bluuebunny/crossref_metadata_2025 huggingface dataset:
75 Parental perspective about the health and development of their extremely preterm child
Authors: Milette Audrey-Anne , Richter Lindsay , Bourque Claude-Julie , Janvier Annie , Robson Kate , Church Paige Therrien , Synnes Anne , Luu Thuy
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Preterm birth outcome studies and clinical follow-up have traditionally focused on neurodevelopment. We previously showed in a selected sample of parents that they also valued other types of outcomes.

Objectives

This study aimed to validate these findings in a more diverse cohort by examining parental perspectives about the positive and negative aspects of their very preterm child’s health and development in relation to level of neurodevelopment impairment (NDI).

Design/Methods

Parents of children born < 29 weeks gestational age in 2016-2018 and seen at two Canadian neonatal follow-up clinics were invited to complete an online survey about their level of agreement with statements about their child’s health, development, and well-being. Parental responses in relation to their child’s level of NDI were examined using Kruskal-Wallis and chi-square for trends tests.

Results

199 parental responses were obtained for 165 children (65% of eligible children). Of these children, 52%, 27% and 21% had, respectively, no, mild to moderate, and severe NDI. Development was the most common source of concerns (49%), followed by the child’s future (35%), and physical health (35%). Parents of children with severe NDI were more likely to express concerns than those with mild to moderate or no NDI. Parents rated their child’s health relatively high with a median score of 8/10 (range 3-10). Children with no NDI were given higher scores than those with NDI (p = 0.004). Regardless of level of NDI, almost all parents agreed with their child being happy (p = 1.000) and having a positive personality (p = 0.207). Figure 1 shows that parental concerns increased with level of NDI.

Conclusion

Parents of preterm children have a balanced perspective on their child’s outcome. Integrating their views when developing core sets of important outcomes for neonatal follow-up is critical.
78 Asking, listening, understanding: Establishing parent and youth priorities in child health research
Authors: Elliott Sarah , Hartling Lisa , Scott Shannon
Published: October 2021

Primary Subject area

Advocacy

Background

A growing body of literature supports the active involvement of stakeholders in the prioritization and dissemination of evidence-based health care information. However, in child health related research, the perspectives of parents and youth are rarely acknowledged.

Objectives

To engage parents and youth in identifying and developing priority lists of research topics that are most relevant and important to youth and their families.

Design/Methods

We engaged parents and youth across Alberta in a modified James Lind Alliance priority setting exercise. Two lists, containing 27 topics were developed and modified in consultation with local parent and youth advisory groups. The respective lists were sent to parents and youth via online surveys. The anonymous surveys asked parents and youth to rank the topics by rating the degree (5-point Likert scale) to which they agreed the topic was a priority for child health research. All topics rated “Agree” or “Strongly Agree” by ≥ 70% of respondents were retained for discussion. Online focus groups (utilizing deliberative dialogue) to discuss priority topics were held with parents and youth, separately. Focus group discussions were analyzed using thematic analysis; resultant themes and subthemes were used to produce representative research questions. These were then sent via a second online survey to all participating parents and youth, who were asked to rank their ‘top 10’ most important child health research topics. Ethics approval was received from our institutional ethics board, and all participants gave informed consent or assent, prior to any data collection.

Results

Initial surveys were completed by 273 parents and 344 youth. This resulted in 5 highly rated health research topics for parents (behaviour, learning, and developmental disorders; mental health; food, environment and lifestyle; quality of health care; and vaccines) and 4 for youth (brain and nerve health, mental health, quality of health care, and vaccines), respectively. The research questions stemming from four parent (n=12) and six youth (n=21) focus group discussions were ranked in a second survey, completed by 43 parents and 62 youth. Parents’ highest ranked research topic was “effect of screen time on children’s neurodevelopment”, while the highest ranked topic from youth was “early signs of anxiety and depression in children and youth” (Tables 1 & 2).

Conclusion

Utilizing the knowledge and experience of Albertan parents and youth, relevant lists of priority topics in child health research were developed. These lists highlight the areas where funding and research should be directed to improve child health outcomes and patient care experiences that are important to parents and youth.
81 The Use of Online Care-Maps for Children with Medical Complexity
Authors: Dharmaraj Blossom , Adams Sherri , Beatty Madison , Moore Clara , Desai Arti , Bartlett Leah , Culbert Erin , Cohen Eyal , Stinson Jennifer , Orkin Julia
Published: October 2021

Primary Subject area

Complex Care

Background

Children with medical complexity (CMC) are a highly medicalized population of children who require specialized care across various settings including the hospital, home and community, making care coordination challenging. Care-maps, a visual representation of the people and places involved in a patient’s care, are one such tool to facilitate care coordination (Figure 1). To date, care-maps have not yet been used in a clinical environment, examined in real time or used via a standardized approach.

Objectives

The aims of our study were to develop a shareable standardized online tool that supports the parental creation of a care-map, and to assess the utility of care-maps in clinical care from a parent, health care provider (HCP), and community perspective.

