bluuebunny/crossref_metadata_2025 huggingface dataset:
X-ray simulations of polar gas in accreting supermassive black holes
Authors: McKaig Jeffrey , Ricci Claudio , Paltani Stéphane , Satyapal Shobita
Published: October 2021

Recent observations have shown that a large portion of the mid-infrared (MIR) spectrum of active galactic nuclei (AGNs) stems from the polar regions. In this paper, we investigate the effects of this polar gas on the X-ray spectrum of AGNs using ray-tracing simulations. Two geometries for the polar gas are considered, (1) a hollow cone corresponding to the best-fitting MIR model and (2) a filled cone, both with varying column densities (ranging from 1021 to 1022.5 cm−2) along with a torus surrounding the central X-ray source. We find that the polar gas leads to an increase in the equivalent width of several fluorescence lines below ∼5 keV (e.g. O, Ne, Mg, Si). A filled geometry is unlikely for the polar component, as the X-ray spectra of many type 1 AGNs would show signatures of obscuration. We also consider extra emission from the narrow-line region such as a scattered power law with many photoionized lines from obscured AGNs, and different opening angles and matter compositions for the hollow cone. These simulations will provide a fundamental benchmark for current and future high spectral resolution X-ray instruments, such as those onboard XRISM and Athena.
Hepatic cyst infection complicated by a hepatobronchial fistula diagnosed with unique features
Authors: Isogai Hatsuo , Inoue Masashi , Miura Masanao
Published: October 2021

A hepatobronchial fistula (HBF) is a rare condition, defined as an abnormal connection of the respiratory system with the liver parenchyma. Although imaging may be helpful for diagnosis, fistulae are often difficult to identify. An 81-year-old woman presented with mild fever and right upper quadrant abdominal pain. Computed tomography (CT) showed bilateral pneumonia and hepatic cyst infection with air-fluid levels. After mechanical ventilation, abdominal CT showed increased air in the hepatic cyst. The drainage bag for the hepatic cyst infection was also inflated by positive pressure ventilation, suggesting a possible HBF. The ventilator was adjusted to minimize pressure on the fistula and prevent retrograde infection. The fistula eventually closed spontaneously. Appropriate antibiotic treatment and continuous drainage resulted in improvement of the hepatic cyst infection; however, the patient died due to respiratory complications. HBF should be suspected when positive pressure ventilation results in increased air at the hepatic infection site.
6 Neurodevelopmental Outcomes of Extremely Preterm Infants with Late-Onset Bacterial Sepsis According to Type of Bacteria
Authors: Roychoudhury Smita , Lodha Abhay , Synnes Anne , Ting Joseph , Augustine Sajit , Afifi Jehier , Bizgu Victoria , Shah Prakesh , Soraisham Amuchou
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Late-onset sepsis (LOS) is associated with adverse neonatal outcome. There is limited data on the long-term neurodevelopmental (ND) outcomes of infants based on type of bacteria causing LOS. We hypothesize that the type of bacterial pathogen causing late-onset sepsis influences the developmental outcome in extremely preterm infants.

Objectives

To compare the neurodevelopmental (ND) outcomes at 18-24 months corrected age (CA) of infants born < 29 weeks who had late-onset sepsis (LOS) caused by: (1) gram-positive bacteria; (2) gram-negative bacteria; (3) mixed (both gram-positive and gram-negative bacteria); and (4) those with no sepsis (that is, no sepsis or culture-negative sepsis).

Design/Methods

In this retrospective multicentre cohort study, we studied infants born at <29 weeks’ gestational age (GA) between January 2010 and December 2017 and evaluated for neurodevelopmental assessment at 18–24 months’ CA at nine Canadian Neonatal Follow-up Network centers. Infants with early-onset sepsis, major congenital anomalies, those who received palliative care at birth, those who died before 2 days of age, those with non-bacterial infections, and those lost to follow up were excluded. Exposure is late-onset sepsis (LOS) which is defined as the presence of a pathogenic organism in the blood or cerebrospinal fluid culture obtained from a neonate suspected of having sepsis after 2 days of age. The primary outcome was a composite of death or ND impairment (NDI) defined as the presence of any one of the following: cerebral palsy, Bayley-III score of <85 on any one of the components (Cognitive, Language, Motor composite score), hearing loss, and visual impairment. Demographic factors and ND outcomes were compared among the four groups using univariate and multivariate analysis.

Results

Of the 3640 infants included, 823 (22.6%) had late-onset sepsis (LOS). Of the 823 infants with LOS, 569 (69.1%) infants had gram-positive sepsis, 172 (20.9%) had gram-negative sepsis, and 82 (10%) had mixed sepsis. Maternal and neonatal characteristics and outcome are reported in Table 1. Outcome data after adjustment for gestational age (GA), sex, antenatal steroids, SNAP-II score, small for gestational age (SGA), maternal age, and caesarian delivery are presented in Table 2.

