bluuebunny/crossref_metadata_2025 huggingface dataset:
24 Persistent pulmonary hypertension and short-term neurological outcomes in infants with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia
Authors: Ismail Rana , Vorhies Erika , Mohammad Khorshid , Soraisham Amuchou , Scott James , Stritzke Amelie
Published: October 2022

Background

Neonatal hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia is a serious clinical condition that may result in permanent neurologic deficits or death. There is an increased incidence of persistent pulmonary hypertension of the newborn (PPHN) in asphyxiated infants. Due to the high disease burden of HIE, studying its altered cardiopulmonary hemodynamics might identify those patients at highest risk for adverse outcome early on.

Objectives

To investigate the relationship between severity of PPHN and the extent of short-term brain injury in infants with moderate to severe HIE who received therapeutic hypothermia (TH).

Design/Methods

Retrospective cohort study of 230 TH-treated HIE infants. PPHN was defined and graded clinically and based on echocardiography findings. The primary outcome was the presence of HIE changes on brain MRI and/or death within the first month of life according to the diagnosis and severity of PPHN. Secondary outcomes were the pattern of HIE on brain MRI; abnormal electroencephalogram (EEG) background, clinical, or electrographic seizures, or need for anti-ictal treatment; clinical and laboratory differences between HIE babies with and without PPHN. A logistic regression model was performed to identify PPHN severity as risk factor for moderate-to-severe brain injury or death.

Results

Brain injury was not found to be different between the two groups according to presence of PPHN whether clinically or based on echocardiography. However, the combined outcome of severe brain injury or death was higher in the clinical PPHN group vs non-PPHN (32.6 vs 22.8%, p=0.014), and early exit from TH due to severe PPHN was associated with the highest mortality (71.4%). Death was found to have a relationship with the severity of PPHN based on echocardiography, with the highest incidence in severe PPHN (36.0 vs 7.7% and 10.0% in the severe, moderate, and mild PPHN groups, respectively, p=0.002). Infants with clinical PPHN were sicker with higher ventilation needs and worse laboratory values compared to those without PPHN. None of the other outcomes were different among the two groups.

Conclusion

In infants with HIE treated with TH, PPHN was not associated with increased risk of brain injury as evident on MRI, nor clinical or electrographic seizure burden. However, mortality was higher in the most severe PPHN categories.
28 Blood culture collection practices in NICU; A national survey
Authors: Hajjar Nicole , Ting Yuk , Khurshid Faiza
Published: October 2022

Background

Blood cultures are the gold standard in the investigation of neonatal sepsis, which is associated with significant morbidity and mortality. However, there are currently no consensus guidelines for blood collection for culture in newborns. In addition, it can be challenging to obtain sufficient blood volume in infants, which can affect the validity of culture results.

Objectives

To examine current practices in blood collection for culture in the investigation of neonatal sepsis in NICUs across Canada.

Design/Methods

A 9-item electronic survey (Appendix A) was sent to each of the 29 level 3 NICUs in Canada, which are equipped to provide highly specialized care for newborns.

Results

Responses were received from 26 (90%) of the 29 level 3 NICUs. Fifty-six percent of NICUs have blood collection guidelines for the investigation of neonatal sepsis. Forty-eight percent of NICUs routinely collect 1.0 mL of blood per culture bottle. By contrast, 32% of NICUs determine adequate blood volume using body weight and 8% using gestational age. In late-onset neonatal sepsis (LONS), 58% of centres process one aerobic culture bottle. Four NICUs (15%) routinely add anaerobic culture bottles. Few centres draw blood for culture from an indwelling catheter when present as a first-line option in LONS. Specifically, one NICU routinely draws blood from a central venous line and four NICUs (17%) routinely draw from a peripheral arterial line. In early-onset neonatal sepsis (EONS), 73% of NICUs draw blood for culture from umbilical lines, while 72% use peripheral venepuncture. Two centres routinely collect cord blood from the placenta for culture in EONS. Only one NICU applies the concept of differential time-to-positivity (DTP) in suspected central-line associated bloodstream infection (CLABSI) to determine whether a colonized catheter is the true source of infection.

Conclusion

There is significant practice variation in blood collection for culture in level 3 NICUs across Canada. Standardization of blood collection practices will improve antimicrobial stewardship and appropriate resource utilization, as well as provide reliable estimates of the true incidence of neonatal sepsis in Canada.
31 Identifying Child Maltreatment in Virtual Medical Appointments - What Are We Missing?
Authors: Lim-Reinders Stephanie , Zwicker Kelley , Ward Michelle , Jain Nita , Kang Kristopher , Malic Claudia , Ornstein Amy
Published: October 2022

Background

Throughout the COVID-19 pandemic, concerns have emerged regarding missed cases of child maltreatment. Evidence suggests an increased incidence of child maltreatment despite a documented decline in reports to child protective services. In Ottawa, reports dropped by 30-40% at the start of the pandemic in 2020. Pediatricians play an important role in the detection of child maltreatment and many have shifted from in person to virtual care. However, there is a paucity of published literature on this topic. We hypothesize that the shift to virtual visits is a barrier to identifying cases of child maltreatment and may contribute to missed cases.

