bluuebunny/crossref_metadata_2025 huggingface dataset:
4 Educational Impact of Targeted Neonatal Echocardiography (TNE) on Neonatal-Perinatal Medicine (NPM) Subspecialty Residents
Authors: Friedmann Isabel , McNamara Patrick , Bhattacharya Soume , Cheng Anita
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Targeted Neonatal Echocardiography (TNE) is a real-time cardiac imaging modality used by neonatologists who have completed a minimum of one-year training in cardiovascular physiology and imaging methodology, to optimize management of neonatal cardiorespiratory compromise. TNE is provided as a clinical service, to aid in diagnosis, treatment, and monitoring of neonatal cardiovascular illness. Potential impacts of TNE on trainee education are unknown.

Objectives

This study aimed to describe trainees’ perspectives on existing neonatal hemodynamics education and perceived impacts of TNE on their education.

Design/Methods

This was a mixed quantitative and qualitative study that surveyed NPM subspecialty residents in Canada and the United States of America (USA), at centres both with and without TNE. Survey questions sought to explore current perspectives on cardiac and hemodynamics curriculum in training programs.

Results

92 residents responded to the survey, of whom 24 (26%) were enrolled in a program with an active TNE service, 64 (70%) were training at a non-TNE centre, and 4 (4%) were unsure. Trainees at TNE centres were more satisfied with their overall hemodynamics training (91% vs. 69%, p=0.040; Table 1). 25% of all trainees felt they do not have sufficient hemodynamics training to prepare them for independent practice. On analysis of curriculum content, cardiac development, myocardial functioning in prematurity, and cardiac mechanics emerged as areas of knowledge gaps among all residents (Table 2). TNE centre trainees reported that bedside TNE teaching offers immediate insights into how patients respond to management decisions, while didactic TNE teaching allows for learning at a slower pace, with appropriate knowledge consolidation. Only 9% of respondents at TNE sites reported a formal process of hemodynamics review between clinical and TNE teams. 90% of respondents believed that a TNE service would positively impact their hemodynamics education by improvement in knowledge of cardiovascular physiology and management decisions.

Conclusion

Most trainees believed that TNE may be a valuable educational tool, with current perceived satisfaction with overall hemodynamics training higher among residents training at TNE centres. 25% of all trainees felt unprepared for transitioning to independent practice. Hence, thoughtful curriculum design for real-time and consolidation learning, with specific emphasis on content gaps, as well as working toward a formal process of hemodynamics review, should be considered.
8 Food Insecurity during COVID-19 in a Canadian Academic Pediatric Hospital
Authors: Van Den Heuvel Meta , Fuller Anne E , Zaffar Nusrat , Li Xuedi , Beck Carolyn , Birken Catherine
Published: October 2021

Primary Subject area

Social Paediatrics

Background

There are concerns of increased food insecurity rates during the COVID-19 pandemic, but there is no evidence to date about families with children with an acute or chronic illness. Parents with a child admitted to the hospital may also experience hospital-based food insecurity, defined as the inability of caregivers to afford adequate food during their child’s hospitalization.

Objectives

We aimed to measure the prevalence of household and hospital-based food insecurity in an academic pediatric hospital setting during the COVD-19 pandemic. We also explored the effects of food insecurity on parental distress and overall caregivers’ experiences obtaining food during their hospital stay.

Design/Methods

This was a cross-sectional study from April to October 2020. Household food insecurity was measured using the 18-item U.S. Household Food Security Survey Module. Three adapted questions about hospital-based food insecurity were added. Parental distress was measured with the validated Distress Thermometer for Parents: “0” indicates “no distress” and “10” indicates “extreme distress”. Descriptive statistics were used to assess the proportions of food insecurity. Linear regression models were used to explore the relationship between food insecurity and parental distress adjusted for potential confounders. To explore caregivers’ experiences we included one open-ended question in our survey, asking: “Do you have any other feedback regarding your food situation during your child’s hospital admission?”. Recurrent themes were identified using qualitative analysis.

Results

851 families were reached by telephone and 775 (91.0%) provided consent to participate. 435 (56.1%) completed at least one questionnaire [Figure 1 Study Flow Diagram]. Caregivers described a high prevalence of household (34.2%) and hospital-based (38.0%) food insecurity. Both adult (B= 0.21 [95% CI 0.07-0.36]), child (B= 0.38 [95% CI 0.10-0.66]) and hospital-based (B= 0.56 [95% CI 0.30-0.83]) food insecurity were significantly associated with parental distress independent of covariates [Table]. In the qualitative analysis, the financial burden and emotional and practical barriers obtaining food in the hospital were identified as important themes. Parents also commented that they “need to eat to be able to take part in the care of their child during hospitalization”.

