Newborn Brain Society

Steering Committee Interview: Dr. Steven Miller

The Steering Committee of the Newborn Brain Society, consisting of seven founding members, plays the essential role of advising the society and helping it to maintain its mission, vision, and objectives. One such member is Dr. Steven Miller, Head of the Division of Neurology and the Centre for Brain & Mental Health at the Hospital for Sick Children, Professor of Paediatrics at the University of Toronto, and Senior Scientist in the Neuroscience & Mental Health Program at the Research Institute of SickKids.

Dr. Miller began working on brain imaging studies in epilepsy during his pediatric neurology residency. He said, “I really liked that link between understanding the brain with this new window – MRI – and addressing a clinical problem that we saw every day, which was children who had seizures.” It was then that Dr. Miller attended a lecture given by Dr. Volpe.  He said, “It was the first time that I really saw basic science totally embedded in clinical research addressing real clinical problems…I got hooked on neonatal neurology from then on in.”

Dr. Miller’s research focuses on “better understanding brain injury and development in the newborn,” specifically through trying to prevent brain injury, and then promoting recovery. Dr. Miller and his multidisciplinary team do this by using “advanced brain imaging and long-term follow-up to help children who were born early or with congenital heart disease.”  Although the traditional areas of research in neonatal neurology are related to premature babies and those born with HIE (hypoxic ischemic encephalopathy) and NE (neonatal encephalopathy), Dr. Miller has enjoyed researching the relationship between pain, the newborn brain, and congenital heart disease. He says, “the field of congenital heart disease is moving from survive to thrive.” That being said, he reemphasizes the fact that prematurity and heart disease in babies are both increasingly important and prevalent issues. More and more babies are being born prematurely every year and heart disease affects about one percent of babies.

Dr. Miller has also contributed to 9 clinical practice guidelines, ranging from a protocol for determining eligibility for therapeutic hypothermia and for monitoring during treatment, to a family guide to pediatric stroke. He is very passionate about bringing research to the point of care, and he’s learned from different people in his interdisciplinary team the importance of implementing guidelines and bringing them to life so that we can learn from them.

Dr. Miller has received many awards over the years including the Holmes Gold Medal from McGill University, Teacher of the Year Award from the Pediatric Residents at UBC, and the Can MEDS Excellence Award from The Hospital for Sick Children, though he distinguishes the Newburger-Bellinger Award from the Cardiac Neurodevelopmental Outcome Collaborative as one of his favorites. He says that “it was especially meaningful to be recognized through the work of Newburger and Bellinger who were really pioneers in that field and opened our eyes to the importance of looking at babies with congenital heart disease.” Dr. Miller also says that the most meaningful award is seeing volunteers and trainees who go through the program and find their place in neonatal neurology and take it to different places.

Dr. Miller has mentored countless people from undergraduate students to fellows, and he’s very “passionate about supporting the career development of young child health researchers.” He says, “that’s how our field grows and that’s how we’re able to ask new and different questions.” Dr. Miller also notes that he’s had the fortune of having so many amazing mentors who’ve helped him grow throughout his career and that “[his] career aspirations are to be a mentor like Donna [Ferriero].” Dr. Miller also mentions that he’s learned a lot from different types of mentees, including physicians, but also people from different disciplines like the rehabilitation scientists. Dr. Miller stresses the importance of working across faculty lines with others like those in the social work, education, or public health fields, and emphasizes “the value of interacting with people outside your primary area of focus.” In order to really tackle the challenges of the baby brain, he says we must broaden our thinking and interact with others that might not traditionally affiliate with neonatal neurology.