Objectives

Our survey assesses if and how Canadian pediatricians are identifying child maltreatment over virtual medical appointments, as well as the barriers and enabling factors to doing so.

Design/Methods

The Canadian Paediatric Surveillance Program (CPSP) is a joint effort with the Canadian Paediatric Society and Public Health Agency of Canada towards national pediatric surveillance through monthly surveys to 95% of Canadian pediatricians. Using their infrastructure, a one-time survey was sent to 2770 pediatricians between November 2021 and January 2022 with data analyzed for qualitative themes and descriptive statistics.

Results

There was a 34% response rate (n= 928) and 704 valid responses. Exclusions were for no provision of virtual care, incomplete surveys or no reported cases of child maltreatment in their career (n=93, 10%). The average number of years in independent practice was 17.5 years, and 69% had not provided virtual care prior to the pandemic. Based on a virtual visit, at least one case of child maltreatment was reported by 16% of physicians prior to the pandemic, and by 11% following March 2020. Nearly one-third (30%) of these cases required a subsequent in-person visit prior to making the report. Social stressors and clear disclosures from patients and caregivers were the main factors leading to reports. The virtual physical exam was not a factor that triggered concerns of maltreatment in any case. Respondents reported at a rate of 68% that it was slightly or much more difficult to detect child maltreatment over virtual visits. Concerns that a case had been missed or identified late in association with virtual care were reported by 29% of physicians (n=206) with some commenting that clear harm resulted.

Conclusion

This survey shows that virtual medical care presents barriers to identifying child maltreatment and may be an important factor in missed cases of child maltreatment.
32 How do Children with Medical Complexity Die? A Scoping Review
Authors: Ng Grace , Bourassa Marie-Hélène , Patel Hema
Published: October 2022

Background

While children with medical complexity (CMC) are recognized as an emerging and unique cohort, end of life remains poorly understood and little is known about illness trajectory, decision making and communication experiences for this group of patients and their families.

Objectives

This scoping review aimed to describe existing literature on the characteristics of end of life in CMC.

Design/Methods

The study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Electronic databases (MEDLINE, CINAHL, PsycINFO, Scopus, Embase) were searched up to June 2021. Studies reporting children, adolescents and young adults who were at end of life and fulfilled the definitional framework of medical complexity by Cohen et al were included by two independent reviewers. Data on study aims, design, methods, outcome measures and key findings were extracted, followed by quantitative and qualitative analysis of the results.

Results

Of 1535 publications initially identified, 23 studies were included. In terms of study characteristics, 20 (87.0%) studies were quantitative, 15 (65.2%) were published from 2015 to 2021 and 14 (70.0%) originated from the USA. Study outcomes were categorized into 5 main groups: (1) Place of death (30.8%), (2) Health care use (23.1%), (3) Interventions received or withdrawn (17.9%) (4) Decision making and communication (12.8%) and (5) Others (15.4%). These outcomes were found to be associated with sociodemographic factors and CMC diagnostic categories. Majority of CMC deaths occurred in hospitals and the mean proportion of hospital deaths reported was 68.8% (33.5% to 91.9%). Studies evaluated health care utilization at end of life in various settings including hospice, home care, hospital and the intensive care unit. Interventions studied in this cohort included mechanical ventilation, cardiopulmonary resuscitation, hemodialysis, procedures and medication use. Studies reported that CMC were subjected to more intensive interventions when compared to non-CMC. The 2 main themes which emerged from qualitative studies were that of advance care planning experiences and the unique end of life experiences of CMC and their families.

Conclusion

This scoping review highlighted the unique characteristics of end of life in CMC and outlined the emerging body of literature as well as knowledge gaps on this topic. A better understanding of this cohort of CMC would serve to inform clinical practice, service development and future research opportunities.
36 Feasibility Testing of Online Health Symptom Trackers for Children with Medical Complexity at Home
Authors: Dharmaraj Blossom , Beatty Madison , Adams Sherri , Moore Clara , Miranda Susan , Stinson Jennifer , Desai Arti , Bartlett Leah , Culbert Erin , Cohen Eyal , Orkin Julia
Published: October 2022

Background

Children with medical complexity (CMC) are a highly medicalized population of children due to the complexity of their clinical presentations, various diagnoses, and multiple care providers. Real-time health information can inform clinicians to make better recommendations and improve clinical outcomes. In other populations, such as children with Type 1 diabetes, online health symptom trackers (HST) were used to facilitate clinic visits and track symptoms longitudinally. To-date, HSTs have not yet been examined in a clinical setting with CMC and their families.

Objectives

The aims of our study were to create a standardized online tool, which supports the creation of online HSTs, and to assess their utility in clinical care from a parent and health care provider (HCP) perspective.

