Hello Friends 👋
Dr. Guilherme Sant’ Anna, a professor of pediatrics at McGill University, shares his journey in neonatology and his work in Brazil and Canada. He discusses the challenges and rewards of working in neonatal care and the differences between the healthcare systems in Brazil and Canada. Dr. Sant’ Anna also talks about the impact of the Neonatologia Brasil Facebook group, which he created to facilitate knowledge exchange among healthcare professionals in Brazil. He highlights the development of an educational website and the adoption of the 10 basic steps for neonatal care and perinatal asphyxia by the Brazilian government. Dr. Guilherme Sant'Anna emphasizes the importance of visiting units and seeing the reality on the ground to identify areas for improvement. He also discusses the concept of a Smart NICU, which aims to simplify monitoring and improve the interaction between babies, families, and healthcare professionals. In closing, Dr. Sant’Anna offers advice for those wanting to make a difference, emphasizing the importance of sharing knowledge and approaching change with optimism and respect.
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Resources mentioned in episode:
Neonatologia Brazil facebook group https://www.facebook.com/groups/neonatologiabrasil/?locale=pt_BR&_rdr
Contact: guilherme.santanna@mcgill.ca
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Short Bio: Dr Guilherme Sant’Anna is a Full Professor of Pediatrics, Faculty of Medicine, McGill University. He did his medical school and residency in Pediatrics/Neonatology in Rio de Janeiro, Brazil where he worked as a neonatologist from 1997 to 2001. Dr Sant’Anna went to McGill University in 2001 for his PhD studies in respiratory physiology under the supervision of Dr J. Mortola. From 2002 to 2004 he did a fellowship in Neonatal Perinatal Medicine at McGill University. After that, he worked for 4 years as Associate Prof of Pediatrics at the Neonatal Division at McMaster University before moving back to McGill University. Dr Sant’Anna is actively involved in education and has participated and organized several national and international meetings.
His research interests are to better understand and optimize the respiratory assistance in preterm infants and the use of innovation and new technologies in neonatal intensive care. In collaboration with Biomedical Engineering and Computer Science at McGill University, and multiple international collaborations, he is working on the development of a SMART NICU/HOSPITAL by using wireless technology and advanced monitoring systems.
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The transcript of today's episode can be found below 👇
Mbozu Sipalo (00:02.295)
Welcome everyone. Welcome to another episode of the Global Neonatal Podcast. We're excited to bring you another interview today. Today we have with us Dr. Gilherme Santana. In the interest of time, I will provide a brief introduction, but we'll have his more extensive bio in the show notes. So Dr. Gilherme Santana is a full professor of pediatrics at McGill University in Montreal, Canada.
Originally from Rio, Brazil, he trained and began his career in neonatology in Brazil before earning a PhD in respiratory physiology at McGill. After completing his fellowship in neonatology, he served as an associate professor at McMaster University before returning to McGill in 2008.
Dr. Santana's research focuses on optimizing respiratory support in preterm infants and developing a smart NICU hospital using wireless technology and advanced monitoring systems in collaboration with BioMed Engineering, Computer Science and international partners. He's actively involved in education and has participated and organized several national and international meetings. Welcome to the podcast, Gilherme.
Mbozu Sipalo (01:33.473)
Shelly Ann, you're also muted.
Shelly-Ann Dakarai (01:38.762)
Sorry about that, yes. So we could just edit that part out. So we didn't hear anything you said, because I had muted you. Do you see where you can mute and unmute yourself?
Guilherme Sant'Anna (01:48.397)
Yes.
Shelly-Ann Dakarai (01:49.738)
Perfect. So yes, so because you don't have earphones, so just mute yourself when she's talking and then unmute. So let's go back from when Embo Zu said, welcome to the podcast and we'll just edit that part out. Thanks.
Mbozu Sipalo (02:02.999)
Sorry, Dr. Santana, could you please pronounce your name for me again? I hope I'm getting it right.
Guilherme Sant'Anna (02:09.196)
No, it's okay, that's no problem, it's Guilherme Santana.
Mbozu Sipalo (02:11.721)
Okay, okay, so we will start again from welcome to the podcast.
Mbozu Sipalo (02:33.055)
Welcome to the podcast Yes, okay, it's time for you to speak now welcome to the podcast
Guilherme Sant'Anna (02:33.228)
Is it time for me to stop?
Shelly-Ann Dakarai (02:40.318)
Yes.
Guilherme Sant'Anna (02:44.718)
Thank you. Thank you for having me. It's a pleasure to be here talking to you.
Mbozu Sipalo (02:48.789)
All right, thank you, thank you so much. Shellyanne, how are you doing today?