Conclusion

Both household and hospital-based food insecurity were highly prevalent in caregivers and significantly associated with parental distress, independent of covariates. High parental distress is known to be associated with a child’s maladjustment to illness and adherence with medical treatment. Hospitals need to strongly consider reducing barriers for parents to obtain food for themselves during their child’s admission in order to reduce parental distress.
11 Exploring the Impact of COVID-19 on Families of Children with Developmental Disabilities: A Community-Based Formative Study
Authors: Filler Tali , Kaur Pardeep , Mohamed Usamah , Minhas Ripudaman , Suleman Shazeen
Published: October 2021

Primary Subject area

Developmental Paediatrics

Background

The COVID-19 pandemic has impacted every facet of society but has been particularly disastrous for families of children with developmental disabilities (DD) living on the margins. The unprecedented repercussions of COVID-19, including quarantine, social distancing, and service restrictions, continue to disproportionately impact these families. This is a pattern observed in previous humanitarian crises, where there has been a lack of response for children with DD. There is an urgent need to understand the experiences of families of children with DD in order to develop a community-driven model of service provision.

Objectives

This study aims to identify the experienced impact of COVID-19 on families of children with DD who have significant needs and social barriers.

Design/Methods

This was a community-based participatory study using a formative research framework in accordance with COREQ guidelines. In-depth interviews (IDIs) were conducted with caregivers and care providers of children with DD. Data were recorded, transcribed, and coded using deductive and inductive coding methods by three independent coders. A peer debriefing strategy was used to verify the coding approach and interpretation of findings in accordance with the RATS (relevancy, appropriateness, transparency, and soundness) guidelines for qualitative research. Perceived parental stress and social support were explored using the Perceived Stress Scale (PSS-10) and Multidimensional Scale of Perceived Social Support (MSPSS).

Results

A total of 25 IDIs were conducted. Of the 15 caregivers interviewed, five were new to Canada. Results suggested both newcomer and non-newcomer families of children with DD are in crisis, reporting high stress and low social support, with increased difficulties navigating and accessing therapies and programs, including those offered virtually. Participants reported behavioural regressions and increased anxiety among their children with DD, as well as caregiver mental health challenges. Providers reported having to change their service delivery model in accordance with public health recommendations, but caregivers said that they were not included in these decisions.

Conclusion

Families of children with DD face extraordinary barriers to care, which may be further compounded by the COVID-19 pandemic. Our study demonstrates the value of community-informed design, particularly in the setting of the COVID-19 pandemic. To deliver truly patient-centred services during the pandemic, there is an urgent need for responsive programming that is built with patients, for patients.
14 Diaphragmatic Electrical Activity in Preterm Infants on Non-Invasive High Frequency Oscillatory Ventilation (DEAP-NHFO Study)
Authors: Wong Jonathan , Sasivimon Soonsawad , Omar Rawan Abu , Dunn Michael , Ng Eugene , Beck Jennifer
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Continuous Positive Airway Pressure (CPAP) is a common form of non-invasive respiratory support for preterm infants. Non-invasive high frequency ventilation (NHFOV) is a relatively new method of non-invasive respiratory support. NHFOV is being increasingly utilized in clinical practice in an attempt to prevent intubation and minimize ventilator-induced lung injury in preterm infants. Preliminary studies suggest superiority of NHFOV over CPAP, but little is known about its mechanism of action and its effect on respiratory control in the newborn. We hypothesize that NHFOV reduces respiratory drive and improves ventilation, resulting in decreased patient diaphragm energy expenditure, which can be assessed by measuring the electrical activity of the diaphragm (Edi).

Objectives

The objective of this study is to compare the effects of non-invasive respiratory support delivered by nasal CPAP versus NHFOV on respiratory pattern, as assessed by the Edi in very low birth weight (VLBW) preterm infants.