Design/Methods

Parents of CMC were invited to use a standardized online care platform called Connecting2gether for 6-months and create online HSTs that could be shared with their HCPs. Online HSTs could be added by parents from a prepopulated list with an open notes section, and the ‘Signs and Symptoms’ trackers could be customized by parents. A demographic survey was completed at baseline. At 6-months a tracker acceptability survey and in-depth semi-structured qualitative interviews were completed to assess the utility and usability of HSTs. HST usage data were also collected. Interviews were analyzed via thematic analysis whereby codes were generated to inform themes, and surveys were analyzed using descriptive methods.

Results

Thirty-six parents enrolled on the platform and 21 (57%) created at least one online HST during the study period. The most used HSTs were ‘Signs and Symptoms’, ‘Sleep’, and ‘How I Feel’. Majority of parents (86%) reported finding the trackers useful. Only 55% of HCPs viewed the HSTs and of those, 36% reporting using them in clinical care. Qualitative interviews revealed three themes: 1) HST Usability: HSTs were used in different settings such as in clinic and school, they were used to guide conversation as a visual over time, and they used in decision making; 2) Enhancement to HST Usage: suggestions included having more options of different symptoms; and 3) Challenges and Barriers to HST Usage: including personal preference and medical stability of the patient.

Conclusion

The ability of online HSTs to visually depict the change in symptoms over time in CMC was found to be a benefit from a parent and HCP perspective. HSTs were identified as a tool used in clinic to guide conversation and decision making, and as a visual to track symptoms longitudinally. However, HCPs need more guidance on how to use trackers. Future directions for online HSTs include integration into the electronic health record to increase accessibility.
38 Developmental Screening Using the Infant Toddler Checklist at 18 Months and School Readiness at 4 to 6 Years
Authors: Nurse Kimberly , Janus Magdalena , Birken Catherine , Keown-Stoneman Charles , Omand Jessica , Maguire Jonathon , Reid-Westoby Caroline , Duku Eric , Lebovic Gerald , Mamdani Muhammad , Simpson Janis Randall , Tremblay Mark , Parkin Patricia , Borkhoff Cory
Published: October 2022

Background

The American Academy of Pediatrics recommends developmental screening at multiple visits using both a general developmental tool and an autism spectrum disorder (ASD)-specific tool. The Canadian Paediatric Society recommends screening at a single visit at 18 months. There is no consensus on which tool is best suited for one-time screening. The Infant Toddler Checklist (ITC) identifies children who are at risk for communication impairment, may detect ASD, and may be a useful screening tool at the 18-month visit.

Objectives

To examine the screening test accuracy of the ITC at the 18-month visit to predict school readiness at kindergarten age.

Design/Methods

This prospective cohort study included children who attended primary care health supervision visits in Toronto, Canada. Parents completed the ITC at the 18-month visit and teachers completed the Early Development Instrument (EDI - a population-level measure of school readiness in kindergarten) at 4-6 years. An ITC screen is positive if there is concern for expressive speech delay (speech composite below the 10th percentile) and/or other communication delay (social composite, symbolic composite or the total score below the 10th percentile). Children were considered overall vulnerable on the EDI if at least one of five domains was below the 10th percentile of the Ontario population: language and cognitive development; physical health and well-being; social competence; emotional maturity; communication skills and general knowledge. We calculated screening test properties with 95% confidence intervals (CIs), using EDI vulnerability as the criterion measure. We used multivariable regression models to examine the association between the ITC and EDI domains.

Results

Of 293 children, 30 (10%) had a positive ITC. At follow-up, 54 (18%) children had a teacher-reported EDI vulnerability. The specificity (range, 87%-96%) and negative predictive value (range, 83%-95%) for the ITC were high; false positive rate was low (range, 4%-13%); sensitivity was low (range, 11%-37%). A positive ITC was associated with a lower score in EDI language and cognitive development (b= -0.62, 95% CI: -1.25, -0.18; P=0.046) and EDI communication skills and general knowledge (b= -1.08, 95% CI: -2.10, -0.17; P=0.036). We found no evidence of an association between ITC and EDI vulnerability.

Conclusion

The ITC at 18 months had high specificity (87%-96%) suggesting that most children with a negative ITC will demonstrate school readiness at 4-6 years. False positive rates were low, minimizing over-diagnosis. The ITC, with its focus on speech and language, communication disorders and ASD, may be a candidate for screening at the 18-month visit.
39 Developmental Pediatrics Canadian Workforce Survey
Authors: McLeod Scott , Marrello Anna , Fehlings Darcy , Eliason Sabrina , Penner Melanie , Mickelson Elizabeth
Published: October 2022

Background

Children with complex developmental needs may require assistance from a developmental pediatric specialist to complete specialized assessments, treatments, and therapies. Despite reports of large waiting lists at many academic centres, there is no workforce information regarding developmental pediatric care in Canada. Prior surveys of the developmental pediatric workforce in the United States have suggested that the pipeline of new trainees completing sub-specialty residency in developmental pediatrics may not be sufficient to meet predicted needs.