Shelly-Ann Dakarai (02:53.608)
I'm great, so excited for this conversation today. I feel like we've worked our way across the globe and now we're gonna hear a little bit about stuff in Brazil. So we're down in South America now, so I'm excited to hear a little bit about that.
Mbozu Sipalo (03:06.507)
Yes, equally excited to hear about Keheme's work in Rio and in Canada as well. All right, so just to get our interview started, can you tell us a bit about what prompted you to pursue neonatology and just the background of your passion for neonatology?
Guilherme Sant'Anna (03:29.27)
Yeah, sure. It's an interesting question. I have to go back a few years. I always wanted to be... When I was in med school, I always wanted to be in urology. I don't know exactly why, but I do not think about any other specialty in medicine.
When I was on my internship, I started to do some calls into the normal nursery, taking care of babies, and then moved into pediatrics and NICU right away. So it's something that, you know, I think it's a privilege. I used to say that to people in Brazil, take care of babies when they are born, take care of them in the NICU or the nursery with families.
is not a job, it's a privilege we have because it's a real pleasure to do that. It's challenging, but it's very rewarding.
Mbozu Sipalo (04:33.633)
I love that. I love you saying that it's a privilege to work with babies. And that's something that we need to hear more of. Thank you for sharing that beautiful reflection. Following on your training in Brazil, you worked for some time there. Can you tell us a bit about your natal care at your institution in Brazil at the time that you were working there?
Guilherme Sant'Anna (04:56.27)
Yes, absolutely. I worked in many different places back there. I finished med school in 1988 and did residency in pediatrics and training in neonatology in Brazil. And when I finished all that in 1992, I stayed working in Brazil until 2001.
So it's basically nine years there as a pediatrician and a neonatologist. So I had the opportunity to work in a few different places and get to know at that time, it's about 30 years ago, how was neonatal care there. Brazil has a very mixed healthcare system. know, they do have...
private hospitals, have foundations, have hospitals supported by charity, and they have public hospitals and university hospitals. So there are local public that belongs to the city, some belongs to the state. So it's very mixed. And of course, when you have...
a system like that to navigate the system, it's not simple, it's complex. I worked most of my time in a university public hospital, which there is a bit more academic work because of the nature to be in a university, belongs to a research institution.
But since I started to be more proactive in teaching my friends, Brazilians, I got to know pretty much the whole country system. So I traveled a lot. It's a big country and I've been in many different places. The last time I was able to count, I visited more than 60 different NICUs across the country.
Guilherme Sant'Anna (07:06.174)
number of cities and states. So I feel like I pretty much have a good understanding on the major difficulties that our colleagues face when they're taking care of babies there. And I used to tell them it's much easier for me here in Canada to practice neonatology and obtain good results than what you guys do there facing all the obstacles, the challenges that they have.
Guilherme Sant'Anna (07:40.142)
Overall, I can tell you my perception is that it's an unbelievable dedication from nurses and physiotherapists and respiratory therapists and psychologists, dietitians, know, everybody that works works in a non -optimal condition with many times lack of equipment.
for no payment, the compensations are not very high, and they do a lot of work with their heart and a lot of dedication and creativity to solve problems. So every time I go there, I come back impressed to see how people are willing to make a difference.
Shelly-Ann Dakarai (08:28.084)
Thanks for sharing that. So I know you worked in Brazil, you said, for nine years, and you gave us a little overview of what the neonatal system was like at the time. Before we get too far into our discussion with what you've been able to help to do there and some more of your interests, for those who might not know a little bit about Brazil, can you speak to us a little bit about your country in itself outside of the healthcare system?
Guilherme Sant'Anna (08:53.582)
Yeah, it's a beautiful place. It's big. I think the Brazilian population now it's 225 million people. There are many states. It's a republic system. So you have a president and it's a democratic country. So it's elected by the people. There's a huge coast, beautiful areas they have to visit.
And the population is pretty young. So you have a lot of young people and the four that are lot of deliveries and babies to take care. Brazil economy is, I would say, it's considered a middle income country. But I used to say so heterogeneous that within the country, you have areas that are pretty low.
in areas that are very high. You have hospitals that are top notch hospitals, luxury hospitals, you have places that you don't have the basic stuff to work.
Guilherme Sant'Anna (10:08.842)
The Brazilians love music, love food, they love soccer. So it's a very fun place to be.
Shelly-Ann Dakarai (10:19.976)
Yes. And you guys just did amazing in gymnastics. So I'm sure. Yeah. Yep. So soccer and gymnastics. Yeah. So thanks for sharing about Brazil. And so I wanted to take the conversation a little bit further now. You know, we talked about, you did your training and you stayed in Brazil for nine years and kind of went all over. Then you decided to move to Canada to do a PhD. What prompted that decision to move on to?