Through his experiences, Dr. Miller has collected many pieces of good advice that he often shares with his mentees. He advises trainees to find questions that they are passionate about. He also adds on to the advice he’s received from Donna Ferriero to say, “pay attention to your patients – listen to them and watch them – and use what you learn from them to help drive new questions.” As a clinician Dr. Miller was always taught, and always tells his trainees, to never leave the room without first asking the family if there’s anything they can do to help. One reason for this is that oftentimes the chief complaint, or the reason for the visit, is not what the family actually needs the most help with. This is why Dr. Miller got involved with CHILD-BRIGHT (which he now co-leads). CHILD-BRIGHT is a “Canadian national patient-oriented research network to improve the lives of children with brain based developmental disabilities and their families.” Through this, he’s been able to more genuinely engage families throughout the entire research process. He often asks them what they want to see researched in the field and what questions they want to see answered, and he advises trainees to do the same so that they are working on the questions that will be the most impactful to these lives. To continue to reach out to families, Dr. Miller has also been involved in public education and has had a lot of media coverage. He says that especially since a lot of the research he does is funded by the government, or the taxpayers, he feels it’s important for them to know what is being done with their money. He says, “we have an important role as ambassadors of the healthcare system and the research system to share our activities and our learnings with our colleagues outside our fields.”

Though Dr. Miller says he wouldn’t change a thing about his career path and where it has led him, he does mention a couple of lessons he says could have been helpful to know early on. “The first goes back to the importance of the patient and family voice in research and how impactful that is, and the other is to think more about what happens in the home when children leave the intensive care unit.” He says as a neonatal neurologist, we usually think about what we can do inside the NICU to help the babies, but what happens after the NICU is also extremely important. Dr. Miller says this often highlights the influence of social disparities on outcomes, “which ends up being very powerful,” and goes on to apply this internationally among countries with varying levels of resources available. Because of this, he calls on those with resources to reach out and offer support to others. He also mentions broadening your thinking as a clinician to encapsulate the question of how the baby got to the NICU, and to think about what happened to the baby as a fetus.

As an expert in the field of neonatal neurology, Dr. Miller shares some of his views on the field and its progress. One of the most important accomplishments of the field in his opinion is the “now broad recognition that the baby brain is not a small adult brain – that this brain is rapidly developing and needs attention that’s distinct from the fully developed brain.” He says this thinking has been fundamental to the development of different therapies like therapeutic hypothermia, but also to helping drive advancement in intensive care in everyday things like managing children’s’ pain, nutrition, or how we follow up with them after discharge. He says it’s been very exciting to see the field move from an emphasis on diagnostics to that of therapeutics. He hopes that as the field refines the diagnostics we’ll not only focus on predicting the babies that will need support, but also on predicting those that will flourish, which would really help how we counsel families. He also hopes that we’ll continue to work on therapeutics for all stages and broaden the window of intervention. He says, “I also hope as a field that we start to tackle social disparities. And I think that’s where – as we think about equity and diversity and inclusivity by broadening the tent of neonatal neurology and thinking about other faculties (i.e. social work, education, dentistry) – that we can really start to address the key issues that are impacting babies through their life course.”

As a leader in many capacities, including the Head of the Division of Neurology and the Centre for Brain & Mental Health at the Hospital for Sick Children, the co-lead CHILD-BRIGHT, and a previous President of the Society for Pediatric Research, Dr. Miller shares some of his lessons in leadership. He says that two of the most important leadership lessons he learned from Dr. Ferriero are, “to be a good listener and to be positive.” He re-emphasizes the importance of listening and goes on to say that he sees it as the most effective strategy.

As one of the founding members of the NBS, Dr. Miller hopes that it will “continue to bring together a diverse and inclusive group interested in the newborn brain no matter their academic background, and that we give them a home through which to share ideas and learn from each other. He hopes that most importantly we will make efforts to bring those learning to the point of care through guidelines and shared experiences across the network.” Dr. Miller also says that one of the things the NBS needs to make sure to do is to be a good listener and be ready to learn from people with diverse backgrounds and experiences.

Dr. Miller also expresses his opinions about having a healthy work-life balance, saying that, “More important than my role in medicine or neonatal neurology is my role as a husband and father. I continue to be inspired by my family and would encourage younger people entering our field to strive for a healthy balance of professional activities and home activities, whatever they are.”

The Newborn Brain Society is very fortunate to have a founding member like Dr. Steven Miller, who brings forth years of experience, refined lessons and knowledge to help better the NBS and achieve its goals.

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