Objectives

In an effort to capture demographic data to understand the current developmental pediatric workforce, we conducted a survey to determine: 1) the demographic profile of developmental pediatric professionals who comprise the current workforce and their career plans; 2) the challenges and trends needing to be considered for future resource planning; and 3) opportunities for innovative care provision within developmental pediatrics.

Design/Methods

The workforce subcommittee of the Developmental Pediatrics Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) drafted a 26-item questionnaire. This cross-sectional survey was pilot tested, and guided by a previous instrument used by the American Academy of Pediatrics. The study population included practicing developmental pediatricians in Canada, who were sent an email link from the RCPSC inviting them to respond. Data analysis was completed using descriptive statistics.

Results

A total of 145 participants completed the study (91% response rate). Forty-five percent of the responding developmental pediatricians have >20 years of experience. Within the next three to five years, 23% of the respondents plan to retire completely from practice. Trends influencing workforce planning were identified including the influence of government funding resources for specific neurodevelopmental disorders (32% of responses), requirements for translation services (70% of responses), and coordination issues with multi-disciplinary assessments (64% of responses). Top ranked priorities for innovative care provision in this specialty included further collaborations with community mental health agencies, capacity building in Autism Spectrum Disorder diagnosis, and an increased focus on care navigation efficiencies.

Conclusion

There are concerning trends present in the demographic distribution of developmental pediatricians given upcoming retirements and increasing service demands. Targeted advocacy to promote capacity building and recruitment to the specialty may be needed to ensure service needs continue to be met.
44 Prevalence estimates of Cerebral Palsy among 4-year-old children living Manitoba, Births: 2013-2015
Authors: Ricci Maria Florencia , Paterson Marie , Anterola Andreah , Hammond Elizabeth , McCammon James , Lau Jonathan , Day Chelsea , Rafay Mubeen
Published: October 2022

Background

Cerebral palsy (CP) is the most common physical disability in children with an estimated prevalence of 2.1 per 1000 live births. Understanding the provincial prevalence of CP and describing clinical sub-types within Manitoba assists with planning future funding and ensuring adequate resources.

Objectives

This study aimed to determine the prevalence estimate of CP among 4-year-old children in Manitoba, and further describe children’s clinical presentation.

Design/Methods

As the Rehabilitation Centre for Children (RCC) is a referral site for all Manitoba children requiring multidisciplinary evaluation/treatment for CP, this retrospective study used RCC’s electronic medical records to identify all 4-year-old children who had a confirmed CP diagnosis, were living in Manitoba and were born between Jan 2013 to Dec 2015. To ensure provincial data was complete, information was cross-referenced with the Pediatric Neurology Clinic’s medical records and the Neonatal Follow-up database. Prevalence rate was determined using Government of Manitoba denominators of same age children. The Gross Motor Function Classification system (GMFCS) determined the child’s level of functioning

Results

The prevalence of CP in Manitoba (birth years 2013-2015) for 108 4-year-old-children is 2.05 (95% CI1.7, 2.5) per 1000 4-year-old children. Of the 108 4-year-old children with CP, 6 (5.6%) had a post neonatal cause, while 102 (94.4%) had a perinatal cause; and 51/108 (47%) were born preterm. Motor subtypes for 108 children are: Spastic 99 (91.7%) including hemiplegia 41.4%, diplegia 21.2%, triplegia 8.1%, and quadriplegia 29.3%; Dyskinetic 4 (3.7%); Ataxic 3(2.8%) and Hypotonic 2 (1.8%). 58/108 (54%) were independent ambulators (GMFCS level II/II).

Conclusion

Our provincial rate of CP is consistent with the prevalence reported in developed countries. Understanding the clinical presentation assists in informing treatment and resources for children with CP in our province.
45 Using fetal ultrasound to predict developmental outcomes in children born with cardiac defects in Manitoba: A historical cohort study
Authors: Ricci Maria Florencia , Zohair Filza , Day Chelsea , Pylypjuk Christy
Published: October 2022

Background

The cavum septum pellucidum (CSP) is a normal anatomical cavity found in the mid-brain of the fetus and is routinely imaged at the time of mid-pregnancy obstetrical ultrasound as part of anatomic survey. Presence of the CSP reflects intact intrahemispheric connections and an intact corpus callosum. The CSP space then closes by the time of birth or early infancy, however persistence of the CSP into adulthood has been described in those with the schizophrenic phenotype of DiGeorge syndrome. Preliminary work by our group in Manitoba has shown utility in measurement of CSP width to improve non-invasive prenatal diagnosis of DiGeorge syndrome among fetuses with and without conotruncal cardiac defects. However, there exists no information about the relationship between fetal CSP width and future neurodevelopmental outcomes, such as Bayley-III scores, in children with cardiac lesions in the absence of underlying genetic comorbidities.