Guilherme Sant'Anna (10:24.022)
Yeah, I know exactly, exactly.
Guilherme Sant'Anna (10:31.148)
gymnastics, yeah.
Shelly-Ann Dakarai (10:50.068)
further studies.
Guilherme Sant'Anna (10:52.27)
It was quality of the training. I was interested in control of respiration in babies, in premature babies. And one of the main professors doing a lot of research on that was Professor Jacobo Mortola from Montreal, Maguio.
So I contacted them not to come to Canada, but to have him going down to Brazil for a week. I was organizing the first international conference in Brazil in Neonatology, Rio de Janeiro at that time.
So I invited him as a speaker for the meeting and of course he spent a week there teaching me many different aspects of how to investigate control of respiration in babies. And at the end of the week he said, why don't you come to Montreal and do some research with me there, which was not in my mind.
I yeah, I haven't thought about it. And then I started to think about it and had to go through all the paperwork and the competition to get a scholarship and et cetera. And I was lucky that I got it. So I came to Montreal to do basic science animal research on control of respiration in his lab. And then after a year and a half,
I decided to move to get some experience on how to practice neonatal care in a first -income country. So I just applied to have a fellowship. Although I was at a staff in Brazil University Hospital, I became a fellow again in my 30s years after a PhD.
Guilherme Sant'Anna (12:45.383)
And then they accepted me, so I did two years of training as a resident in neonatology at the Montreal Children's. And at the end, I started to get some offers to stay in Montreal.
and went back to Brazil for 10 months and then I decided to come back to McMaster. was nothing was planned. It just kept happening. And then when things happen, you either take the opportunity or not. So I decided to make those choices.
Mbozu Sipalo (13:24.871)
That's a very interesting storyline of what got you to live in Canada and thank you for sharing that. So although you have settled in Canada, you continue to do work in Brazil. Can you tell us about the work you have done in some of the NICUs in Brazil and also like the impact that work has brought in the Brazilian NICU space?
Guilherme Sant'Anna (13:52.95)
Yeah, you know, I don't know if that has happened with any of you, but probably some people listening to the podcast will identify themselves. Once you leave your country, you're always attached to the country, So I was...
feeling a little bit, you know, feeling that you are a trader, you have a privileged life in Canada, practicing neonatology, and your colleagues are in that situation back in Brazil. I never lost contact with my Brazilian friends. And because I was doing research here at McGill and publishing, and I was always in contact with them, they keep inviting me to go.
to Brazilian conferences. So they organize a conference, they invite me as a speaker, we'll go there, talk. And in 2016, I've been doing that for a while,
I talked into a meeting and I left the meeting and I was in the airplane flying back and I I don't think I'm making any difference by coming here, standing up on the stage, giving a talk and leaving. That doesn't make a difference. As you know, when we talk about education, that's probably the worst way to learn is just to attend the talk.
two years down the road, you cannot tell me anything on that talk that you have been attending with a few exceptions. You don't remember. You just don't remember. And me talking what I was doing in Canada is not the reality of what people need in Brazil to make a difference. So I was in this flight when I landed in Montreal. I thought, you know what, I got to do something that I can talk to people.
Guilherme Sant'Anna (15:42.538)
more like practically, what's your problem? What can you do here and there? And in our unit, the nurses had just created at that time a Facebook group where they were talking about NICU problems in that Facebook group. So I thought, I'm going to go and create a Facebook group with some friends in Brazil that do neonatology.
And I didn't know anything about social media. I did not have Facebook. So I went to those nurses and said, can you show me how to do that? So they created a group. They got my cell phone and they created a group right away in front of me. And they said, well, how do you want to call it? So, well, I said, Neonatologia Brasil. So it's Neonatologia Brasil. And they created and then I invited a few people.
that I knew and the idea was that we can in that group exchange. How do you do that? I do it this way. what do you think about that? And this became, this was December 2016. So it started in January 17 and then from 20 people became 200 and then a thousand.
and then just keep growing. And then went to 21 ,000, 22 ,000 healthcare professionals. And basically went viral in the country and everybody in the country that at some point was connected from Amazon, Amazonas down to the South people. And I promoted the group as a forum of full respect, no criticism.
I just put it there, something you want to know. And I was making posts, here we practice this in this way. Here we do that in this way and open the forum for discussion. And that became really, really a big, big change in unitology in the country because the country was working with separate groups. People never talked.