Design/Methods

Parents of CMC were invited to use a standardized online care platform called Connecting2gether for 6-months and create online care-maps that could be shared with their HCPs and other community members (i.e., teachers, secondary caregivers). Demographics and internet usage surveys were completed at baseline and an acceptability survey was completed at 6-months. Surveys were analyzed using descriptive methods and care-maps were analyzed via descriptive visual analysis.

Results

Thirty-seven parents enrolled on the platform and 25 (70%) created a care-map and used it for the duration of the study. Of the 25, 14 (66%) went back and made revisions and 17 (80%) reported using it in clinic, home or school. Visual analysis demonstrated 11 categories (bubbles) that were commonly included. All care-maps included a Medical Team, School/Daycare and Family and Friends category, which automatically populated. The majority of care-maps included a central child bubble with the child’s photo (92%), and Community Medical Services (i.e. rehab centers) (60%). Less frequent categories included Home Care (28%), Goals (16%), and 12% included What I Like, Funding, and Community/Foundation individual bubbles. Some parents reported initial uncertainty, but at end-of-study, some reported care-maps as the most useful feature of the platform. Fifty seven percent (12/23) of HCPs viewed the created care-map and only 20% used it in the child’s care. The majority (83%) of HCPs specifically valued seeing the big picture of the child’s care, found it easy to navigate and the detail it provided.

Conclusion

The ability of care-maps to illustrate the intricate web of medical and non-medical care supporting CMCs in their daily life provides insight and value for parents, HCPs and non-HCPs. Care-maps were found to be valuable from the perspective of HCPs. Parents reported initial uncertainty, highlighting the importance of the HCP promoting the use of care-maps with their patients and families.
85 Exploring reporting of ethno-racial identity and immigration status in published studies on children new to Canada: An integrative scoping review
Authors: Cheung Bonnie , Kaur Pardeep , Suleman Shazeen , Minhas Ripudaman
Published: October 2021

Primary Subject area

Global Child and Youth Health

Background

Children immigrating to Canada may face racism and xenophobia depending on their ethno-racial background and immigration status. In Canada, immigration statuses include economic or family immigrants, resettled government or privately sponsored refugees, or asylum seekers, while some have no formal immigration status, otherwise considered undocumented. Research supporting newcomer child health should account for their immigration status and ethno-racial identity to capture the impact of discrimination.

Objectives

To critically examine the reporting of ethno-racial data and immigration status in published literature on the health needs of newcomer children to Canada.

Design/Methods

An integrative scoping review was performed, using the methodological framework outlined by Arksey & O’Malley. A literature search in Medline, PsycINFO, Scopus, Embase and Cochrane Central for articles published until July 2019 was conducted. Inclusion criteria were original research studies on newcomer children (0-18 years) in Canada in English or French from 2009 onwards. After undergoing title and abstract review, we extracted descriptions of participant immigration status and ethno-racial identity.

Results

4147 articles were identified. After removal of duplicates, 2632 articles underwent title and abstract review, with a kappa-statistic of 0.93, suggesting high inter-rater agreement. Seventy-five studies were included in the final analysis. Overall, there were no consistent descriptions of immigration status or ethno-racial identity. Of the 75 articles included for final analysis, only 27% (20/75) described their participants’ immigration status in some capacity; the majority (75%) of these did not separate out participants by their immigration status (15/20) and of these, 67% combined all types of refugee and economic immigrant statuses together (10/15). With respect to ethno-racial data, the majority of studies (65%, 49/75) did not report on their participants’ ethno-racial identities. Of those that did, 65% (17/26) reported their participants’ ethnicity alone, while only 15% (4/26) reported their race alone and 19% (5/26) reported both race and ethnicity.

Conclusion

Our scoping review demonstrates that many studies focusing on newcomer children to Canada do not consistently collect and analyze their participants’ immigration status or ethno-racial identity. In doing so, studies may falsely conflate the experiences of newcomer children and ignore the impact of racism and xenophobia on their access to care, leading to worsening stigma and access to care. We suggest that research that often informs evidence-based guidelines for newcomer children should consider immigration status and ethno-racial identity to consider the impact of xenophobia and racism and improve health outcomes.
90 Lung ultrasound in pediatric asthma patients: A pilot study characterizing findings at baseline stat
Authors: Marzook Noah , Dubrovsky Alexander
Published: October 2021

Primary Subject area

Emergency Medicine - Paediatric

Background

Unlike the lung ultrasound (LU) findings of pneumonia, bronchiolitis, pleural effusions and pneumothorax, which have all been well described, the sonographic pattern of asthma remains unclear. Previous pediatric studies have shown that pediatric patients with acute asthma exacerbations had positive LU findings. It is also unclear whether these findings were the result of acute infections associated with the exacerbation or if the findings would be present at baseline, outside an exacerbation in an asthmatic patient.

Objectives

The primary objective of this study is to characterize lung ultrasound (LU) findings in stable asthma pediatric patients presenting in a tertiary care asthma or respiratory clinic.