Design/Methods

In a prospective, randomized, crossover study, 20 preterm infants with birth weights ≤1500 g requiring CPAP were randomized to either NHFOV or CPAP for 105 min, followed by crossover to the other method for the same duration. Edi was continuously measured by a feeding catheter with miniaturized sensors embedded in its wall (Maquet, Solna). The general sequence was 15 minutes for acclimation to the mode, 75 minutes for a feed to be completed, followed by 15 minutes for breath-by-breath analyses of neural breathing pattern. Primary outcome was difference in the peak Edi between CPAP and NHFOV. Secondary outcomes included difference in other measures of respiratory drive: neural respiratory rate, neural inspiratory time, diaphragm energy expenditure, transcutaneous pCO2, number of apnea episodes on the Edi, and episodes of clinically significant apnea.

Results

No significant differences in Edi timing, Edi min, Edi peak, apnea, or CO2 were observed between the two modes of respiratory support.

Conclusion

In this cohort of VLBW preterm infants, neural respiratory pattern was not significantly different between NHFOV and CPAP. With this baseline information in stable preterm infants, it would now be important to assess whether these results hold true in infants with more severe lung disease, where NHFOV is often used as escalating support from CPAP.
29 Caregiver-Reported Delay in Presentation to Pediatric Emergency Departments for Fear of Contracting COVID-19: A multinational cross-sectional study
Authors: Davis Adrienne , Sunderji Alia , Marneni Shashidhar , Seiler Michelle , Hall Jeanine , Cotanda Cristina Parra , Klein Eileen , Brown Julie , Gelernter Renana , Griffiths Mark , Hoeffe Julia , Gualco Gianluca , Mater Ahmed , Manzano Sergio , Thompson Graham , Ahmed Sara , Ali Samina , Goldman Ran
Published: October 2021

Primary Subject area

Public Health and Preventive Medicine

Background

Visits to pediatric emergency departments have decreased up to 75% during the pandemic, with corresponding increases in high acuity visits, inpatient admissions, and intensive care unit admissions compared to historical cohorts.

Objectives

To determine if caregivers of children presenting to pediatric emergency departments (EDs) during the COVID-19 pandemic are delaying presenting to care for fear of contracting COVID-19. Secondary objectives were to: a) evaluate potential predictors of delay; b) describe the proportion of children whose symptoms worsened during time to presentation.

Design/Methods

A multicentre cross-sectional survey study of caregivers accompanying their children aged 0-19 years old to 16 pediatric EDs in 6 countries, from May-June 2020. An anonymous online survey, completed by caregivers via RedCAP, included caregiver and child demographics, presenting complaints, if they delayed presentation and whether symptoms worsened during this interval, as well as caregiver concerns about the child or caregiver having COVID-19 at the time of ED visit.

Results

Of 1543 caregivers completing the survey, 287 (18.6%) reported a delay in seeking ED care due to concerns of contracting COVID-19 in the hospital. Of those, 124 (43.2%) stated their child’s symptoms worsened during the waiting interval. Caregiver relationship to child [mother] (OR 1.85, 95% CI 1.27-2.76), presence of chronic illness in child (OR 1.78. 95% CI 1.14-2.79), younger age of caregiver (OR 0.965, 95% CI 0.943-0.986), and caregiver concerns about lost work during the pandemic (OR 1.08, 95% CI 1.04-1.12), were independently associated with a COVID-19-related delayed presentation in multivariate regression analysis.

Conclusion

Almost one in five caregivers reported delaying ED presentation for their ill or injured child, specifically due to fear of contracting COVID-19 while in hospital. Mothers, younger caregivers, caregivers of children with chronic illness, and those concerned about lost work were at highest risk for delay.
40 Provider Perspectives of a Pediatric Patient Portal
Authors: Goldbloom Ellen , Courtney Jennilea , Barrowman Nick , deBoer Jennifer , Teitelbaum Mari , Macaulay Karen , DeGiovanni Tammy , King W James
Published: October 2021

Primary Subject area

Technology

Background

Patient portals (PPs) can enhance patient engagement and have potential to improve quality of care. However, despite positive perceptions of them by patients and their families, adoption remains low. Since provider promotion of PPs has been shown to impact patient activation and use, understanding providers’ perspectives of PPs is a critical component to successful implementation and impact. Yet there is sparse information, beyond anecdotal reports, about provider opinion, particularly in pediatrics.

Objectives

We sought to evaluate clinician perceptions regarding the implementation of a PP in a pediatric environment.

Design/Methods

An electronic survey was sent to all clinicians in a pediatric tertiary health centre. Perceived and expected PP usefulness/usability, impact on clinician-patient/family relationships, workload, security, privacy, and medicolegal risk were evaluated, as well as overall attitude toward PP adoption and interest in future PP functionality. Descriptive statistics were calculated and analyzed for all survey items.