Guilherme Sant'Anna (18:04.498)
and then suddenly the whole country is talking and the people in the northeast is listening to the people in the south. It's all you guys have the same problem I have here. So can you send me your protocol and helping each other and respecting each other? And it was always a multi -disciplinary group, but not just for doctors. Since the beginning, so I want nurses here, I want every health care professional here. And the doctors, because it's very hierarchical in Brazil and the doctors have started to...
listen more to the nurses and listen more to the other professionals. And that became a real, real difference, made a big difference in terms of mobilizing the neonatology in the country. And I started to get multiple invitations to go, Dr. Santana, can you come visit my unit? Can you come? Because I started to post when I was going to a unit, coming back.
pictures, the good things on that unit, the things that the unit can change and make a difference. And then others got excited. I won the same for my unit. So I started to get invitations to go all over the country. And they did. I traveled a lot. Many times they were paying for my flight ticket. I never charged anything for education. So they were just paying for my flight ticket.
and the accommodation and the meals. In some situations, I pay on my pocket for the flight ticket and when there. And the Neonatology Brazil, the things that we are discussing and posting, people started to talk on rounds in units in Brazil. And then the staff started to, I want to be part of this group as well, see what they talking about. So that's pretty much how it happened. We did some
research. I think we have four or five publications from the group, Neonatology Brazil. We did surveys around the country and we published that as well to validate. In the middle of this process, I got a call from a group of people who was working for a long, long time on the idea to develop an educational website from the Brazilian government.
Guilherme Sant'Anna (20:26.09)
on maternal and infant health. So they call me and say, well, we see what you're doing in Neonatology Brazil, and we have this idea that's in the drawer for many years, and we want to get it out. So can you help us? So they flew me to Brazil and had several meetings with this group that was working in a straight relationship with the Ministry of Health.
And then we basically established what we call a portal. It's a website for maternal and neonatal infant care, but basically neonatal care, it's maternal neonatal care. And in that, we develop an amazing educational material that's on their website with talks, with protocols, with recommendations about a number of things in neonatology, that in forums.
weekly forums of discussions like we are doing here, talking to people online. therefore, any people anywhere in any unit in the country can access for free that website. So if I have a situation here, don't know what to do. You just go there and you assess. So that website became extremely successful. I forgot the number, but millions.
of access on the website and we keep refining it. I'm still doing work with them in many different. So we, one year into the website, we created the 10 basic steps for neonatal care. And the governor of Brazil just adopted it. So there's a group
from the governor of Brazil that's called QualiNeo. It's quality and neonatology, QualiNeo. And this group, they help 30, I think it's 30 or 32 major maternity hospitals in the country that are public. And each of them has about 10 to 15 ,000 deliveries a year and major difficulties.
Guilherme Sant'Anna (22:51.278)
quality of neonatal care in these hospitals and quality adopted the 10 basic steps in neonatal care. Basically, the government made posters of that, made didactical material, educational material for that. I've been giving several talks and then trained people to give talks on that. How can you do the basic? Well, basic care, it's not advanced care. Basic care, well,
to make a difference in neonatal mortality and improve the care on these people. So following that, and if I'm talking too much, can interrupt me. Following that, we developed also the 10 basic steps for perinatal asphyxia to take care of babies that are born with hypoxic ischemic encephalopathy, which is a major problem in the country. We published that. did a huge survey in the country.
The 10 basic steps for HIE has also been adopted by the government. So pediatricians across the country are using that material to improve neonatal care. I keep receiving every month, sometimes every week. I get messenger messages or text messages or WhatsApp messages or emails.
of people telling me how that has made a huge difference in the unit. For example, I got many years ago a text message from a pediatrician that works in Macapá. Macapá is a very small state on the north of Brazil, close to the Amazonia forest, where she says that she had 100 % mortality in babies less than 34 weeks in her unit, and now she has 100 % survival.
since we taught them the basic steps and more than anything, we taught them how to do bubble CPAP, a very simple CPAP for this baby. So this is very rewarding because it has done a huge change. The academic centers, I don't think, made such different centers in the big cities, but made a big, big change in the country of the country.
Guilherme Sant'Anna (25:14.606)
and then these small units. So I visited big maternity hospitals in Manaus, which is in the center of Amazonia, in Belém, which is also in Amazonia area, and in the northeast of Brazil. And these people, they're hungry to learn. So it's very nice to go and teach them there because they can't come to these big conferences.
and they cannot go to international conferences because many of them don't speak English. So I go there and they basically dissect and translate, digest and give them this is what you need to do in a very simple language, in a very simple way. And that has, I think, was the big, big thing in the whole story is just to simplify, simplify science and digest for them and give it and feed them with that.
and teach them how to do the basics.