Objectives

To determine the relationship between cavum septum pellucidum (CSP) width and neurodevelopment in children born with sever cardiac defects.

Design/Methods

This was a historical cohort study of children born with cardiac anomalies in Manitoba (2009-2019). Eligible children with developmental pediatric follow-up between ages 18-24 months corrected age were identified using a clinical repository. Post-processing measurement of fetal CSP at mid-gestation using stored obstetrical ultrasounds was performed by two blinded and independent reviewers in a standardized fashion. Ultrasound reports were also reviewed to collate data about routine fetal biometry and imaging data then linked to demographics, birth information, surgical details and neurodevelopmental outcomes (Bayley-III scales). Linear regression models were used to evaluate the relationship between CSP width and Bayley-III scores; inferential statistics were used to compare outcomes between groups (biventricular versus single-ventricle repair).

Results

78 of 111 eligible cases had stored ultrasound images and included in the analysis. Most children were delivered at term following vaginal delivery (71%), with normal birthweight and Apgars. Median CSP width was 3.8mm (SD 1.2). There was a range conotruncal cardiac anomalies and 47% required single-ventricle repair. There was no obvious relationship between

CSP width and Bayley-III motor (p=0.932) or cognitive domains (p0.686), however there was a trend towards larger CSP and higher Bayley-III language scores (p=0.049).

Conclusion

The influence of the deoxygenated blood on the developing fetal brain in modifying outcomes for children with severe cardiac defects needs future study to improve postnatal development in this high-risk group.
46 Patterns of referrals for evaluation of Autism Spectrum Disorder in the pediatric population of Saskatchewan as a predictor of diagnostic outcome
Authors: Legault Olivier , Neufeld Ruth
Published: October 2022

Background

The Alvin Buckwold Child Development Program (ABCDP) serves Northern and Central Saskatchewan as a tertiary diagnostic centre for Autism Spectrum Disorder (ASD) but data is lacking on referrals and diagnostic outcome.

Objectives

This study aimed to assess if referral patterns are associated with diagnostic outcome of ASD.

Design/Methods

We conducted a retrospective cross-sectional study of patients from the ABCDP who were referred and assessed for ASD, or who received a diagnosis of ASD, from January 1st, 2016 to December 31st, 2018. Predictor variables were the referring clinician type and referral content. Suspicion for ASD from referrals were reported as being concerning for one, both or none of the DSM-5 core criteria for ASD (social communication and interaction “criteria A”; restricted and repetitive behaviors “criteria B”). When available, speech-language pathologist (SLP) reports were reviewed to identify concerns of social communication. The main outcome was a diagnosis or not of ASD. Risk ratio (RR) and odds ratio (OR) were estimated by simple logistic regression models to assess the association between individual variables of referral patterns and diagnosis of ASD.

Results

The final dataset included 527 patients after excluding 128 patients (123 were not seen at our center and 5 had a virtual assessment of ASD). A total of 365 patients received a diagnosis of ASD, 140 did not receive a diagnosis, 21 had their diagnosis deferred and one had this information missing. Referrals by physiotherapist (PT) were 46% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,46; 95% CI 1,37-1,54; p=0,022). Referrals by SLP were 25% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,25; 95% CI 1,12-1,39; p<0,0001). Referrals identifying concerns of social communication in SLP reports were 29% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,29; 95% CI 1,16-1,43; p<0,0001). Using no criteria as reference group, referrals with concerns of criteria A were about 2.7 times more likely to lead to a diagnosis of ASD (OR=2,69; 95% CI 1,427-5,054; p=0,002).

Conclusion

In our study population, we found that certain referring clinician type (SLP, PT) and content of referrals (concerns for social communication in SLP reports, main concerns related to criteria A) are more likely to lead to a diagnosis of ASD. These findings could be used to identify referrals with a higher risk of ASD and allocate resources accordingly.
47 Prevalence of and Factors Associated with Language Impairment in Canadian Children with ASD
Authors: Lee Nolan , Weikum Whitney , Ip Angie
Published: October 2022

Background

Autism Spectrum Disorder (ASD) is a life-long neurodevelopmental disorder affecting 1 in 66 Canadians aged 5-17, and language impairment is a common comorbidity in this population. We aimed to determine the relative prevalence of diagnosed language impairment in children with ASD. We also examined factors associated with language impairment in children with ASD.

Objectives

1 – To determine the relative prevalence of language impairment in children diagnosed with ASD.

2 – To identify factors associated with language impairment in children with ASD.

Design/Methods

Our study sample included 6,862 children aged 0-19 years, assessed for ASD (61% diagnosed with ASD) between 2010-2017 in British Columbia, Canada. ASD was diagnosed by a provincially qualified specialist and the assessment included the use of the Autism Diagnostic Observation Schedule (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R). We also looked for associations between language impairment and gender, age, intellectual disability (ID), family history of language disorders, and attention deficit hyperactivity disorder (ADHD), using chi-square analyses.