Design/Methods

Eligible patients >6 years of age, underwent a LU by the study sonographer between December 19, 2017 to June 25, 2019, during their regular follow up visit at the pulmonology clinic or scheduled pulmonary function test. Patients were defined as asthmatic if they had a positive methacholine challenge test (MCT) or spirometry at the day of the visit or in the past. Patients were excluded if they had an upper respiratory tract infection in the past 4 weeks, or had any other known pulmonary diseases. Baseline demographic and asthma severity (ISAAC score, ACQ-7) questionnaires were filled out by the patients, following which they underwent a LU by a novice sonographer using a 6-zone protocol. A blinded expert sonographer interpreted the images offline. A positive LU was defined as presence of more than 3 B-lines, consolidation (<1cm or >1cm), absent lung slide, and/or presence of pleural fluid.

Results

Fifty-two patients were enrolled in the study and 19.2% (CI 8.31-30.15) of the asthma patients had positive LU findings. The positive LU findings were diverse including B-lines (80%), small consolidation (80%), pleural line anomalies (10%). Positive LU findings were not correlated to any demographic value.

Conclusion

In our study, 19.2% of asthma patients at baseline have a positive LU. Lung consolidations larger than 1 cm were rarely seen. There were no significant differences between demographic data in asthmatic patients with positive compared to those with negative LUS. This positive LU scan rate is in keeping with a prior study on LU in pediatrics.
97 Decreasing invasive urinary tract infection screening in a paediatric emergency department: A quality improvement initiative
Authors: Paluck Felicia , Kestenbom Inbal , Test Gidon , Ostrow Olivia , Brimmer Brooke
Published: October 2021

Primary Subject area

Emergency Medicine - Paediatric

Background

Fever is a common presentation among children coming to the Emergency Department (ED) and a urinary tract infection (UTI) often needs to be excluded. Sterile techniques, like catheterization, are invasive, can be traumatizing to children, and are time consuming to complete. A two-step approach has been shown to reduce the catheterization rate in febrile, young children without unintended consequences.

Objectives

Our aim was to implement a two-step approach for UTI screening in febrile children 6-24 months in order to decrease unnecessary urine catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs).

Design/Methods

After engaging key stakeholders and a nursing champion, we created a process map to understand the current urine collection process in our ED, and areas for targeted improvement. Using the model for improvement, we adopted a 2-step pathway for a suspected UTI in children 6-24 months as our change idea. The pathway involved identifying children who met inclusion criteria for UTI screening, followed by urine bag application and urinalysis (UA) if clinically indicated. Only if the UA was positive, a second urine sample was collected via catheterization, for repeat UA and culture. Through multiple PDSA cycles, our pathway was implemented in the ED along with concurrent staff education. The outcome measure was the rate of ED urine catheterizations. Process measures included the total number of urine cultures sent to microbiology and percent positivity. The balancing measures included ED LOS and RVs.

Results

Since project initiation in July 2019, the ED catheterization rate decreased from 73% to 53% (Figure 1) and the number of urine cultures sent to Microbiology decreased by 23%. The number of urine cultures sent to Microbiology decreased by 23% with a mild improvement in the positivity rate by 2% (Figure 2). There was no significant change in RVs. There was a slight 10-min increase in ED LOS, most likely confounded by the COVID pandemic.

Conclusion

Using improvement methodology, we successfully decreased the number of unnecessary catheterizations in children and the number of urine cultures sent to microbiology. Further refinements to our intervention are ongoing and include optimizing urine screening equipment in patient rooms, poster reminders, re-education for providers, and introducing a parent resource explaining the 2-step pathway. This improvement work is also being spread to the paediatric wards and can easily be adopted by other paediatric centres. It has also been adapted by the Choosing Wisely hospital campaign.
99 Impact of COVID-19 pandemic on children with medical complexity: Parental perspective about the role of a Complex Care program
Authors: Thibault Louis-Philippe , Marano Maria , Saad Lydia , Doré-Bergeron Marie-Joëlle , Couture Karine , Gaucher Nathalie , Bourque Claude-Julie , Kleiber Niina
Published: October 2021

Primary Subject area

Complex Care

Background

The COVID-19 pandemic led to major and rapid organizational and structural healthcare changes including a switch from ambulatory services towards telemedicine and decreased access to home services. Children with medical complexity (CMC) require many medical services and are generally prone to infectious complications. Little is known about the impact of the pandemic on families of CMC. Understanding how CMC families experience the COVID-19 pandemic is essential to tailor healthcare services to answer their needs more effectively.

Objectives

We explored parental experience of CMC during the COVID-19 pandemic, and how the complex care program (CCP) answers their new needs.

Design/Methods

This qualitative study was conducted between July 2020 and January 2021 in a tertiary care pediatric university hospital centre. Semi-structured interviews were done with parents of CMC, admitted in the CCP at least 1 year prior to the beginning of the pandemic. The interview guide was co-constructed by physicians and nurses from the CCP. Interviews were transcribed verbatim and analyzed using NVivo. Data were organized into codes and categories. Thematic content analysis was performed by grouping categories and highlighting emerging themes.