Shelly-Ann Dakarai (26:17.386)
Thanks so much there to unpack. So I want to go back a little bit to the Facebook group because it started with just an idea and something that was essentially in your pocket that then grew. So I'll come back to that. But because we were talking about the 10 steps and the simplicity, really, it seemed like you made an effort to stick to 10 steps. So I'm curious as to one, what prompted the decision to
make sure that we focus on simplicity and 10 steps and then perhaps maybe can you share a little bit about the 10 steps in basic neonal care and a little bit about the perinatal asphyxia.
Guilherme Sant'Anna (26:57.004)
Yeah, sure, absolutely. Do we have like five hours here? The thing is, know, Shelley, it's very interesting. I don't know if you have, that has ever happened with you. So you go into these conferences and you teach and everybody nods their head and take notes, you know, and take a picture with the professor. They love to do that in Brazil.
They go back to their unit and they don't apply and they don't change anything you have said. And then you go to these meetings and they come to ask you questions and you ask them questions, how do you do that in your unit? And everything is great. Nothing has a problem. So until I started to walk into the units. So what I did is that...
When they were inviting me, Dr. Santana, can you come here and teach us? I'm in Brasilia, for example. Brasilia is the capital of Brazil, but it's in the center of the country. They say, yeah, I'll go there. I'll talk into your conference as far as you let me visit your unit. So I started to do that. I started to accept invitations with the condition.
And the condition is that I can't visit your unit. And at the beginning, there was a bit of resistance, but then when they realized that what I was doing was to help, not to criticize, he opened all the doors. And that's why I have visited more than 60 units. And why am I telling you that? It's because when you walk in, you see the reality.
and you see little things that you will never think about in a conference that they are doing there and they can change and make a big difference. I'll give you an example. So I walk into a unit in Manaus and then I see a baby that's there after birth and this baby's on CPAP and there's no water into the humidification system. In fact, the baby is not connected to any humidifier.
Guilherme Sant'Anna (29:17.922)
So it's basically getting cold, dry air in the nostril. So we said, well, where is the water here? no, we forgot to put the water, blah, blah, blah. So they go there and they put the water. And they said, how do you know the temperature of the air that you are putting on the CPAP system? we don't.
and say, well, how do you adjust the humidifier? We'll just put a number two here. The humidifiers in many units in Brazil have no control of temperature. Why? Because the manufacturer sells to them cheap humidifiers. Basically, many of them have four little dots. So you can put on the first one the knob on the first dot, on the second, on the third, and the fourth.
So I said, what that means? And they said, I don't know. We don't know. So if I put in the second dot, this kid will be receiving air at which temperature? I don't know. They said, I don't know. And one of the major problems there that they told me is that CPAP here doesn't work. We put these babies on CPAP, they bleed. There's a lot of bleeding in the nose. And they thought, this is because the nurse doesn't know how to suction, because the prongs are too hard. We buy cheap.
You guys have good prongs in Canada." And I said, well, but you're offering cold air, dry, and this is a mucosa. This is going to get dry and bleed because you're giving cold and dry air. So nobody has ever told me that before I walked into the unit and saw it. Okay? So I saw it and I basically taught them, you're going to have to...
keep humidified all the time, put this on the highest dot, get a thermometer, and then go after half an hour running that, put a thermometer close to the prong and detect the temperature of the air. So I did it for them. So I show them how to do. I put all together, show them how to do. And the thermometer did not blink, did not put a number there because it was below 32. Every time it's below 32 degrees.
Guilherme Sant'Anna (31:40.334)
It doesn't show, there is no display. So we let it go for half an hour, then I put a thermometer, was 33 degrees. Then we let it go for another half an hour and I put a thermometer again and it was 36. So you gotta have to give temperature that's close to body temperature. So it needs to be 36 .5 for the baby, otherwise it's gonna bleed. So I detected that this is in one of the 10 steps of basic...
your natal care. I also detected that everybody is on antibiotics therapy. And they use a lot of antibiotics because they are afraid of infection. Even if the baby has no infection, the blood culture is negative. Everything is negative, baby is getting antibiotics. And I keep detecting a lot of things that nobody's going to tell you in a conference. You can only see that, know, positioning,
mechanical ventilation done incorrectly, know, feeding. The catheter the nurses were doing the suction was the thinnest one. I no, no, you have to use the larger one. How are you going to remove a plug with a very thin catheter? So many things, and we started to put that into the 10 steps. And this is, no, we did not reinvent the wheel. We do not use any high tech thing. It was just...
reinforcing basic care. So the first of the 10 steps is neonatal resuscitation according to the NRP guidelines. So that's the first one. And then I think the second one, I don't know in order by heart, but the second one is about basic CPAP care. you do the many units in Brazil thought they had to incubate babies.