Conclusion

Late-onset bacterial sepsis, especially gram-negative sepsis and mixed infections, were associated with increased risk of composite outcome of death or neurodevelopmental impairment (NDI), or NDI alone, at 18-24 months corrected age (CA) in infants <29 weeks’ gestational age (GA).
10 High spontaneous ductal closure even at the extreme of prematurity
Authors: de Carvalho Nunes Gabriela , Wutthigate Punnanee , Simoneau Jessica , Beltempo Marc , Sant'Anna Guilherme , Altit Gabriel
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Extremely preterm newborns are at risk of prolonged patency of the ductus arteriosus (PDA). Current literature has failed to indicate improvement in outcomes after exposure to strategies promoting ductal closure. As such, our center abandoned these practices in 2013.

Objectives

Describe the spontaneous PDA closure in premature infants, including those infants born at the extreme of gestational age (< 26 weeks).

Design/Methods

Retrospective study of newborns < 29 weeks, admitted within 24 hours after birth between 2015 and 2019 and without genetic or congenital anomalies. Newborns who were last known to be alive, with an available echocardiography, and who were not exposed to any intervention to accelerate PDA closure were included. Images were reviewed by experts blinded to the outcomes.

Results

296 infants were analyzed. 37 (12%) did not survive their hospitalization, and 16 were exposed to interventions to accelerate ductal closure at some point during their lifetime (4 ligations, 4 catheter-closure, 5 ibuprofen and 3 acetaminophen). Out of the 243 remaining newborns, 214 had at least one echocardiography to ascertain ductal patency or closure (100% of those <26 weeks). The average gestational age was 26.3±1.5 weeks, with 84 (39%) being <26 weeks. PDA closed spontaneously in 194 (91%), with 60 having closure ascertainment after discharge (average age at closure ascertainment of 36.4 [IQR: 34.4 – 40.1] weeks). Of the 84 <26 weeks, 76 (90%) had confirmation of ductal closure. The 20 infants with an open PDA at the last evaluation were followed in an outpatient setting and considered small/restrictive. In our cohort, 92/243 (38%) were exposed to post-natal steroids. In the <26 weeks group, 74% were exposed to steroids, at a cumulative dose of 1.64 [0.89 – 2.44] mg/kg. BPD was found in 57% of the overall cohort and in 79% of <26 weeks.

Conclusion

The majority of newborns < 29 weeks, and even those at the extreme of gestational age (< 26 weeks) spontaneously closed their PDA before term-corrected age. While BPD rate was similar to previous cohorts, post-natal steroids use was high.
13 Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy
Authors: Bhattacharya Soume , Read Brooke , Miller Michael , daSilva Orlando
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Surfactant delivery via a thin endotracheal catheter during spontaneous breathing, a technique called minimally invasive surfactant therapy (MIST), is an alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multi-access catheters, vascular catheters and, recently, custom-designed catheters for this purpose. The impact of choice of catheter on procedural success and adverse effects has not been reported.

Objectives

The objective of the present study was to compare the procedural success and adverse effects of MIST, using a semi-rigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multi-access catheter (MAC).

Design/Methods

This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics, data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath were compared using a Chi Square test or Fisher’s test, as appropriate. A P value of less than 0.05 was considered significant.

Results

A total of 139 neonates received surfactant via MIST method during the study period. 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two groups were similar (Table 1). A higher proportion of neonates in the Angiocath group received atropine (100% vs. 76%, P =.002] and fentanyl (98% vs. 36%; p<0.001) than the MAC group.

The procedural success was 91% in the Angiocath group and 89% in the MAC group (p >.99). Multiple attempts were needed in 24% of neonates in the Angiocath group, and 37% in the MAC group (p=0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%) (P=0.012). Other rates of common adverse effects were similar between the two groups (Table 2).

Conclusion

The overall procedural success of MIST was similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with Angiocath use, though this difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, possibly related to higher use of procedural sedation in this group.
21 Long-Term Ophthalmologic Outcome of Young Adults Born Extremely Preterm
Authors: Zhou Tianwei , Kassis Pierre-Olivier , Hamel Patrick , Qian Cynthia , Chemtob Sylvain , Nuyt Anne Monique , Luu Thuy
Published: October 2021

Primary Subject area

Ophthalmology

Background

Retinopathy of prematurity (ROP) remains the dominant cause of severe visual impairment in childhood in North America and Europe. With the salient improvement in neonatal care since the 1980s, more and more very/extremely premature infants survived and are now reaching adulthood. Premature birth interferes with the critical period of retinal maturation and foveal development. The development of ROP further damages the retina and its vasculature. So far, outcome studies on visual functions and ocular structure in adults born preterm remain scarce.

Objectives

The first aim of this study is to describe the visual function and retinal structure in a cohort of young adults who were born prematurely. With the recognition of the insidious nature of ROP, we also aimed to investigate if ROP could exert a “second hit” beyond prematurity.

Design/Methods

This cross-sectional observational study compared visual function of young adults (18-29 years old) born prematurely (< 30 weeks of gestational age [GA]) versus full-term controls. Participants were categorized into three groups: preterm without ROP, preterm with ROP, and term. Comprehensive ophthalmologic examination was performed with blinding to preterm and ROP status. Best corrected visual acuity (BCVA) was assessed with a standardized linear Snellen chart and contrast sensitivity (CS) with the Vistech system. When analyzing BCVA, refractive errors, and contrast sensitivities, we further grouped data based on the strong eyes (better BCVA) and the weak eyes (worse BCVA). Area-under-the-curve (AUC) analysis was performed to gauge the overall CS. Group comparisons were done using ANOVA.