Results

Eleven families (14 parents – 4 fathers, including 3 couples) were interviewed. The first wave of the pandemic seemed to have caused important uncertainty and anxiety amongst parents of CMC. Almost all the parents reported cancelling numerous appointments in order to avoid coming to the hospital at all costs. Some parents, worrying specifically about the fragility of their child, stopped working and stayed home to reduce transmission risks. Fear of facing shortages in medications, nutritional supplements and medical equipment for home care was frequently expressed. They did not express worries about the de-confinement periods. The support provided by the CCP’s staff was greatly appreciated, namely active problem-solving via phone calls, videoconferences, emails and pictures, leading to fewer hospital visits and less need to seek emergency care. Some reported that more general communication from the CCP (e.g., a weekly information email), would have helped to interpret the overwhelming amount of information from the media. Parents expressed a strong desire to maintain telemedicine services after the pandemic.

Conclusion

The COVID-19 pandemic brought additional worries to parents of CMC enrolled in CCPs, including fear of shortages and virus transmission. Direct communication with the CCP and remote problem-solving were greatly appreciated by families. Improvement to follow-up include finding ways to help interpreting data from the media.
104 New Presentations of Anorexia Nervosa and Atypical Anorexia Nervosa In Adolescents During the COVID-19 Pandemic
Authors: Agostino Holly , Burstein Brett
Published: October 2021

Primary Subject area

Adolescent Medicine

Background

The coronavirus (COVID-19) pandemic has had profound effects on adolescent mental health. Beginning in mid-March 2020, public health measures were implemented throughout the province of Quebec, including full school closure and confinement. Previous studies have demonstrated the association between stressful events and the exacerbation of anorexia nervosa (AN), however the association of the COVID-19 pandemic on new AN diagnoses remains unknown.

Objectives

To assess the incidence and severity of newly diagnosed AN or atypical AN (AAN) cases among adolescents during the COVID-19 pandemic compared to the five preceding years.

Design/Methods

We performed a retrospective analysis from Jan 1 2015 to Nov 15 2020 of new eating disorder assessments at an urban tertiary pediatric hospital. Baseline demographic information and clinical assessment variables were collected. The primary outcomes were the incidence of de novo AN or AAN diagnoses and hospitalization within 7 days of diagnosis. Event rate time trends were compared during the period of pandemic public health measures (March 2020 to November 2020) to the proceeding 5-years (January 2015 to February 2020) using an interrupted time series and logistic mixed modeling.

Results

Overall, 353 patients met inclusion criteria during the study period. Median patient age was 15.9 (IQR 13.8-16.9) years, 93% were female, and 65% of patients were diagnosed with atypical AN. For the full cohort at diagnosis, %mBMI was 92% (SD ±15%) and mean weight loss was 11 Kg (SD ±7Kg). In the 5 years preceding the pandemic, there were 4.5 new AN/AAN cases per month with a modest downward trend (ßcoeff=-0.016). During confinement, new diagnoses rose to 8.0/month with a steep upward trend (ßcoeff=1.417, p < 0 .001). Similarly, hospitalizations for new cases increased from 0.8 to 2.6/month with a significant increase in linear tend (ßcoeff -0.012 vs. 0.500, p < 0 .001). Moreover, patients diagnosed during COVID-19 confinement had a shorter duration of symptoms (6 months vs. 10 months, p=0.001), with a higher percentage of body weight loss (19% vs. 16%, p=0.03) at a faster rate (2.3kg/mo vs. 1.5Kg/mo, p=0.001). Bradycardia was more pronounced at diagnosis during the pandemic (55 bpm vs. 62 bpm, p=0.001) with a greater proportion meeting threshold for admission (38% vs. 19%, p=0.001).

Conclusion

During the COVID-19 confinement, new diagnoses of AN and AAN nearly doubled and hospitalizations for these patients more than tripled. Markers for disease severity were more pronounced and evolved more rapidly. Findings highlight the urgent need for increased community resources during the pandemic, as well as prospective research to understand drivers and prognosis for these patients more effectively.
108 Comparing autoimmune encephalitis variants in a pediatric cohort from Hamilton, Ontario
Authors: Grinberg Mark , Schneeweiss Michelle , Povolo Christopher , Inkaran Jeyanth , Jones Kevin
Published: October 2021

Primary Subject area

Neurology

Background

Autoimmune Encephalitis (AE) is an emerging cause of epilepsy with numerous variants, including anti NMDA-receptor encephalitis, for which there is a detectable antibody. However, it is believed that there are many variants of AE for which an antibody has not yet been discovered.

Objectives

This study aimed to determine the differences in disease course of AE patients with and without detectable anti-NMDA receptor antibody.

Design/Methods

This retrospective analysis is part of a Canada-wide project aimed at evaluating the epidemiology and characteristics of AE. Cases with suspected AE were retrieved and screened by two independent reviewers against AE criteria. Those that met criteria were analyzed for trends and stratified into NMDA receptor antibody positive (NMDAr) and negative categories for inter-group analysis. Of 23 cases reviewed, 11 met criteria (aged 1-17 years, 27% males), of which 7 were NMDAr positive.