baby is in respiratory distress, I need to intubate. I need to give surfactant. You there's a lot of pressure from pharmaceutical companies in this country that you got to give surfactant to this baby. the problem is, or you might say, what's the problem to intubate and give surfactant other than the cost of buying the drug? Or the problem is they are intubated and they're never extubated. And
Guilherme Sant'Anna (34:04.908)
because they're never extubated, then they develop ventilator lung injury, and then they develop BPG, and then they die because they get stuck on the ventilator. And I've seen in many units at that time babies being ventilated for no reason. Babies, would never be ventilator here where they had mechanical ventilation for days until they develop multiple complications and die. So these things are the things that we started to put into the
basic steps. Do not use antibiotics if the cultures are not positive. You can start, trust your blood culture. So we started to teach them how to collect blood for the blood culture, how to talk to the lab about reliability of the blood culture. And if the blood culture is negative, it's negative. Stop it. You know, so those things are things that we put into these 10 basic steps.
neonatal care. Temperature control in the delivery room, temperature control on transport to get to the unit. Now you have to be very careful with that. Use the thermal mattress. You know this is a bit expensive but it's worth it. You you can you spend more money in other things than that. So if you have a tiny baby that is very likely to become hypothermic, please buy
some of these chemical mattresses and use that. And they started doing that. They started to buy that. They go back to the administrator. So it's been basically reinforcing things that we do here that is automatic. We don't even think about that because this is the basic stuff that we do that for them is not.
Shelly-Ann Dakarai (35:57.48)
And you, you brought up, you talked a lot about humidity, which was one of the questions we were going to ask. So you kind of brought it up on your, on your own is cause there are. How important is having a humidified source for your CPAP? Because there are these, CPAP devices that are built and marketed to the low and middle income context who don't, don't have humidity. And, and the reason why they're good, they're good and they're, they're, they're seen as needed in, those settings is because.
many places don't have blenders or compressed air. And so they have technology to be able to bring in air. Yep. And so you can give blended air through these devices. So they seem like a great option, but many of them don't come with humidity. I've heard some folks say, well,
You're saving the bigger babies anyways in those settings, so it's okay. And so someone with your background with your respiratory physiology knowledge and all the experience in Brazil, how important do you think that is?
Guilherme Sant'Anna (36:55.735)
Yeah.
Well, ideally, you should have it. Ideally, you should have humidity because it's a high flow of air into a mucosa. And if it's not humidified, over time, it's going to get dry. And as soon as it gets dry and accumulates secretion, it's going to bleed. And then when you have bleed, you have clots and you have more dryness. And then you fail and get intubated because you fail to pop.
I am very familiar with multiple systems like the one you just described. And I'm working with one of those systems and they brought this VIO C -POP system to Brazil, which is very much like you just said, there's no need to have power.
But the vial has an extra bottle, so the flow goes into a water bottle first and then to the bubble bottle, so has a double. So it gets some humidification. There's no warmer, so the temperature is cold. But the vial also, the noozle that they have for the...
for the blinging of the air, get some of the air that's ambient air, which is 22 degrees. It's not as cold as the air that comes out of the wall, which is way colder. But anyway, any CPAP system, if you want to keep the baby a CPAP long time, over a week, it's not going to work if there's no humidification or no...
Guilherme Sant'Anna (38:33.358)
temperature control because it's gonna damage the nostril. If it's for 48 hours, 24, 48, 72 hours, that's fine. And I think it's very worth it because it's gonna save the baby life. And this is the reason why I've been pushing.
the biosystem in Brazil, in many of these areas that I visited, that they just need for 48 -72 hours, the bigger babies, they are like some TTN or some mild RGS, some moderate RGS, they just need stabilization for 24 -48 hours and then they're fine. So you don't need to intubate them and works. So even if the umbilication and the temperature is not ideal. For the ones that you want to, the smaller ones that you want to keep on CPAP longer,
We keep primis here 30 days, 40 days on CPAP. You have to have humidification and you have to have heating. So the air has to be warm.
And what I taught to the Brazilians is that because they don't have the wired system, you know, basically the inspiratory limb and the expiratory limb, the plastic has no wires. So it's not a heated system. I tell them you have to see condensation. If you don't see condensation, it's because the temperature is wrong. It has to be with the condensation. And what I'm going to do with the condensation is just tell the nurse that she needs to drain.
frequently and try to get the bubble or the bottle of the CPAP very close to the incubator just so you don't have this huge system hanging out because that's when it gets cold and condensate. So basically what they try to do is it comes out of the CPAP straight into the incubator to the baby and back into the bottle so there's not much system outside and therefore you keep them warm.