Results

The overall prevalence of language impairment in children diagnosed with ASD (n = 1820, 44%) was similar to those not diagnosed (n = 1199, 44%). There was more mixed receptive/expressive (80% vs 65%) and less expressive only (22% vs 29%) language impairment in children diagnosed with ASD than without. Looking only at the children diagnosed with ASD, there was no significant difference when evaluating gender (boys 44%, girls 41%; p = 0.094), but younger age was positively associated with language impairment (age <6y 53%, ≥6y 24%; p < 0.01). Increasing severity of ID was negatively associated with language impairment (mild: 44%, p = 0.911; moderate: 33%, p = 0.001; severe: 21%, p < 0.001). Family history of speech language disorder was positively associated with language impairment (no family history 12%, family history 20%; p < 0.01). Presence of comorbid ADHD was negatively associated with language impairment (no ADHD 47%, ADHD 28%; p < 0.01).

Conclusion

In children who have been referred for an ASD assessment, the prevalence of language impairment is similar in those with and without ASD. Children with ASD are more likely to be diagnosed with mixed language impairment than expressive only language impairment, although this difference may in part be due to challenges in fully assessing a child with ASD’s receptive language.
48 Transforming Transitions: Developing Cultural Competence in Supporting Caregivers of Children and Youth Growing Up with Autism Spectrum Disorder
Authors: Rajendram Rageen , Kaur Pardeep , John Tomisin , Babra Isha , Zubairi Mohammad Samad , Young Elizabeth , Minhas Ripudaman
Published: October 2022

Background

Transition to adulthood is a stressful time for caregivers of children and youth with Autism Spectrum Disorder (ASD). Anecdotally, we know that cultural perspectives can directly influence decisions made around ASD diagnosis, treatment, and transition to adulthood. However, there is a paucity of research into these cultural perspectives and how they may affect illness trajectories.

Objectives

1.Through open-ended responses, identify cultural values that play a role in decision making around health care and life course planning during transition to adulthood in ASD.

2.Identify criteria for success in adulthood from parents of children and youth with ASD in a culturally diverse population.

3.Identify systemic barriers that prevent families from accessing culturally sensitive care

4.Educate health care workers on any unique cultural perspective that may impact transition planning.

Design/Methods

In-depth interviews (IDIs) were conducted with caregivers (i.e., parents/guardians) of children and youth with autism. Interviews were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders, with inter-rater reliability confirmed by Cohen’s kappa coefficient.

Results

A total of 12 IDIs were conducted. The main themes that were discussed included caregivers’ understanding of adulthood for their child with ASD, barriers to accessing services, the importance of culture and religion/spirituality to their child’s future, recommendations to improve current services and programming and the impact of the COVID-19 pandemic on decision-making. Caregivers expressed their desire for their child to be independent as they transition to adulthood. They also described how cultural or religious/spiritual practices are integrated into their child’s life and the importance of maintaining their cultural identity. Caregivers emphasized the lack of culturally tailored resources as their child transitions to adulthood to maintain that sense of community.

Conclusion

Caregivers’ cultural perspectives are an integral part of their identity and an important aspect of their environment that should be taken into consideration as children and youth with ASD transition to adulthood.
52 Underweight in the first 2 years of life and growth in later childhood
Authors: South Courtney , Keown-Stoneman Charles , Birken Catherine , Zlotkin Stanley , Malik Vasanti , Maguire Jonathon
Published: October 2022

Background

Underweight occurs when caloric intake is insufficient to maintain growth. While it has long been assumed that underweight in the first 2 years of life is associated with lower growth potential in later childhood, longer term growth outcomes in high income countries are unclear.

Objectives

The primary objective was to evaluate the relationship between underweight in the first 2 years of life and body mass index z-score (zBMI) in later childhood. Secondly, we examined the relationship between underweight in the first 2 years of life and weight-for-age z-score (WAZ) and height-for-age z-score (HAZ) in later childhood, and how sex and the zBMI growth trajectory in the first 2 years of life modify these associations.

Design/Methods

This was a prospective cohort study conducted through The Applied Research Group for Kids (TARGetKids!) practice-based research network. Healthy children 0-10 years of age were included. The primary exposure was underweight in the first 2 years of life using zBMI <-2 as per the World Health Organization (WHO). The primary outcome was zBMI, and secondary outcomes were WAZ and HAZ between 2 and 10 years of age. Linear mixed effects models were used for the primary and secondary analysis to take into account multiple growth measures over time. Interaction terms for sex, and the zBMI growth trajectory in the first 2 years of life were used to explore effect modification.