Results

The NMDAr subgroup was characterized by behavioural changes, focal seizures, and prodromal fever on presentation, whereas the receptor negative subset had a much higher variability of symptoms, without any distinctive patterns. On average, the NMDAr positive group showed an increase in white blood cell count on CSF analysis, and a slight increase in the proportion of patients presenting with supratentorial lesions on MRI. Both groups had abnormal findings on EEG. However, despite the lack of gross differences in findings, all of the NMDAr positive cases received IVIG (most with corticosteroids as well) while only 2 NMDAr negative patients received immunomodulatory therapy. At discharge 6/7 of the NMDAr patients had some form of residual movement disorder while the NMDAr negative group had more variable residual symptoms at discharge.

Conclusion

Our findings show that a high index of suspicion in the diagnosis of AE is required due to the indistinct distribution and variety in its presentation. Negative antibody findings should not rule out AE due to the possibility of unidentified antibodies. Future studies should explore why differences in treatment between the two groups exist, and if slight differences in presentation influence clinical decision-making.
111 The Prevalence of Asthma in Canadian Kindergarten Children and its Association with their Developmental Health: A Population-Level Cross-Sectional Study
Authors: Schneeweiss Michelle , Reid-Westoby Caroline , Hu George , Pottruff Molly , Janus Magdalena
Published: October 2021

Primary Subject area

Epidemiology

Background

Asthma, the most common chronic illness affecting Canadian youth, can profoundly and adversely impact a child’s quality of life. Previous studies have shown a diagnosis of asthma can influence a child’s physical and socio-emotional functioning. Current data on asthma prevalence rates among Canadian children is scarce, and it is still unclear how this diagnosis impacts their development at school entry.

Objectives

The goals of the current study were to 1) examine the prevalence of teacher-reported asthma in Canadian kindergarten children, and 2) investigate the association between asthma and children’s concurrent developmental health.

Design/Methods

A cross sectional, population-level study of kindergarten children diagnosed with asthma as reported on the Early Development Instrument (EDI), was carried out in Canada from 2010-2015. Children’s developmental health in kindergarten was measured with the EDI. This 103-item questionnaire is completed by teachers for their students aged 4-6 years and covers demographic information, as well as five different domains of development. Descriptive statistics were examined for children with and without asthma. The level of statistical significance was adjusted using a Bonferroni correction to account for multiple hypothesis testing. The chi-square and one-way ANOVA statistics, as well as effect sizes (Cramer’s V, and eta squared) were reported for all descriptive analyses.

Results

958 children (0.002% of the final analytical sample) were identified as having a teacher-reported diagnosis of asthma. Compared to their peers, children with asthma were significantly more likely to: be male (68.2% vs 51.2%); have a special needs designation (19.0% vs 3.6%); have a functional impairment (53.5% vs 15.9%); be identified by their teachers as needing further developmental assessment (32.3% vs. 13.1%); and miss, on average, 3 more days of school than their peers (9.44 vs. 6.71). They were also more likely to fall below a vulnerability threshold on one or more of the developmental domains (55.9% vs. 28.8%, Figure 1).

Conclusion

It is likely that the EDI captures only severe cases of asthma, as parents are more likely to disclose their child’s illness to teachers if it may influence their ability to function in a classroom. As such, children with asthma, especially those with severe forms, may require additional support. A partnership in which physicians provide preventative care, and teachers provide academic and classroom assistance, may help to ensure the optimal development of children with asthma, and close gaps between them and their peers.
113 Simplifying consent - Use of the novel integrated consent model in paediatric clinical research
Authors: Yeung Frances , Cameron Saoirse , Taheri Sepideh
Published: October 2021

Primary Subject area

Hospital Paediatrics

Background

Obtaining informed consent from patients to participate in clinical research has traditionally been a cumbersome process, often requiring lengthy documentation and the involvement of trained research staff. Moreover, this process can be a burden to the patient/family. As a result, progress in paediatric research and enabling continual improvement in care has been slow.

In the last decade, research ethicists have proposed a new “integrated consent model” (ICM) for obtaining informed consent for pragmatic clinical trials that compare standard-of-care interventions, where there is clinical equipoise. In most cases of ICM, only a brief discussion with verbal consent is required, along with a handout on study purpose, risks, benefits, and procedures. This allows for a more condensed consent process, which maximizes clarity and minimizes information overload. ICM also allows the patient/family to maintain prospective autonomy and decision-making, as compared with deferred or waived consent. The ICM model allows staff in the circle of care to obtain consent, which minimizes the stress of meeting an additional person. To our knowledge, ICM has not yet been used in the paediatric population.

Objectives

The objective of this abstract is to report on the utility of ICM in a non-randomized clinical trial carried out in the inpatient setting of a tertiary children’s hospital.