Results

In this study, 88 individuals born prematurely and 86 individuals born full-term were recruited. Among the strong eyes of the 3 groups, there was no significant difference for BCVA or refractive errors (see image). Among the weak eyes, the preterm with ROP group had the worst BCVA and refractive outcomes, compared to the preterm without ROP and term groups. In the strong eyes, the CS AUC of the preterm with ROP group (16.22 ± 2.69 p<0.0001) was significantly lower than both the preterm without ROP (18.13 ± 2.01) and term (19.55 ± 2.48) groups. In the weak eyes, the AUC of the 3 groups showed a significant and progressive decline from the term group (18.9 ± 2.84) to the preterm without ROP group (18.29 ± 2.14), then to the preterm with ROP group (15.24 ± 2.21).

Conclusion

In our cohort of young adults born preterm, prematurity alone did not affect their BCVA and refractive errors. However, ROP was independently associated with a lower BCVA, higher refractive errors, and a reduced contrast sensitivity. Our data have shown that prematurity and ROP have independent effects on contrast sensitivity. This study highlights the necessity of long-term ophthalmologic follow-ups for adults who were born prematurely.
22 Housing Need Amongst Children with Medical Complexity: A Cross-Sectional Descriptive Study of Three Populations
Authors: Esser Kayla , Moore Clara , Hounsell Kara Grace , Davis Adrienne , Sunderji Alia , Shulman Rayzel , Cohen Eyal , Orkin Julia
Published: October 2021

Primary Subject area

Complex Care

Background

Children with medical complexity (CMC) have medical fragility, complex chronic disease necessitating specialized care, functional disability, and/or high technology dependence. Housing is an important social determinant of health, yet research on prevalence and types of housing need in CMC is limited. Housing need encompasses unstable (frequent moves), inaccessible (lack of ramps/lifts), inadequate (major repairs needed), unsuitable (not enough bedrooms), or unaffordable housing. Given the association between housing and health, housing need may be an important consideration when caring for CMC.

Objectives

The primary objective was to describe the prevalence of and factors related to housing need in CMC. The secondary objective was to compare housing need between CMC, children with one chronic condition (Type 1 diabetes; CT1D) and healthy children (HC) to understand the relationship between chronic conditions and housing need.

Design/Methods

This was a cross-sectional descriptive study. Housing affordability, adequacy, suitability, stability, and accessibility were evaluated through surveys administered to caregivers of CMC, CT1D, and HC at a tertiary-care paediatric hospital using convenience sampling. The association of binary outcomes of housing need between groups was analyzed using logistic regression models, adjusting for sociodemographic factors (income, education, employment, geography, immigration status).

Results

453 caregivers participated (Table 1). Compared to caregivers of HC, caregivers of CMC had higher odds of reporting one or more moves in the last two years (1.3 times), having safety concerns (3 times), using a common area as a bedroom (5.2 times), and experiencing housing stress (3.2 times), after sociodemographic factors were adjusted for (Table 2). Families of CT1D also had elevated odds of some indicators of housing need compared to HC, although to a lesser extent than CMC. 62.2% of CMC indicated they had to reduce spending on basics in order to afford their rent/mortgage, compared to 35.9% of CT1D and 25.2% of HC. Nearly two-thirds of CMC (60.2%) reported a need for accessibility accommodations in their home. Of those who installed accommodations, 62.9% felt the installations were a financial burden (cost ranged from $800-$80,000).

Conclusion

Families of CMC had higher odds of reporting unstable, inadequate, unsuitable, and stressful housing compared to HC even after sociodemographic factors were accounted for, suggesting an association between complexity of child health conditions and housing need. Access to appropriate housing may improve the health of CMC. Health care providers can screen for housing need, become familiar with housing interventions, and advocate for improved resources to address housing need in CMC.
24 Reducing vibrations to improve infant patient safety during transportation
Authors: Renesme Laurent , Darwaish Fadwa , Greenwood Kim , Aubertin Cheryl , Green James , Chan Adrian , Langlois Robert , Redpath Stephanie
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Each year, thousands of newborns are transported by air or ground ambulance to receive specialized medical care. For neurologically immature and physiologically compromised infants, especially preterm infants, the noise and vibration exposure during transport are high despite preventative measures, and may be an important contributor to brain injury risk.

Objectives

To develop a new tool to investigate vibrations during neonatal transport and mitigation strategies.

Design/Methods

Proof of concept study including 3 steps: 1) Characterization of the vibrations during transport. Accelerometer sensors placed on different layers of the Neonatal Patient Transport System (NPTS) (neonate manikin, mattress, incubator, deck, stretcher, and vehicle floor) with a variety of ambulance on road tests performed to capture data. 2) Experimentation - A shaker table was used to develop a standardized test environment. Vibration testing was performed, with the entire NPTS mounted on the shaker table. 3) Mitigation - Shaker table tests were repeated using different configurations of mattress and harness types on manikins with different bodyweights.