Results

Among the 5,803 children included in the primary analysis, the mean age was 4.07 months, and 52.2% were male at baseline. In adjusted models, underweight in the first 2 years of life was associated with lower zBMI, lower WAZ, and higher odds of underweight at 2, 5, and 10 years of age (p <0.0001). Underweight in the first 2 years was associated with a lower HAZ at 2 years of age (p<0.0001), but not 5 (p=0.08), or 10 years of age (p=0.8). Females with underweight had lower zBMI and WAZ at 5 and 10 years of age, and lower HAZ at 10 years of age compared to males with underweight (p<0.05). Children with underweight and lower growth trajectory in the first 2 years had lower zBMI, WAZ, HAZ, and higher odds of underweight at 2, 5, and 10 years of age compared to children who did not have underweight (p<0.05). Children with underweight and high growth trajectory in the first 2 years had similar zBMI, WAZ, higher HAZ and lower odds of overweight at 10 years of age (p<0.05), compared to children who did not have underweight.

Conclusion

Underweight in the first 2 years of life was associated with lower growth in later childhood. These relationships were amplified for females and children with underweight who had low growth trajectory in the first 2 years of life and were attenuated among children with underweight who had high growth trajectory in the first 2 years of life.
53 The association between maternal preconception BMI and child zBMI growth rates
Authors: Deveci Arin , Keown-Stoneman Charles , Maguire Jonathon , O'Connor Deborah , Birken Catherine
Published: October 2022

Background

Elevated body mass index (BMI) and rapid growth in early childhood are important predictors of obesity risk. While studies have identified an association between maternal preconception BMI and child BMI z-scores (zBMI), the association with zBMI growth rates during distinct growth periods is unclear.

Objectives

To assess the association between maternal preconception BMI and child zBMI growth rates and BMI z-scores, in children aged 0 to 10 years old. Additionally, to examine whether child sex and gestational weight gain (GWG) modify these associations.

Design/Methods

This longitudinal study consisted of healthy children (0 to 10 years) enrolled in a primary care practice-based research cohort. The exposure was maternal BMI measured during the preconception period, defined as the 2 years prior to pregnancy. The primary outcome was child zBMI growth, modeled with piecewise linear splines for age. The secondary outcome was repeated measures of child BMI z-scores. Piecewise linear mixed models were used to determine the association with growth, while linear mixed models were used for zBMI. Effect modification by child sex and GWG was explored.

Results

499 children were included. Maternal preconception BMI had a small, but statistically significant association with child zBMI growth rates during some growth periods, with the strongest association from 0 to 4 months (0.007; p=0.004). Maternal preconception BMI was also associated with child zBMI; 1kg/m2 increase was associated with 0.03 zBMI increase (p=0.001). Child sex and maternal GWG did not modify these associations.

Conclusion

There is evidence to suggest an association between maternal preconception BMI and child zBMI growth and scores. In addition to maternal and pregnancy benefits, preconception interventions may have longer-term benefits for child growth.
57 Update of IMPACT Invasive Meningococcal Surveillance, 2016-2020
Authors: Bettinger Julie , Sadarangani Manish , Le Saux Nicole , Morris Shaun , Top Karina , Halperin Scott , Tsang Raymond
Published: October 2022

Background

Meningococcal conjugate vaccine (MCV) programs in Canada began in 2002.

Objectives

This study examines the most recent surveillance data to describe the current Canadian epidemiology of invasive meningococcal disease (IMD) and the effect of MCV programs, especially on age and serogroup distribution.

Design/Methods

Active metropolitan area surveillance for hospitalization of adults and children due to IMD, which was defined as a clinical infection with Neisseria meningitidis isolated or detected by molecular methods or culture from a sterile body site. The study was conducted via the 12 centres of the Canadian Immunization Monitoring Program, Active (IMPACT) network from January 1, 2016 – December 31, 2020.

Results

During 2016-2020, a total of 105 pediatric (<20 years of age) and 145 adult IMD cases occurred. Serogroup B accounted for the greatest proportion of pediatric cases (N=58, 55.2%), followed by W (n=19, 18.1%) and Y (n=9, 8.6%) and C (n=2, 1.9%). Among adults, serogroup W accounted for the majority of cases (n=55, 38.0%), followed by Y (n=41, 28.3%), B (n=33, 22.8%) and C (n=7, 4.8%). The age distribution for serogroups covered by MCV programs has shifted to adults. The median age was 24.2 years (33.4 mean). Whereas the median age of serogroup B cases was 7.7 years (19.4 years mean) with 63.7% of cases occurring in children < 19 years of age and 46.2% in children 0-4 years of age.

A total of 20 people died from meningococcal infections in 2016–2020. Five deaths were in children, four from serogroup B and one from serogroup W. Fifteen deaths were in adults, one from serogroup B, eight from serogroup W, three from serogroup Y, and three from Non-typeable/Other/Unknown serogroups.

Conclusion

Serogroup B, which is not covered by MCV programs, still accounts for the majority of pediatric IMD. Serogroup C has been controlled and rarely causes pediatric infection. With the implementation of MCV programs in children and adolescents, the median and mean age at infection has increased across all serogroups, except serogroup B. Serogroup W is still causing IMD among pediatric age groups.
58 Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada
Authors: Piché-Renaud Pierre-Philippe , Panetta Luc , Farrar Daniel , Hepburn Charlotte Moore , Drouin Olivier , Papenburg Jesse , Salvadori Marina , Laffin-Thibodeau Melanie , Kakkar Fatima , Morris Shaun
Published: October 2022

Background

There are limited data on outcomes of SARS-CoV-2 infection among infants (<1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions.