Design/Methods

We compared two widely accepted standards of care for maintaining peripheral intravenous catheter patency in a cohort of children, namely continuous infusion (“to keep the vein open” or TKVO) versus saline lock (SL). The ICM process was reviewed and approved by REB. Nurses in the circle of care received a study package that included an REB approved “consent script” to be read to the patient/family, a single page information sheet, and instructions on documenting the obtained verbal consent in the patient’s chart (Graphic 1).

Results

With ICM, 79% of participants were recruited into the trial by a nurse. Patient recruitment was completed 4 months ahead of the predicted schedule (Figure 1). Nursing, research, and medical staff were satisfied with ICM and found it easy to administer. ICM occurred smoothly and quickly for patients/families, with no interference with their medical care and practically no disruption to their daily schedule.

Conclusion

ICM is a practical alternative to laborious traditional consent models, is associated with higher patient recruitment rates, and is less burdensome for the patient/family. Paediatricians should be aware of the utility of this novel consent model.
117 Formal Leadership Teaching in Canadian Pediatric Residency Programs
Authors: D'Arienzo David , Dandavino Mylene
Published: October 2021

Primary Subject area

Medical Education

Background

Effective clinical leadership is known to improve clinical outcomes, health service delivery, effective resource allocation, and patient and staff satisfaction rates. Although it is well known that leadership skills can be taught and are necessary for all physicians, there are very few described residency-level structured leadership-training curricula. Yet, pediatric residency programs' Competence-By-Design (CBD) includes 19 stage-specific, leadership-focused Milestones, spanning 10 Entrustable Professional Activities (EPAs) that will need to be assessed.

Objectives

The purpose of this study was to map how leadership is formally taught in Canadian pediatric residency programs and to explore how leader-specific milestones and EPA are incorporated into programs’ training.

Design/Methods

Program Directors from all Canadian pediatric residency programs were invited to complete an online, anonymous survey, which was developed using the AMEE Seven-Step Survey Development guidelines. The survey explored demographics, teaching structure, teaching content and methods, assessment, and participants’ perspectives. Descriptive and thematic analyses were performed.

Results

Ten of the 17 pediatric programs directors responded to the survey. All program directors (n=10), stated that there is a need for mandatory, formal leadership teaching and formal leadership skills assessment for pediatric residents. Yet, half of respondents (n=5) reported no formal leadership teaching and residents' leadership skills are not formally assessed in three (of 10) pediatric residency programs. Additionally, none of the programs offers stage-specific leadership teaching.

Of the programs that offer formal leadership teaching, four programs’ teachings are stand-alone courses, while one program has a longitudinal leadership curriculum. Only one program offers formal teachings on leader-related CBD EPAs and/ or Milestones. Seven programs formally assess residents’ leadership skills. Of these, four programs use a formal assessment tool, while three programs do not use any assessment tool. None of the programs utilizes a validated or published leadership skills assessment tool.

Thematic analyses revealed that the common barriers to introducing a formal leadership curriculum include limited available time in residents’ teaching curriculum, lack of expertise and resources to teach leadership, and difficulty in assessing leadership skills.

Conclusion

Although residency programs identify leadership teaching and assessment as necessary, most pediatric residency programs lack formal leadership teaching and assessment. Additionally, no such teaching is stage-specific. Understanding the current state of programs’ leadership teaching will help better prepare programs for the integration of leadership milestones/ EPAs in the curriculum.
131 Characterizing atlanto-occipital dissociation and its association with pediatric traumatic cardiac arrest: A descriptive case series
Authors: Jeong Dayae , Freire Gabrielle , Beno Suzanne
Published: October 2021

Primary Subject area

Emergency Medicine - Paediatric

Background

Atlanto-occipital dislocation (AOD) is a type of cervical spine injury (CSI) that is commonly fatal or associated with severe neurologic consequences. Although rare, AOD is now more commonly recognized in children as improved prehospital care allows for more patients to reach trauma centres and undergo definitive imaging. Patients with AOD often present with cardiorespiratory instability and prompt diagnosis is crucial. However, diagnosis may be delayed due to variation in imaging practices and lack of literature on this topic.

Objectives

Primary objective: Describe the demographic characteristics, clinical presentation, and long-term outcomes of children with AOD, compared to other upper CSI. Secondary objective: Describe the frequency of AOD and other upper CSI in pediatric traumatic cardiac arrest (PTCA) and the utility of a lateral c-spine radiograph in this setting.

Design/Methods

This was a retrospective, single-centre case series of all pediatric trauma patients age < 16 years diagnosed with upper CSI seen at a tertiary pediatric trauma centre from 2000-2020. Patients were included if they had evidence of bony or ligamentous injury from C0-2. The diagnosis of upper CSI was ascertained on autopsy, when available, then cross-sectional imaging, then plain radiographs, when the other modalities were unavailable. Data was obtained from manual chart review and analyzed using descriptive statistics.