Results

1) Characterization: Road transport exposed the manikin’s head to vibrations that exceeded adult standards. Examining the frequency spectra of the accelerometer signals across different layers of the NPTS suggests that two interfaces, stretcher/vehicle floor and incubator/deck, may be critical for intervention to mitigate the vibrations, as they both showed the highest gains in vibration power.

2) Experimentation: Comparison between the on-road and shaker table tests showed that the shaker table was able to reproduce on-road transportation with acceptable fidelity. The shaker table setup can serve as a standardized environment to explore the impact of several NPTS design variables on vibrations transmitted to the patient.

3) Mitigations: Different mattresses were shown to influence the vibrations experienced by the manikin. The head restraint harness type showed an amplitude reduction of the peak frequency component for all experiment types and for most mattress types compared to a standard 5-point harness.

Conclusion

Our study demonstrated that: i) vibrations during neonatal transport can exceed adult standards; ii) acceptable fidelity simulation of road conditions can be achieved using a shaker table system; and iii) the most effective approach for vibration mitigation should consider the whole NTPS, instead of focusing solely on the isolette.
27 ECG monitoring during NRP: A false sense of security?
Authors: Gariépy-Assal Laurence , Moussa Ahmed , Assaad Michael-Andrew
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

During neonatal resuscitation, use of an electrocardiogram (ECG) provides a more reliable measurement of heart rate than auscultation or pulse oximetry. Having an ECG monitor may, however, provide a false sense of security in the unlikely scenario of a newborn with pulseless rhythms. This could delay critical resuscitative steps during neonatal resuscitation.

Objectives

The aim of this study is to evaluate whether the presence of ECG monitoring has an impact on the resuscitative steps of neonatal resuscitation providers.

Design/Methods

We conducted a prospective crossover randomized controlled trial, which took place at Sainte-Justine University Health Center in Montreal, Quebec, Canada. Residents, fellows, attending physicians, transport nurses, and respiratory therapists were recruited in teams of three. They participated in two simulation scenarios (pulseless electrical activity [PEA] with and without ECG monitoring). Teams were randomized to one of the scenarios and then crossed over. A debriefing session followed the two scenarios. All sessions were video-recorded. The primary outcome was the time to pulse check once the simulated mannequin was programmed to become pulseless. Secondary outcomes were the number of pulse checks, time to intubation, time to start of chest compressions, and time to administration of epinephrine.

Results

Preliminary results (n=5 groups, 10 scenarios) showed that the time to check the pulse once the mannequin was pulseless was longer when ECG electrodes were used (98.0 vs 55.6 sec, p = 0.07). There was a statistically significant decreased number of pulse checks with the ECG compared to without (2.4 vs 5.6, p = 0.004). Time to start of positive pressure ventilation (31.3 vs 27 sec), intubation (182.4 vs 179.2 sec), chest compressions (235.2 vs 227.6 sec), and epinephrine administration (340.8 vs 241.5 sec), were all increased in the presence ECG monitoring, but the difference between groups was not statistically significant.

Conclusion

ECG monitoring may alter the behaviour of individuals and delay recognition of a pulseless state, but preliminary data suggest that clinical endpoints are not affected.
30 Risk Factors for Stage III Necrotizing Enterocolitis in Very Low Birth Weight Neonates – A retrospective case-control study
Authors: Lalitha Renjini , Qureshi Mosarrat , Hicks Matthew , Kumaran Kumar
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Stage III necrotizing enterocolitis (NEC-III) is a serious intestinal inflammatory disease in neonates, with high case fatality rate and significant morbidities including need for surgical intervention. Research focusing on risk factors for the development of NEC-III are lacking.

Objectives

To determine the risk factors for NEC-III and its outcomes among neonates born under 33 weeks gestational age (GA).

Design/Methods

This was a single-centre retrospective case-control study of preterm neonates born under 33 weeks GA who were admitted to Stollery Children’s Hospital neonatal intensive care unit (NICU), Edmonton, Alberta, between January 2015 and December 2018. NEC-III cases were compared with Stage II NEC (NEC-II) and matched with 2-4 non-NEC controls by GA ± 1 week and date of birth within 3 months. Univariate and multivariate analysis compared the risk factors for NEC-III, adjusting for GA, birth weight, and sex.

Results

Out of 1360 babies born <33weeks, 71(5.2%) had NEC-II and above during the study period (Figure 1). NEC-III constituted 46% of the total number of NEC cases. Average age of onset of NEC-III was 13.7 days versus 23.9 days for NEC-II (p=0.01). Neonates with NEC-III were of lower GA (25.4weeks) compared to NEC-II(27.3 weeks) and non-NEC (26 weeks), (p=0.0008), had higher severity of illness with Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE-II score) of 47.5 versus 28.4 for NEC-II and 37 for non-NEC ( p=0.003), spent more days on vasoactive agents (3.7 days versus 1.1 days and 1.8 days for NEC-II and non-NEC respectively; p=0.05).

