr. Jonathan D. Wasserman
Chapter 15 – Hematology Dr. Sruthi Thomas Dr. Jillian Baker
Dr. Katherine A. Boone
Chapter 16 – Infectious Diseases Dr. Hassan Jamal Dr. Ari Bitnun
Dr. Katherine A. Boone
Chapter 17 – Congenital Dr. Ahmed Hassan Dr. Gregory Costain
Malformations, Syndrome, and
Inherited Metabolic Disorders
Chapter 18 – End of Life Care Dr. Katherine A. Boone Dr. Adam Rapoport
Page 3 of 212
, Editors
Katherine A. Boone, MBT, MD
Fellow in Paediatric Palliative Care
University of Toronto
Maya E. Dahan, MDCM
Fellow in Neonatal-Perinatal Medicine
University of Toronto
Elise M. Halpern, MSc, MB BCh BAO
Resident in Paediatrics
University of Toronto
Melissa K. Lorenzo, MD
Fellow in Paediatric Emergency Medicine
University of Toronto
Senior Editor
Douglas M. Campbell, MSc, MD
Neonatologist
Director of NICU
St. Michael's Hospital, Unity Health Toronto, Toronto
Medical Director Allan Waters Family Simulation Centre, Unity Health Toronto
Toronto Centre for Neonatal Health
Associate Professor, Pediatrics
University of Toronto
Back to Table of Contents Page 4 of 212
RESIDENT’S
HANDBOOK OF
NEONATOLOGY
FOR RESIDENTS BY RESIDENTS
FIRST EDITION
KATHERINE A. BOONE ◈ MAYA E. DAHAN ◈ ELISE M. HALPERN
MELISSA K. LORENZO ◈ DOUGLAS M. CAMPBELL
,Acknowledgements
We are grateful to the many contributors to this handbook including content experts, fellows, and
residents. We also acknowledge the tremendous neonatal expertise that exists within Canada outside
of our contributors and are grateful to the creators of Canadian paediatric guidelines that form the
foundation of this handbook. We would also like to thank the Toronto Centre for Neonatal Health for
supporting the free access and distribution of this handbook so that all Canadian residents and
paediatric practitioners can access this resource.
We would like to acknowledge the land on which the contributors to this handbook live and work.
For thousands of years it has been the traditional land of the Huron-Wendat and Petun First Nations,
the Seneca, and most recently, the Mississaugas of the Credit River. Today, Toronto is home to
Indigenous Peoples from across Turtle Island. Indigenous Peoples on the land now-called Canada
face social and political barriers to health related to systemic discrimination, both current and
historical. As a result, Indigenous Peoples have unique healthcare needs and can face challenges
related to healthcare resources. Resources related to Indigenous health, cultural safety,
reconciliation, and Jordan’s Principle can be found on the Canadian Paediatric Society website.
Preface
The Toronto Resident’s Handbook of Neonatology was created for residents, by residents. It is the
culmination of 2 years of work (2020 to 2022) by 27 residents, and 18 content experts based in
Toronto, Canada. It is meant to be used as a quick on-call reference for residents, study guide for final
year residents, and clinical resource for general paediatricians. The content is broadly applicable to
any Canadian context where neonates are cared for. Canadian Paediatric Society position statements
form the foundation of the content. In the absence of CPS statements, national / international
guidelines, hospital-specific guidelines, and expert opinion were used. Content references can be
found at the end of each chapter. The chapters represent an overview of common clinical neonatal
problems and are not meant to be in-depth detailed reviews. We endeavor to update the chapters
every 5 years.
Back to Table of Contents Page 2 of 212
,Table of Contents
Published 2022
Author Expert Reviewer
Common NICU Abbreviations Dr. Elise M. Halpern
Chapter 1 – Routine Newborn Care Dr. Erin Landau-Crangle Dr. Brian Simmons
Dr. Elise M. Halpern
Chapter 2 – Maternal Medical Dr. Norah MacMillan Dr. Rudaina Banihani
Illness
Chapter 3 – Antenatal Care Dr. Alessia Gallipoli Dr. Paige T. Church
Chapter 4 – Neonatal Dr. Dayae Jeong Dr. Emer Finan
Resuscitation and Procedures
Chapter 5 – Common Dr. Tanvi Agarwal Dr. Douglas M. Campbell
Neonatal Consults Dr. Celine Conforti
Dr. Katherine A. Boone
Chapter 6 – Routine Preterm Care Dr. Maya Dahan Dr. Eugene Ng
Dr. Mirriam Mikhail
Dr. Yolanda Scoleri
Chapter 7 – Fluid, Electrolytes, Jordan Mann, RD Dr. Christopher Tomlinson
and Nutrition Dr. Usamah Mohammed
Chapter 8 – Neurology Dr. Harry Chandrakumaran Dr. Vann Chau
Chapter 9 – Respirology Dr. Maya Dahan Dr. Michael S. Dunn
and Ventilation Dr. Alexandra Kilian
Chapter 10 – Cardiology Dr. Herman Bami Dr. Lynne E. Nield
Dr. Ali Lootah Dr. Dany Weisz
Dr. Elise M. Halpern Dr. Anica Bulic
Chapter 11 - General Surgery Dr. Ashna Asim Dr. Sharifa Himidan
Dr. Sasha Ayoubzadeh Dr. Christopher Tomlinson
Dr. Carlos Zozaya
Dr. Joshua Ramjist
Chapter 12 - Gastroenterology Dr. Carlos Zozaya Dr. Christopher Tomlinson
Dr. Joshua Ramjist
Dr. Melissa Lorenzo
Chapter 13 – Nephrology Dr. Priya Saini Dr. Seetha Radhakrishnan
Dr. Elise M. Halpern
Chapter 14 – Endocrinology Dr. Joshua Stanley Dr. Jonathan D. Wasserman
Chapter 15 – Hematology Dr. Sruthi Thomas Dr. Jillian Baker
Dr. Katherine A. Boone
Chapter 16 – Infectious Diseases Dr. Hassan Jamal Dr. Ari Bitnun
Dr. Katherine A. Boone
Chapter 17 – Congenital Dr. Ahmed Hassan Dr. Gregory Costain
Malformations, Syndrome, and
Inherited Metabolic Disorders
Chapter 18 – End of Life Care Dr. Katherine A. Boone Dr. Adam Rapoport
Page 3 of 212
, Editors
Katherine A. Boone, MBT, MD
Fellow in Paediatric Palliative Care
University of Toronto
Maya E. Dahan, MDCM
Fellow in Neonatal-Perinatal Medicine
University of Toronto
Elise M. Halpern, MSc, MB BCh BAO
Resident in Paediatrics
University of Toronto
Melissa K. Lorenzo, MD
Fellow in Paediatric Emergency Medicine
University of Toronto
Senior Editor
Douglas M. Campbell, MSc, MD
Neonatologist
Director of NICU
St. Michael's Hospital, Unity Health Toronto, Toronto
Medical Director Allan Waters Family Simulation Centre, Unity Health Toronto
Toronto Centre for Neonatal Health
Associate Professor, Pediatrics
University of Toronto
Back to Table of Contents Page 4 of 212