Results

Thirty-six patients were excluded for not meeting upper CSI criteria. Of 93 patients with upper CSI, 24 had AOD: 14 (15%) complete and 10 (11%) incomplete (Table 1). The mechanism of injury was motor-vehicle-collision in 23 (96%) of these patients, and a fall in one (4%). All patients with complete AOD presented in PTCA and only one (7%) survived. Of seven patients with AOD who received a lateral c-spine x-ray during resuscitation, 5 (71%) had identifiable injuries. In contrast, of the 10 patients with incomplete AOD, only 1 (10%) presented in arrest and none died. Only one patient received an x-ray during resuscitation, which showed the injury but went undetected, and 100% of final diagnoses were made through CT. The majority of incomplete AOD patients were managed non-operatively and had minimal to mild disability.

Conclusion

In our study population, complete AOD was highly fatal with all patients presenting in PTCA. In contrast, incomplete AOD carried a more favorable prognosis with 100% survival and minimal-mild disability. If there is suspicion for AOD, a lateral c-spine XR in the trauma bay can aid in early diagnosis, guiding neurosurgical management and/or goals of care discussions.
134 Virus kinetics and biochemical derangements in children with Ebolavirus disease
Authors: Kjaldgaard Lindsey , Hawkes Michael , Claude Kasereka Masumbuko , Dixit Devika
Published: October 2021

Primary Subject area

Infectious Diseases

Background

In the second largest outbreak of Ebolavirus disease (EVD) on record (Democratic Republic of Congo, 2018-2020), 3470 cases were confirmed, 29% of them among children under 18 years of age.

Objectives

To describe virologic and biochemical characteristics of pediatric patients with EVD, and to compare these to a control group of adults with EVD.

Design/Methods

Retrospective medical record review of children < 16 years old from two treatment centres in North Kivu, DRC. A control group of patients 16-44 years old was included as a reference comparator group. Patient demographics, serial measurements of viral load, serial biochemistry panel, and frequent point-of-care glucose test results were abstracted from the chart record. Funding provided by the Association for Health Innovation in Africa (AFHIA).

Results

Seventy-three children and 234 adults were included, admitted from April 24 to October 14, 2019. Pediatric patients commonly had electrolyte imbalances (36% hypokalemia, 52% hyperkalemia, and 74% hyponatremia), AKI (51%), elevated liver enzymes (median peak ALT 380 IU/L and AST 570 IU/L), and rhabdomyolysis (48%). Viral load at admission (7.2 versus 6.5 log10copies/mL, p=0.0001), peak viral load (7.5 versus 6.7 log10copies/mL, p<0.0001), and time to clearance of viremia (16 versus 12 days p<0.0001) were significantly different in children. Duration of hospital stay (20 versus 16 days, p<0.0001) was prolonged in children, a direct consequence of slower clearance of viremia. There was no significant difference between groups in other laboratory values. Factors including ALT >525 U/L, viral load (VL) >7.6 log10copies/mL, BUN >7.5 mmol/L, and CRP >100 mg/L were associated with mortality in children, as in adults. In a multivariable logistic regression model, ALT and VL remained statistically significant independent predictors of mortality.

Conclusion

Pediatric patients with EVD, like adults, experience multi-organ involvement with life-threatening kidney and liver injury, rhabdomyolysis, and electrolyte imbalances. Pediatric patients have significantly higher viral loads throughout the course of EVD than adults.
138 Fluid overload in newborns undergoing abdominal surgery
Authors: Niknafs Nikoo
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Infants undergoing abdominal surgery, particularly those born preterm, are at risk of postoperative fluid overload and acute kidney injury due to immature cardiac and renal functions, which could contribute to increased morbidity and mortality.

Objectives

The purpose of this study was to evaluate the burden of fluid overload and acute kidney injury among newborns undergoing abdominal surgery and the association with adverse neonatal outcomes.

Design/Methods

Newborns who had undergone laparotomy from January 2017 to June 2019 admitted to a tertiary level Neonatal Intensive Care Unit were included in this retrospective cohort study. Fluid overload was assessed by the maximum percentage change in body weight and the difference between actual and prescribed fluid intake post-operatively. Acute kidney injury was defined as an increase in serum creatinine >1.5 times of baseline or >26 mmol/L, or oliguria (< 0 .5mL/kg/hr over 24-hour).

Results

There were 60 eligible infants with medians [IQR] gestational age (GA) and birth weight being 29 weeks [25–36] and 1240 grams [721–2871], respectively. Indications for laparotomy included small bowel obstruction (45%), necrotizing enterocolitis (23%), and large bowel obstruction (11.7%). In the first three post-operative days, 24/60 (40%) required inotropes, 5/59 (8.5%) had hyponatremia (<130 mmol/L), and 15/31(48.4%) developed hypoalbuminemia (<20 g/L). 52/60 (86.7%) infants had serum creatinine measured and 4 (6.7%) fulfilled our AKI criteria.

The median of actual fluid intake was significantly higher than the prescribed fluid intake in the first 7 post-operative days (p<0.01) [Figure 1]. Medians [IQR] of maximum % change of body weight within the first 3- and 7-days post operation were 6 [3–13] and 11 [5 –17], respectively. While we did not identify any associations between post-operative fluid overload and mortality/bronchopulmonary dysplasia in this cohort, we found that every 1% increase in weight gain within the first 3 days post-operation were associated with an increase in 0.6 day of invasive ventilator support (p=0.012) [Figure 2]. Such correlation still exists after adjusting for GA (p=0.033).