There was a trend towards lower Apgar score <7 at 10 mintues in NEC-III versus non-NEC (AOR 2.59, 95% CI [0.88-7.67]; p=0.085). Death or short bowel syndrome was higher for NEC III (AOR 12.4, 95% CI [1.16-132.28]; p=0.037).

Conclusion

In this case-control study of neonates born under 33 weeks GA, after adjustment for known confounders, duration of UAC and prolonged rupture of membranes were significantly associated with increased incidence of NEC-III. Composite outcome of mortality or short bowel syndrome were higher in NEC-III.
31 Noninvasive high-frequency oscillatory ventilation in preterm infants: Safe and effective
Authors: Soucy-Giguère Laurence , Drolet Christine , Piedboeuf Bruno , Hébert Audrey
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Mechanical ventilation is frequently used in preterm infants for various indications, but is associated with multiple complications, including bronchopulmonary dysplasia and poorer neurodevelopmental outcomes. Noninvasive high-frequency oscillatory ventilation (nHFOV) is a noninvasive ventilation (NIV) strategy used to avoid mechanical ventilation and associated complications. However, its effectiveness remains controversial, and its safety has not been established.

Objectives

The objectives were to evaluate the effectiveness of nHFOV to prevent intubations and support adequate ventilation in preterm infants, and to assess its safety profile.

Design/Methods

This was a retrospective crossover case study including 24 infants and 30 nHFOV instances between May 2018 and June 2020. Infants were included if they were placed on nHFOV for at least one hour; each nHFOV trial contributed as one instance. Data was collected from health records. Effectiveness outcomes were: successful transition to another NIV mode without requiring intubation, and variations in CO2, FiO2, and number of spells. Safety outcomes were: apparition of intraventricular hemorrhage (IVH), gastrointestinal complications, nasal cutaneous trauma, and comfort as assessed with the Neonatal Pain, Agitation and Sedation Scale (N-PASS). Descriptive statistics were used for baseline characteristics. Nonparametric and semiparametric tests were used to compare outcomes pre- and during nHFOV.

Results

Baseline characteristics are presented in Table 1. At initiation of nHFOV, mean chronological age and weight were 24 days (95% CI: 20 – 28) and 1119 grams (95% CI: 1038 – 1200) respectively. The most frequent indication for nHFOV was spells (56.7%), and the mean duration of nHFOV instances was 3.9 days (95% CI: 2.7 – 5.1) (Table 1). In 18 (60%) cases, infants transitioned successfully to another NIV mode without requiring intubation. Levels of CO2 and number of spells were significantly lower during nHFOV than pre-nHFOV. There was no significant difference in FiO2 pre-nHFOV and during nHFOV. No apparition or progression of IVH was observed following the use of nHFOV. There was no significant difference in N-PASS, nasal trauma, and gastrointestinal complications pre-nHFOV and during nHFOV (Table 2).

Conclusion

This study suggests that nHFOV is an effective ventilation method to avoid intubation and to decrease spells in preterm infants, without increasing complications.
34 Improving workflow efficiency by implementing priority indication in paging communication
Authors: Lee Jimin , Desai Tejas , Horwitz Jennifer , McLean Connor , Nelson Matthew , Seidman Gillian , Buba Melanie
Published: October 2021

Primary Subject area

Hospital Paediatrics

Background

Paging is an important method of communication in hospitals but can also interrupt clinical care unnecessarily. These interruptions decrease workflow efficiency and negatively affect patient care.

Objectives

The goal of this project was to decrease clinical care interruptions from non-urgent pages to pediatric residents by implementing a priority indication system that was: (1) consistently used (90% pages with a priority level indicated); (2) clearly defined (80% concordance in the priority levels between senders and recipients); and (3) satisfying to end users (80% rating the paging system as satisfied).

Design/Methods

The Plan-Do-Study-Act method of quality improvement was used. The study was conducted at an academic children’s hospital, where numeric paging occurs through a switchboard operator. Three priority levels (1 being most urgent) with a respective expected callback time (5-15, 15-30, 60+ minutes) were determined through a pilot study and stakeholder consensus. A priority level was selected by the page sender and displayed beside a callback number.

Process measures were indication of priority levels and concordance of priority levels between senders and recipients. Outcome measures were reduced interruptions to clinical care from non-urgent pages and user satisfaction. Balancing measures included patient safety incidents. Run charts, surveys, and page logs were used to track the impact of interventions.

Results

In the first two months, 1325 out of 2208 (60%) pages had a priority level indicated. In the subsequent two months after providing feedback to users, the proportion increased to 1822 out of 2410 (76%). Subsequent bimonthly indication rates have ranged between 74% and 83%.

Among pages with a priority level indicated over 16 months (n=13,934), 26% were assigned priority 1, 62% priority 2, and 11% priority 3. There was a 74% concordance in priority levels between senders and recipients. 26% of pages were received while a resident was directly interacting with a patient. Fewer residents felt that their workflow was being frequently interrupted by non-urgent pages (from 65% to 39%). End user satisfaction improved. There were no patient safety incidents.