Guilherme Sant'Anna (40:30.594)
The VIO is the same. They the VIO CPAP system just below, they tell you to put below the radiant warmth, so it keeps it a little bit warm and it's not far away from the baby. What I've seen in Brazil, many systems use the ventilator to give CPAP. So the ventilator is at the side of the incubator, but then you have this huge...
inspiratory limb, an expiratory limb coming from the ventilator all the way up to the incubator and then back, so this huge one gets a lot of condensation if you don't humidify, if you don't warm it correctly.
Mbozu Sipalo (41:11.233)
Thank you so much.
Guilherme Sant'Anna (41:11.372)
So there's a, I studied who was just accepted for publication in June of New NATO perinatal medicine is a simple intervention then in a small unit in Bento Gonçalves in the south of Brazil. They learn, I gave some workshop there and they learn it's like you fly to the capital and then you drive about two or three hours uphill. It's a small unit there.
And then I taught them about that many years ago. So they put a protocol with whatever they had, not ideal humidifiers and way to check, but they did. So they said, they put a very strict policy for the respiratory people to check the water every four hours, to check the temperature every four hours. And then they did a pre and post analysis.
the incidence of nasal bleeding before and after dropped more than 40%. So before they had a few kids that needed to be intubated, after there was no baby that needed intubation. And these are babies that are both 30 weeks. So imagine, we're not talking about the 26 week or 27, but you talk about babies that are salvageable and were not being saved because of simple things.
Mbozu Sipalo (42:36.597)
Really, really insightful accounts you have about doing the simple things well. That would be CPAP and warmth, which is really, really important for preterm babies, especially. So thank you so much for sharing that account. Just to go back to a bit of your professional background, I know that one of your interest points is the smart NICU.
And I personally have never heard of that before, and I'm sure many of our listeners haven't either. So would you please tell us a bit about what Smart NICU is and the background behind Smart NICU?
Guilherme Sant'Anna (43:22.57)
Sure, you know, this is something we started three years ago. The Montreal Children's Foundation came to us and, you know, do you guys have any projects? we have this project here hanging on for a few years and we were never able to secure funds for that and they loved the idea and they went for, you know, the donors that they know.
And one day they called me back and said, we got it. We got the money you need to move forward with that. So we have been working very proactively on that since the COVID stopped. And it was very difficult because all that happened in the middle of the COVID and we're not able to do any research in the middle of the COVID. So I had to wait to go back to normal life. And since the COVID stopped,
we have been very proactive in that. So there's a few things in what we call a smart hospital or smart NICU. And of course, one of the components is AI. But it's not the only component. We very much want to think about families and the interaction between babies and families and health care professionals in the NICU.
So one thing that we noticed is that up to today, and I'm sure it's the same with you, when you have babies in the NICU, to monitor those babies, you have to put leads and there's wires and there's cables and the monitors. And these kids have multiple wires and leads and they're connected to bedside monitors. And these, I know.
For me, was, can we still doing that 30 years down the road when there's so much new technology out there? Why nobody try to come up with something that is way simple and much easier for the baby and for the families? So one of the biggest projects in the Smart NICU component of the smart hospital
Guilherme Sant'Anna (45:38.438)
is to eliminate the wires and the cables. So basically, we are testing wireless sensors. It's kind of a patch that you put in the chest of the baby and you get heart rate and respiratory rate, temperature, skin temperature, wireless to the tablet. So you don't need cables, you don't need wires. A lot of these sensors exist.
the research labs doing that. And so we did a lot of search and we end up with some collaborators. And those collaborators are high top level technology people, academic centers, and some spin off companies from those labs. And we are testing. We've done a lot of testing by now.
in real life, not in experimental conditions, everything is perfect, but putting the babies in real life. Of course, they have both because we cannot eliminate the standard of care. So they have the wired system plus the wireless system. So we are collecting the information and comparing if the wireless is giving me similar information that the wired system gives me.
And we have done more than 50 babies and we have about like almost 2000 hours of recording of heart rate and temperature and et cetera. And I am very optimistic we're going to in the next two or three years moving to that, you know, have babies monitored without the need of this big.
bedside monitors. One thing that, when I started into that, I never realized, I'm not sure if you do, is why the bedside monitors are just beside the baby, right? I was, my gosh, it makes no sense because, you know, you're laying down on the bed and the monitor is above you and every time alarm goes off, it wakes you up and disturbs you. So,
Guilherme Sant'Anna (47:52.322)
They are there because they need wires and cables. You cannot make three meters wires to push the monitor outside. So, initially, today you can put on the website, on the wire, on the network, wireless network, and have a copy, and you see these big systems outside of the unit. Basically, it's a mirror of what's going on at the bedside. So...
