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Neonatologist's unique vision ushering in practice change

Doctor Souvik Mitra

In May of 2022 IWK neonatologist, Dr. Souvik Mitra, spoke before Canadian Parliamentarians as one of the best and brightest health researchers and innovators the country has to offer. As a Game Changer in Health Research and Health Innovation panelist his work is being celebrated for its promise to effect revolutionary change in human health and healthcare.

Mitra’s ongoing research explores whether simple, inexpensive drug treatments such as ibuprofen or acetaminophen can safely treat a potentially devastating heart condition called the patent ductus arteriosus (PDA) in extremely premature babies, thereby reducing the need for heart surgery.

“Deciding between which baby will need surgery or an intervention or will respond to surgery is a critical question,” says Dr. Santokh Dhillon, a pediatric cardiologist at the IWK Health. “Souvik is contributing to the solution.”

PDA is a common condition in preterm infants born earlier than 33 weeks of gestation, especially problematic in babies born extremely premature (born less than 28 weeks of gestation). Before birth, the aorta and the pulmonary artery are connected by the ductus arteriosus, a blood vessel essential to fetal blood circulation. Within minutes or up to a few days after birth, the vessel should close as part of the normal changes occurring in the baby’s circulation. In some babies, especially those born
premature, the ductus arteriosus remains open (patent). If the PDA is small and not interfering with blood flow then time may lead to a spontaneous closure. However, if it does not close on its own and starts affecting the baby’s circulation, drug therapy is necessary. Surgery is usually the last resort when multiple attempts at closing the PDA with drug therapy is ineffective.

Dr. Patrick McNamara, a world leader in neonatal hemodynamic research, established formal neonatal echocardiography training in Canada. In 2021 he and Mitra published a paper challenging the status quo on PDA clinical trials.

“Souvik is one of the rising stars in the field of neonatal hemodynamics,” says McNamara, Division Chief of Neonatology, University of Iowa and Chair of the Neonatal Hemodynamics advisory at the American Society of Echocardiography.  “His work on characterizing the effectiveness of treatments for PDA is globally regarded and is practice changing.”

According to the Canadian Neonatal Network Annual report 2020, 57 out of every 100 infants born before 28 weeks in Canada were diagnosed with PDA.

“The treatment of neonates has evolved and become increasingly advanced over the years and historically treatment was often directed by the preference or opinion of the physician,” says Nadine Grimm, a clinical pharmacist in the IWK’s neonatal intensive care unit (NICU). “While we will continue to see some variation, I believe Souvik’s work to engage current and former NICU families in discussions and research is key to living our mission of practicing family-centered care and ultimately improving outcomes for our patients.”

For both Mitra’s colleagues and the families of those tiny patients it is just as much his team-first approach that is changing the face of PDA care. Everyone’s opinion is valued and discussions about patient care are encouraged.

“Souvik’s vision of bringing patient family wishes and contributions into the conversation is unique and extraordinary,” says Dhillon. “In the past we may have been making decisions for these tiny little babies without knowing what the parents wanted.”

“I had the privilege of working with Souvik on his very first week on service and I remember being struck by how collaborative he was from the beginning, and how much he cared for the patients and families,” says Grimm.  “It was evident from the beginning that he would be very easy to work with and I felt then that he would bring a lot to the department of neonatology and to the IWK.”

Mitra looks for ways to make improvements by asking thought-provoking questions. And through research efforts he is working to make sure those improvements do happen.

“Based on this research we changed our practice at the IWK and began using high dose ibuprofen for treatment in our neonates,” says Grimm. “Other Canadian centres have followed suit. After having worked in NICU for almost 20 years at that point, it was very inspiring for me to see research being done at the IWK making an impact on our patients and bringing about change.”

“I have been fortunate to work closely with him on several PDA-related projects and have found Souvik to be a thoughtful and innovative clinical effectiveness researcher,” says McNamara. “He has a very bright future.”