Conclusion

Using existing infrastructure, we implemented a paging priority indication system that decreased interruptions to clinical care. Residents reported improved workflow efficiency, and end users expressed improved satisfaction with paging communication. The gap in the perception of urgency between senders and recipients will need to be further evaluated. While a priority level indication is particularly pertinent to hospitals using numeric pagers, a standardized indication of priority levels can also be beneficial in hospitals using an alternative communication system.
39 Physical and social distancing measures and child health behaviours during COVID-19: A cohort study
Authors: Li Xuedi , Vanderloo Leigh , Maguire Jonathon , Keown-Stoneman Charles , Aglipay Mary , Anderson Laura , Cost Katherine , Charach Alice , Vanderhout Shelley , Birken Catherine
Published: October 2021

Primary Subject area

Public Health and Preventive Medicine

Background

Various studies have examined the general impact of the COVID-19 outbreak on children’s health behaviours. The impact of public health measures practised by children during COVID-19 is relatively unknown.

Objectives

The primary objective was to determine the association between physical and social distancing measures and children’s outdoor time, sleep duration, and screen time during COVID-19.

Design/Methods

A longitudinal study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) between April 14 and July 15, 2020. Parents were asked to complete questionnaires about isolation, physical distancing practices, and children’s health behaviours. The primary exposure was the average number of days that children practised physical and social distancing measures per week. The three outcomes were children’s outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed effects models were fitted using repeated measures of primary exposure and outcomes.

Results

This study included 554 observations from 265 children. Physical and social distancing measures were associated with shorter outdoor time (-17.2; 95% CI -22.07, -12.40; p < 0.001) and longer total screen time (11.3; 95% CI 3.88, 18.79; p = 0.003) during COVID-19. The association with outdoor time was stronger in younger children (< 5 years), and the associations with total screen time were stronger in females and in older children (≥ 5 years).

Conclusion

Physical and social distancing measures during COVID-19 have resulted in negative impacts on the health behaviours of Canadian children living in a large metropolitan area.
54 Body Mass Index vs Weight-for-Length in Infancy and Cardiometabolic Outcomes at Age 8-10 Years
Authors: Roberge Jean-Baptiste , Harnois-Leblanc Soren , McNealis Vanessa , van Hulst Andraea , Barnett Tracie A , Kakinami Lisa , Paradis Gilles , Henderson Mélanie
Published: October 2021

Primary Subject area

Public Health and Preventive Medicine

Background

The WHO provides body mass index (BMI) curves for infants 0 to < 2 years old, but how these compare to the recommended method (weight-for-length [WFL]) in predicting later adiposity and cardiometabolic measures is uncertain.

Objectives

Our project aimed to: 1) confirm that WFL and BMI in infancy are associated with adiposity and cardiometabolic measures at 8-10 years old; and 2) compare the predictive ability of the two methods. We hypothesized that both methods would perform similarly.

Design/Methods

WFL and BMI Z-scores (zWFL and zBMI) at 6, 12, and 18 months of age were computed using data extracted from health booklets, used among participants in a prospective cohort study investigating the natural history of obesity and cardiovascular risk in youth (n = 464). Outcome measures at 8-10 years included adiposity, lipid profile, blood pressure, and insulin dynamics. The relationships between zWFL, zBMI, and each outcome were estimated using multivariable linear regression models. Outcome prediction at 8-10 years was compared between the two methods, using eta-squared and Lin’s concordance correlation.

Results

zWFL and zBMI were associated with all measures of adiposity at 8-10 years. Associations with other cardiometabolic measures were less consistent. For both zWFL and zBMI across infancy, eta-squared were highly similar and the Lin’s coefficients were markedly high (> 0.991) for all outcomes.

Conclusion

zBMI measured in infants appeared to be equivalent to zWFL for predicting adiposity and cardiometabolic measures in childhood. This lends support to the sole use of zBMI for growth monitoring and screening of overweight and obesity from birth to 18 years.
58 Relationship Between Early Laboratory Measures and Neurological Injury in Neonates Undergoing Therapeutic Hypothermia
Authors: Kebaya Lilian , Ee Mong Tieng , Miller Michael , Bhattacharya Soume
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Hypoxic-ischemic encephalopathy (HIE) is a major contributor to morbidity and mortality. Therapeutic hypothermia (TH) is the standard of care for neonates with moderate to severe HIE. Brain magnetic resonance imaging (MRI) is the imaging modality of choice for confirmation of HIE, assessment of injury severity, and prognostication. Reliable, inexpensive and widely available laboratory measures for early identification of risk for neurological injury can play a critical role in the optimal management of neonatal HIE, especially in the resource-limited setting. Our study examined whether derangements in early routine laboratory measures (acid-base, haematological, metabolic) were worse in neonates with MRI findings of neurological injury.

Objectives

Primary objective: To evaluate the role of early laboratory measures in predicting neurological injury as detected by MRI at 72 hours. Secondary objective: To evaluate the role of early laboratory measures in predicting survival to NICU discharge in patients with HIE.