Conclusion

In our cohort of newborns undergoing abdominal surgery, weight gain within the first three post-operative days was associated with an increase in duration of invasive ventilator support. Fluid overload does not seem to be associated with acute kidney injury. Careful attention to intra and early postoperative fluid balance may play an important role in optimizing outcomes of newborns undergoing abdominal surgery.
139 Understanding the Psychosocial Impact of the Novel Coronavirus Pandemic – A Focus on Children and Families
Authors: Gander Sarah , Flood Kate , Campbell Sarah , Bonner Katie
Published: October 2021

Primary Subject area

Social Paediatrics

Background

The novel coronavirus (COVID-19) pandemic is a major global threat that emerged in 2020. Many countries have enacted policies such as mandatory school closures, business closures, and self-quarantining to keep people at home and prevent further spread of the virus. Previous research has shown that pandemics and subsequent disease containment measures negatively affect children and families, both psychosocially and economically.

Objectives

The current study explores the potential psychosocial impacts of the COVID-19 pandemic and subsequent disease containment measures on a number of domains (employment/business, education, finances, medical care, access to medication, technology, children/family, access to community services) through an online survey. The current abstract focuses on the emotional well-being of children and how families have been affected by the restrictions and changes related to the COVID-19 pandemic.

Design/Methods

Participants were asked to complete an online survey through a secure portal. The survey consisted of questions about household demographics and socio-economic status (SES), as well as five psychometric scales measuring satisfaction with life, psychological well-being, anxiety, depression, and substance use, and specific questions about how the COVID-19 pandemic has impacted respondents’ daily lives in the previously identified domains. This is the first of four longitudinal surveys that will be conducted throughout this study.

Results

A total of 571 participants completed the survey. Of these participants, 41.3% identified as being a parent or guardian with children under 18. The focus of this abstract is the subset of respondents with children. Roughly three quarters of participants identified that their children were emotionally impacted by COVID-19, the school closures, or missing friends or family (Yes = 46.6%; Somewhat = 30.5%). Parents also reported loss of access to childcare, disruptions to their visits with their children living outside the home, and feeling like they could not access timely medical care for their children. Demographic information and other relevant responses and information can be found in Tables 1 and 2, respectively.

Conclusion

The impacts of the COVID-19 pandemic will be felt for years to come and will shape an entire generation of children. Even in the current sample, which consisted largely of individuals from medium-high SES households, most reported that children had been impacted emotionally. Understanding and mitigating the impact on children and adapting resources in the short term and the long-term to meet the growing needs of our communities must be top priorities for pediatricians and community service providers.
141 Sickle cell disease and physical activity: Is it safe?
Authors: Corvalan Cifuentes Melissa-Zoraya , Pastore Yves D , Nguyen Thanh-Diem , Bérubé Denis , Dahdah Nagib
Published: October 2021

Primary Subject area

Hematology and Oncology - Paediatric

Background

Though physical activity (PA) is beneficial for healthy individuals and for those with chronic disease, its impact on sickle cell disease (SCD) children remains poorly studied. Moreover, patients may refrain from PA given a perceived fear of SCD complications.

Objectives

1) Evaluate whether SCD children engage differently in PA compared to their peers. 2) Evaluate the cardiopulmonary impact of PA in a group of SCD patients.

Design/Methods

Prior to the COVID-19 pandemic, SCD patients aged 8-17 years old consented to answer a PA questionnaire (PAQ) and have their school peers answer the same PAQ. PAQ, a well-described surrogate marker of PA, is a standardized questionnaire evaluating PA during the last 7 days. Patients and their peers were approached only during the school year. A set of HbSS patients were invited to participate in a supervised exercise test including pre- and post-effort PFT, echocardiography, EKG, measurement of troponins and NT-proBNP and a methacholine challenge to evaluate exercise-induced bronchial hyperreactivity. T-test was used as statistical analysis, using SPSS V24. The study received IRB approval.

Results

Questionnaires from 25 SCD children (13 SS and 12 SC) were compared with 36 matched-school peers. SCD patients were overall less active (p=0.04). While their level of activity was similar at school, SCD patients were overall less active after school (p=0.028), in the evening (p=0.008) and weekends (p=0.049). While the difference was significant for both SS and SC patients, SS were less active than SC, although this difference was statistically not significant. Five HbSS patients on HU were subjected to an exercise test. There were no statistical differences in the pre- and post-PA evaluations including measurements of troponin, NT-proBNP and functional testing. None of them had exercise-induced hyperreactivity.

Conclusion

Overall, SCD patients are less active than their peers, mostly outside of school. The absence of cardiopulmonary modifications during PA is reassuring, although our study was limited to 5 HbSS patients on HU. Whether HU has a protective role cannot be excluded. Our results encourage us to further evaluate PA interventions outside of school in SCD patients. Interventional studies evaluating the risk-benefit ratio of PA in SCD children are further needed.