How SickKids nurses are advancing neonatal brain care
Summary:
This Neonatal Nurses Week, meet three nurses whose specialized skills and leadership are advancing neurocritical care for newborns with complex neurological conditions while supporting families through some of their most challenging moments.
Inside the SickKids Neonatal Intensive Care Unit (NICU), Nurse Practitioner (NP) Yanina Falamarz begins a procedure called a reservoir tap on a preterm baby. While a bedside nurse gently steadies the baby's head, she carefully removes cerebrospinal fluid that has built up after a bleed in the infant's brain using a small reservoir placed beneath the scalp.
The procedure is used for premature babies with post-hemorrhagic ventricular dilatation (PHVD), a condition in which increased fluid in a cerebral ventricle causes pressure on a developing brain. Removing the fluid helps relieve pressure and protect the brain.
The procedure can take up to 30 minutes, because the fluid must be removed slowly and carefully. While she works, Falamarz teaches the nurses observing the procedure, explaining why the fluid accumulated, what signs to watch for and how to safely support the baby.
When a patient is stable and a parent or caregiver is present, this moment also gives her a chance to involve caregivers more actively in their child's care. The parent can hold and soothe their baby while Falamarz works, and she often encourages them to speak or sing to their child.
“You Are My Sunshine” is one of the popular choices among families, Falamarz says. The notes carry across NICU beds in the room, and she explains it’s now one of her favourite parts of the procedure.
Scottie was one of many patients who have received a reservoir tap from a specially trained group of nurse practitioners in the NICU, including Falamarz. Born at 24 weeks, she experienced a brain bleed shortly after birth. As fluid accumulated in the spaces within her brain, she was transferred from Sunnybrook to SickKids for surgery to place a ventricular access device (reservoir). Beginning at 27 weeks, the reservoir was tapped regularly to relieve the fluid and protect her developing brain.
Registered Nurse Serg Sister, and Nurse Practitioners Diane Wilson and Yanina Falamarz care for a patient undergoing therapeutic hypothermia (cooling therapy) in SickKids NICU.
"Scottie's mom was one of several parents who told me that singing during a reservoir tap was meaningful for her," says Falamarz. "Over time, I started encouraging more and more families to do it."
When Scottie’s parents arrived at SickKids, they were terrified by the prospect of surgery and unsure what their daughter’s future might hold. They remember nurses and physicians taking the time to explain each step, include them in decisions and care for Scottie with tenderness.
“At the beginning, we felt like we were drowning,” says Scottie's mother, Carli. “Coming here, with all the support and the care the nurses and doctors gave, it felt like we could breathe again.”
This is neonatal neurocritical care at SickKids. It is highly specialized care delivered through collaboration and vigilance. Above all, it’s putting families first, and encouraging them to play an active role in the care process, because the bond between families and their babies is crucial for recovery and development.
A small window of time to make a lifelong difference
The Neonatal Neurocritical Care Program at SickKids supports newborns with conditions affecting the brain and nervous system, including reduced oxygen to the brain around birth, seizures, stroke, bleeding in the brain and congenital brain differences. Their care may involve continuous brain monitoring, ultrasound, MRI, specialized treatments and developmental follow-up.
The program began in 2014 with Nurse Practitioner Diane Wilson and a shared vision from the neurology and neonatology programs. Wilson worked in the NICU and saw that SickKids already had neurocritical care expertise across specialties but felt that this patient group would benefit from the development of standardized processes and from having teams work together in a coordinated unit.
What started as a small team has grown into an interdisciplinary program involving neonatal nurses and nurse practitioners, neonatologists, neurologists, neurosurgeons, neuroradiologists, neurophysiologists and developmental follow-up specialists.
Between July 2014 and December 2025, the program supported more than 2,880 NICU patients. Today, approximately one quarter of babies admitted to the NICU receive care through the program.
“We have a small window of time with these patients to make a huge impact that can affect the rest of their lives,” Wilson says. “Things can change from one day to the next, and babies’ brains are still developing. It takes a dedicated team providing meticulous care, and NICU nurses play an integral role in that care.”
Weekly neurology rounds bring the disciplines together to review each baby’s clinical course, brain monitoring and imaging, align on treatment and discuss what the findings may mean for development. Just as importantly, the team considers how to communicate that information clearly and consistently to families.
Serg Sister, Registered Nurse in the NICU, co-chairs the Neuro Interest Group in the unit alongside Falamarz.
He first joined the group to expand his knowledge and experience caring for babies with neurological conditions. Today, he helps educate and support other nurses in the unit, reviews policies and brings practice changes into the NICU’s digital handbook.
One example is expanding opportunities for parents to hold their babies during therapeutic hypothermia, also known as cooling therapy. The treatment is often used for babies with hypoxic-ischemic encephalopathy (HIE), a type of brain injury caused by a lack of oxygen and blood flow around the time of birth.
These newborns are often critically ill and have to be transported urgently to the SickKids NICU soon after birth, meaning many parents do not always have the opportunity to hold their baby in those early moments. As a result, care practices that safely support parent-infant closeness during treatment can have a profound impact on families.
Falamarz and Serg Sister, Registered Nurse, prep a patient in the NICU for therapeutic hypothermia (cooling therapy).
"Studies have shown how important skin-to-skin contact is for babies," says Sister. "We found that even babies receiving cooling therapy and connected to specialized equipment, particularly those with mild-to-moderate HIE, can often still be safely held by their parents. So, the committee developed a process to help make that possible."
During the 72-hour treatment period, nurses carefully manage cooling therapy using a specialized cooling blanket and other equipment.
“Parents see all the equipment and may not know where they can touch their baby,” Sister says. “Now they are holding their babies, they understand why they are being cooled and we are creating those bonds earlier. We've spread this information across the unit, and nurses are taking the time to make that happen.”
For Wilson, Falamarz and Sister, this exemplifies the program’s impact, which they strongly believe is in the system built around every baby.
“That means making all care ‘brain care,’” says Falamarz. Alongside Sister, she encourages experienced and new nurses to bring emerging evidence to the bedside.
“Even small decisions, like clustering care so a baby can rest, managing light and sound or recognizing small changes supports a developing newborn brain.”
Beyond coordinating the program, Wilson and the team share SickKids’ approach with clinicians around the world who come here to develop their knowledge of neonatal neurocritical care, through an international neonatal neurology fellowship program.
“They recognize the work that we do and how we make an impact,” says Wilson. “And they want to take that back to their home countries and replicate what we’re doing here.”
For families like Scottie’s, that impact continues long after their time in the NICU. Wilson remains involved in Scottie’s care through follow-up appointments with the neonatal neurodevelopmental team, and just before her most recent appointment, Scottie surprised her parents by reaching a new milestone. She pulled herself up to stand for the first time.
“She's 16 months old now. It’s a miracle, how much she’s overcome,” says Scottie’s father, Stephen. “I don’t doubt her for a second. It just may take a little time, and that’s okay.”
Stories like Scottie's reflect the collective impact of the nurses and interprofessional team members who care for babies and families in the NICU every day.
"Behind every milestone an infant reaches is a team whose unwavering commitment to families makes the exceptional care we provide possible," says Christine Elliott, Quality Lead for the NICU.
This Neonatal Nurses Week, we recognize Wilson, Falamarz, Sister and all NICU nurses whose expertise and vigilance help support families and give newborns with complex conditions the strongest possible start.
"We are incredibly proud of the NICU team and the impact they make every day," says Andrea Riekstins, Senior Clinical Manager for the NICU. "We believe that 'Every Little Thing" matters (our team's tagline). Every action, no matter how small, can make a meaningful difference in a child's future."