Design/Methods

This single-centre, retrospective cohort study included neonates ≥ 35 weeks gestation with moderate to severe HIE, who had undergone therapeutic hypothermia. Based on findings of brain MRI completed within 72 hours of life, our cohort was divided into 2 groups: neonates with, and without, evidence of neurological injury consistent with HIE. Baseline characteristics, as well as laboratory measures, were compared between groups, and a receiver operating characteristic (ROC) curve analysis was conducted to determine the cut-off for prediction of neurological injury based on the highest sensitivity and specificity values.

Results

104 neonates were analyzed. Baseline characteristics (Table 1) were similar between both groups, except for cord venous pH and base excess (BE), which were significantly lower in the abnormal MRI group (p = 0.02). In bivariate analysis, pH (at 1 h of age, p = 0.027), BE (at 1 h, p = 0.001, and 6 h of age, p = 0.004), ionized calcium (at 6 h of age, p = 0.02), and platelets (at 1 h of age, p = 0.004) were significantly different in neonates with abnormal MRI. In ROC curve analysis, BE at 1 h of life was the best predictor of abnormal MRI (AUC = 0.71, p = 0.002), with a cut-off value of ≤ -14.95, sensitivity of 67% and specificity of 66% (Figure 1).

Conclusion

Among neonates with HIE undergoing TH, early laboratory measures such as acid-base status, ionized calcium, and platelet count were worse in neonates with abnormal MRI, in comparison to neonates with normal MRI. Base excess at 1 h of life is a good predictor of abnormal MRI. Future prospective studies to validate these findings are needed
70 Sharing Child Health Knowledge in an Urban Inuit Community: A Needs Assessment
Authors: Bierstone Daniel , Hummel Brian , Newhook Dennis , Jetty Radha
Published: October 2021

Primary Subject area

Public Health and Preventive Medicine

Background

It is well established that significant health disparities continue to affect Canadian Indigenous children living both in remote and urban areas. A critical component of health promotion is health knowledge dissemination. A 2011 Health Council of Canada study identified the need for better community knowledge of parenting and child health as intervention targets among Indigenous communities across Canada.

Objectives

In the present study, we aimed to explore the perspectives of Inuit parents and caregivers in one urban setting (Ottawa, Ontario) on the dissemination of child health knowledge specifically, with the intention of guiding future community-based child health promotion initiatives.

Design/Methods

Ottawa, being home to the largest Inuit population living outside Inuit Nunangat, provided an ideal study location. Many Inuit report relocating to Ottawa for employment, education, or for greater access to heath services. We therefore partnered with the Ottawa-based Inuuqatigiit Centre for Children, Youth, and Families, to design and conduct a needs assessment through a series of focus groups. Focus groups explored participants’ current sources of child health knowledge, child health topics of interest, and preferred formats for child health knowledge dissemination. Focus groups were held at Inuuqatigiit and included a meal of country food shared by study participants and research team members to support relationship-building and engagement. Focus groups were analyzed using an inductive approach to qualitative thematic analysis.

Results

24 Inuit parents and caregivers participated in 4 focus groups. Factors affecting preferred sources of health knowledge included trustworthiness, fear of discrimination, cultural differences, and having a holistic approach. Participants identified several child health issues that should be the focus of future child health knowledge sharing initiatives, in particular those in which a sense of cultural dissonance was felt between traditional and Western approaches. In-person and online/interactive sessions were preferred over written materials. Many participants agreed that child health knowledge-sharing initiatives should be designed and delivered with involvement of the community. Participants also emphasized the importance of synthesizing traditional knowledge of Elders with that of health professionals.

Conclusion

There is a need for better child health knowledge dissemination strategies among the Ottawa Inuit community as a crucial aspect of health promotion. Special considerations when designing such initiatives must be given to historical dynamics of trust and mistrust of the health professions, to addressing cultural differences, and to the role of community members in the design and implementation of initiatives.
74 Central venous line-related thrombosis in neonates: A population-based study
Authors: Desjardins Marie-Pier , Hébert Audrey , Pelland-Marcotte Marie-Claude
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

The incidence of central venous line (CVL)-related thromboembolism (TE) in neonates is rising dramatically. The mainstay of treatment in neonatal thrombosis is anticoagulant therapy. However, management of neonatal CVL-related TE is particularly complex, as the higher risk of systemic and intracranial bleeding, especially in premature babies, must be balanced with the thrombotic risks, including death, or morbidity such as organ dysfunction, post-thrombotic syndrome, and neurodevelopmental sequelae. There is a paucity of evidence regarding the epidemiology of neonatal CVL-related thrombosis, to help clinicians identify neonates at high-risk of CVL-related thrombosis, as well as to tailor treatment based on the risks and benefits of anticoagulants in neonates.

Objectives

The objectives of this retrospective cohort study are: 1) to determine the main risk factors of CVL-related TE in neonates admitted to the neonatal intensive care unit (NICU); and 2) to compare the effectiveness and safety between different antithrombotic treatment modalities for neonatal CVL-related TE using the Canadian Neonatal Network (CNN) database and electronic medical chart review.

Design/Methods

Neonates ≤ 28 days of life admitted to the NICU for ≥ 24 hours requiring a CVL with TE confirmed by imaging were included in the study. The main effectiveness outcome is the resolution of TE, whereas the main safety outcome is the apparition of a major bleeding. In this study (n=39), we compared the effectiveness and safety outcomes according to antithrombotic treatment modalities (conservative vs. anticoagulation).