Objectives

The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2.

Design/Methods

This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged <1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 31st 2021, and were classified by disease severity and primary cause of hospitalization. Multivariable logistic regression was performed to identify infants' characteristics associated with hospitalization.

Results

A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions, and infants <1 month had higher odds of hospitalization than infants aged 1-3 months (Table). In total, 20 infants (3.8%) met criteria for severe disease.

Conclusion

We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group is uncommon with most infants having mild disease. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants.
59 Understanding asymptomatic testing uptake amongst school aged children and staff for SARS-CoV-2 testing in elementary and secondary schools
Authors: Cardenas Analyssa , Bruce-Barrett Cindy , Campigotto Aaron , Dharmaraj Blossom , McGovern Christine , Science Michelle , Orkin Julia
Published: October 2022

Background

Enhanced health and safety measures, such as symptom screening, physical distancing, cohorting, masking, and asymptomatic testing for children have been introduced into schools to prevent SARS-CoV-2 transmission. Although asymptomatic testing has been considered a measure to reduce in-school transmission, it has not been broadly implemented or evaluated. To address this, a pilot project with public health, school boards, and hospital-based testing partners was established to assess the feasibility of offering on-site and low barrier SARS-CoV-2 polymerase chain reaction (PCR) testing across schools in the Toronto region.

Objectives

The primary objective of this study was to assess the feasibility of offering on-site and low barrier PCR asymptomatic testing across schools in the Toronto region.

Design/Methods

A six-week testing pilot across the Greater Toronto Area took place. Schools were selected to participate in expanded testing to determine case prevalence in high-risk settings of school-based SARS-CoV-2. Students and staff were excluded if they had tested positive for COVID-19 in the last 3 months. Different testing opportunities were offered based on the testing partner and school preference including location and modality. Descriptive methods were used to assess the uptake of testing and case positivity by individuals recommended to be tested.

Results

Eighteen schools participated in the pilot testing. All students and staff were invited to participate in asymptomatic testing. Testing was offered to 9282 students and 1000 staff, and testing uptake was 29% (2729 students) and 54% (544 staff), respectively. Forty-eight percent of tests (1645) were oral nasal tests, 18% (622) were NP swab tests and 33% (1120) were saliva tests. Of the saliva tests, 52% (590) were on-site saliva tests and 48% (530) were take-home saliva kits. The staff and student positivity rate for on-site testing was 1.9% and 4.9% for tests completed at the COVID-19 Assessment Center at SickKids.

Conclusion

Results from this pilot project demonstrate that on-site PCR testing uptake remained low despite offering in-school testing, specialized support, and reduced barriers by using non-invasive testing with the use of saliva/oral nasal/PCR testing kits. Results highlight the challenges of asymptomatic testing and the balance of resource utilization for low case counts. Future studies should examine alternate means of symptomatic testing.
83 Pediatric Resident Perspectives on a Procedure Day Pilot Program
Authors: Harry Bishal , Bhatt Mihir
Published: October 2022

Background

Royal College objectives emphasize the importance of competencies in lumbar punctures (LPs) amongst pediatric trainees. While a relatively common procedure in pediatrics, studies show that skills decay over time and that trainees may experience uncertainty and variable success rates in performing LPs. Unsuccessful LPs can lead to increased treatment costs, inappropriate antibiotic use, and patient morbidity. Further, the Hematology/Oncology department at our centre has diagnostic and therapeutic LPs that are performed under procedural sedation weekly and do not always have a learner in attendance.

Objectives

To implement an initiative in a pediatric residency program allowing residents to sign up for these procedure days. The goals of this initiative were to provide additional opportunities in a safe, controlled, and well-supervised setting to improve LP competence and confidence amongst residents. In addition, we can use this to develop a formal procedural curriculum in our program.

Design/Methods

A pilot proposal was presented to all stakeholders (program leadership and hematology/oncology departments) for approval. Residents were then able to sign up for twice-weekly procedure days to enhance LP skills. Following the pilot, residents were sent a questionnaire to assess their perceptions of the initiative and skill enhancement using a 5-point Likert scale. With the second iteration of this initiative due to start in 2022, we will be using pre- and post-procedure day surveys to further assess self-reported improvement in various domains.

Results

A total of 14 residents signed up for 42% of eligible days (range of 1-4 days per resident). Total number of LPs ranged from 2-20 per resident over the pilot. All respondents agreed that the initiative was useful in improving their technical skills and confidence. 91% of respondents strongly agreed this pilot should continue to be implemented in the program.

Conclusion

This educational initiative successfully improved resident perceptions of LP skills. Residents felt they were more confident and skillful after this enhanced educational opportunity.