These monitors are very expensive. Phillips, General Electric, and Drager, they're very expensive monitors. With the wireless system, any tablet can do that. So it's going to be super cheap. And the sensors we are testing, they are rechargeable. So you can basically take it out, clean, put it back. Charge, so it comes with a charger.
So very attractive for middle or low income countries where you can provide monitoring of heart rate, all these vital signs anywhere. You just need to have a tablet and the outlet to power your charger and it's mobile. You can go with the baby wherever the baby goes and it's
The results we're checking, it's pretty reliable, it's pretty good. So this is one of the components of this My Hospital. There are many other ones because it keeps multiplying, it keeps growing. People come with new ideas every day here. We started very small, three of us. Now we have like 15 people working on the project and many collaborations.
So we hope that, you know, as again, it goes into the line that trying to simplify things take away the complexity of having all these things.
Shelly-Ann Dakarai (49:47.668)
Right? Mm -hmm. Wow. Certainly exciting work. And I'm sure we look forward to the next couple of years seeing this come to fruition. And like you said, it might hold huge possibilities as well for the low and middle income context. So we're getting to the end of our time together. And I wanted to just see if you had a little bit of advice for anyone who is wanting to make change, specifically someone
Like in your situation where you're outside of your home country, but you still are very connected. We understand that completely, the two of us. And you still want to stay connected and try to make a difference, but just not sure where to start. Any words of advice for someone in that situation?
Guilherme Sant'Anna (50:35.399)
Well, know it's... Every situation is a different situation. So I think if you get knowledge, there's no point to keep the knowledge with yourself. Right? This is very much what I always thought about. You know, what's the point for me to know a lot of stuff and just keep it for myself and don't teach people and don't help?
people. So find a way to do it. Find a way to go back to your country and help with your knowledge. And can be simple things from simple teaching to rounds on the unit. know, people look up to you because you have been successful outside. They listen to you. Be nice. Don't walk in criticizing. I never do.
I always walk in and find the good things. And then after I acknowledge a few things, I these little things here, you can change. I understand you are doing this way, but what about if you're doing this way? Maybe, you know, that's how you are able to make changes, you know, because if you criticize people, they just close up to you and they don't listen to you anymore.
And I am still to find somebody who likes to be criticized. You walk in somebody's house and say, you start criticizing, I don't like this couch here, I don't like this thing. You don't do that, right? So you have to be respectful with...
with the difficulties that people face every day. I always give them a very optimistic message, help them, really help. I've written many papers with Brazilians, simple studies, I take my free time to do that because I have my own research here. They get so happy and so stimulated and so excited to move forward that it's worth it. And yeah.
Guilherme Sant'Anna (52:40.399)
And try to do that as much as possible, having fun by doing that. And think, like I said in the beginning, it's what we do, because we take care of mothers and fathers and babies who are the future. It's a huge privilege to do that.
know, to help these people. Not everybody has this opportunity. And I wake up every day saying, my God, I have an opportunity to help babies to get out and go home and have life, full life. And this is fantastic. You know, so think about that. And the more unified you are as a group of health care professionals working in neonatal care, the more they will benefit from that. You know, put your ego aside.
You know, many people want to do things to be famous, you know, just to get recognition. I think the major recognition is to see the outcomes getting better.
Mbozu Sipalo (53:45.591)
Wow, on that inspiring note from you, one of our amazing Neonatologists, sadly, we have to end today's really energizing and exciting podcast. Thank you, thank you so much for being with us here today and just being so approachable. Yeah, I think it's really important for the champions of Neonatology to be really approachable, like you've said.
The last question we have for you is how can we connect with you? How best can we connect with you?
Guilherme Sant'Anna (54:25.058)
Well, if you Google my name, you're going to find a lot of stuff there in my email. So you can just send me an email. I'll be happy to help.
Mbozu Sipalo (54:28.865)
you
Guilherme Sant'Anna (54:35.47)
And yeah, we can take from there. You send me an email and I try to answer everybody. Sometimes there's not enough time. It's only 24 hours a day. But yeah, it's always a pleasure to do that. I've learned I was very lucky to be coached by phenomenal people who taught me to work in the way I do now. So it's not just...
Mbozu Sipalo (54:45.953)
you
Guilherme Sant'Anna (55:04.81)
me it's because I learn with the best so it's always you know I feel that I have to do the same.
Mbozu Sipalo (55:13.811)
Thank you so much. We will add your email in the show notes and add links to the Facebook groups and the website that you also talked about during the interview. Thank you so much for meeting with us today and catch us next on the next episode of the Global Neonatal Podcast. Thank you so much for joining us.
Guilherme Sant'Anna (55:36.013)
Thank you.
Shelly-Ann Dakarai (55:39.53)
Thanks, bye.
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