Results

The median gestational age is 35[26-38] weeks, and the mean birth weight is 2096±1110 g. CVL responsible for TE was umbilical venous catheter (28%), umbilical arterial catheter (46%), peripherally inserted central catheter (PICC line) (8%), and peripheral arterial catheter (18%). The anticoagulation therapy is more effective to achieve a partial and complete resolution of TE than the conservative treatment after a mean follow-up of 7 weeks (p=0.02). However, there were no differences according to antithrombotic treatment group regarding safety outcome assessed by major bleedings (p=0.2).

Conclusion

Our results tend to suggest that anticoagulation therapy is more effective to achieve resolution of CVLs-related TE than conservative treatment without compromising the safety of neonates. However, a large multicentric study is required to evaluate the risks and benefits of anticoagulants in neonates.
86 Virtual MacPeds: Leveling up to the new virtual reality of medical education
Authors: Mazze Nina , Zahn Kristen , Niec Anne , Ngo Quang
Published: October 2021

Primary Subject area

Medical Education

Background

The COVID-19 pandemic and physical distancing measures limited in-person learning experiences for resident postgraduate learners through mandated social distancing measures. Our training program responded by creating online synchronous and asynchronous learning opportunities to supplement learning and replace lost experiences. Virtual MacPeds is an online curriculum created using Kern’s six-step approach to curriculum development to supplement resident learning during COVID-19. The curriculum included online lectures, a live teaching calendar that includes links to sessions across rotations and subspecialties, and a resource rolodex with links to online learning materials.

Objectives

The purpose of this study is to evaluate the components of the Virtual MacPeds curriculum that were most useful to residents.

Design/Methods

Virtual MacPeds was piloted from March 2020 to June 2020 to 51 core pediatric residents in PGY1-4. The Kirkpatrick Model for learning evaluation was used to assess resident reaction to the implementation of the curriculum. A voluntary online survey was emailed to residents with the opportunity to respond from June to July 2020. Descriptive statistics were used to assess learner engagement and perception of the curriculum.

Results

Resident response rate was 38.2% (n=20, PGY1 =8, PGY2 =6, PGY3=5, PGY4=1). 95% of respondents had reduced in-person teaching sessions during COVID-19 and 80% had impacted clinical rotations (self-isolation, virtual care, patient volumes). Prior to Virtual MacPeds, 65% used online educational resources. 95% used the curriculum, all of whom found it helpful in fulfilling Royal College learning objectives. 85% of participants attended the online lectures - those who did not attend noted schedule conflict. 100% would use Virtual MacPeds in the future. Participants noted that Virtual MacPeds should include a live teaching schedule (100%), online lectures (84.2%), self-study modules (73.7%), resource rolodex (52.6%) with suggestions for recorded lectures (89.5%) and simulations (57.9%).

Conclusion

Virtual MacPeds is an acceptable and useful supplement to resident learning during COVID-19. Useful elements of the curriculum include online lectures, a live teaching schedule, resource rolodex and self-study modules.
92 Balint Groups: An Initiative to Help Residents Better Understand the Clinician-Patient Relationship
Authors: Finstad Warner , Jeong Dayae , Humphreys Joanna , Lord Sarah , Diskin Catherine , Lam Justin
Published: October 2021

Primary Subject area

Medical Education

Background

A Balint group is an educational tool that allows residents to reflect on challenging experiences with the doctor-patient relationship. Guided by trained facilitators, residents consider these cases from the doctor, patient and doctor-patient perspectives together with their colleagues. Balint groups can support the recognition of the emotional complexity underlying these interactions, which in turn reduces burnout, improves patient care and team dynamics, and strengthens professional identities.

Objectives

1) To evaluate the effect of Balint groups on trainees’ perceived comfort levels in navigating, debriefing, and supporting peers through challenging patient-physician encounters; 2) To evaluate the effect of Balint groups on the perceived culture of support within the paediatric residency program at the University of Toronto.

Design/Methods

The University of Toronto Pediatrics Residency Program incorporated Balint groups into the curriculum in 2018. Supported by faculty, residents led their introduction and improvement using Quality Improvement methodology. Outcome measures included perceived comfort levels in navigating and supporting peers through challenging patient-physician encounters, and the perceived culture of support within the program. Outcome measures were obtained using a 5-point Likert scale. Rates of group participation were collected as a process measure.

Results

All outcome measures improved between the first and second year of Balint group implementation. Residents’ comfort levels in navigating difficult patient-physician encounters increased from a mean of 2.5 (out of a 5-point Likert scale) to 3.0, in debriefing complex scenarios from 3.1 to 3.9, and in supporting peers from 3.2 to 3.8. The perceived culture of peer support improved from a mean of 3.5 to 4.2.

Conclusion

A Balint group is a reflective educational tool, which has a positive impact on residents’ experiences navigating patient relationships. Introducing these sessions at our institution has shown an encouraging trend in improving residents’ comfort levels with difficult clinical encounters and fostering a culture of support.