Results

Four hundred and seventy-three participants (87% female; 71% < age 50 years; 26% physicians) completed the survey (24% response rate) representing a broad range of clinical areas and PP experience. Respondents understood (94%), accepted (92%), and agreed (89%) that PP implementation provided better patient access and care. Only 24% of respondents felt their PP training was adequate. Clinician observations of their patients and families using the PP are displayed in Figure 1. While 86% of clinicians reported that the PP had not changed their overall workload and productivity, 41% felt it would increase as more patients become active. There were minimal PP-related privacy/security concerns, but 24% of respondents felt their medico-legal risk concerns would increase with a PP, as more patients become active. Seventy-nine percent of respondents reported that PP use does not change the quality of care they deliver. Forty-six percent would like their patients to be active on the PP, while 48% were indifferent. Future portal functionality favoured scheduling, questionnaires, and e-visits.

Conclusion

While the justification for PP implementation is acknowledged, compared to existing literature and current patient experiences, clinicians underestimate their potential value, overestimate their impact on workload and patient anxiety, and feel that they need more training to properly use a portal. These results will guide the next steps in PP optimization locally, and should aid other centres in understanding and addressing clinician concerns, with the goal of improving PP activation and use. Although concerns about PPs cited by providers are largely unfounded, they persist and remain a barrier to optimal leveraging of this tool.
48 Chronic kidney disease prevalence and glomerular filtration rate trends in children with type 1 diabetes
Authors: Favel Kristen L , Mammen Cherry
Published: October 2021

Primary Subject area

Nephrology

Background

Children with type 1 diabetes (T1D) are at risk for acute kidney injury (AKI) secondary to diabetic ketoacidosis, as well as chronic kidney disease (CKD) from diabetic nephropathy.

Objectives

The primary objective of this study was to assess the prevalence of abnormalities in estimated glomerular filtration rate (eGFR) in children with T1D. As a secondary objective, we sought to explore the relationship between clinical characteristics and trends in eGFR.

Design/Methods

This ambispective cohort study involved children aged 18 years or younger with T1D (n = 420), followed in the diabetes clinic at British Columbia Children’s Hospital (BCCH), the tertiary pediatric hospital in Vancouver, British Columbia, Canada. Data was collected from the BCCH paper and electronic health records. CKD was defined as eGFR less than 60 mL/min/1.73 m2. Being at risk of CKD was defined as having a mildly decreased eGFR (60 to < 90 mL/min/1.73 m2) and/or hyperfiltration (eGFR ≥140 mL/min/1.73 m2). eGFR was calculated using the modified Schwartz formula (36.5 x height in cm / serum creatinine in umol/L). Linear regression analysis was used to describe the relationship between eGFR and duration of T1D.

Results

Of the 420 participants, 225 (54%) were male, with a median age at T1D diagnosis of 6.1 years and T1D duration of 4.8 years (range < 1.0-15.0 years). One-hundred and eighty-six (44%) children were hospitalized for DKA, of which 89 (48%) developed AKI. No participants had an eGFR < 60 mL/min/1.73 m2, and 317 (76%) had normal renal function. Fifty-one participants (12%) had an eGFR < 90 mL/min/1.73 m2, and 52 (12%) demonstrated hyperfiltration. When analyzed as a cohort cross-sectionally based on duration of T1D, there was a significant linear decline in eGFR of 1.4 ml/min/1.73 m2 per year (95% CI -1.95, -0.87 mL/min/1.73 m2).

Conclusion

In a large group of pediatric patients with type 1 diabetes, 24% were at risk for chronic kidney disease based on a mildly decreased GFR and/or hyperfiltration. The pattern of eGFR decline over time is concerning and relevant, as this cohort is at risk for CKD secondary to diabetic kidney disease. Strategies are needed to improve the follow-up and management of early CKD in children with type 1 diabetes to maintain their renal function into adulthood, and more studies are needed to quantify further change in eGFR in the young adult population.
51 Donor Milk in the NICU: A Community Pediatrics Perspective
Authors: Stoltz Tasha , Jones Aaron , Rogers Lynn , Sidhu Hargun , Patel Rina , Shamsuddin Adib , Lee Catherine , Graham Campbell , Costa Andrew , Rosner Jodi
Published: October 2021

Primary Subject area

Community Paediatrics

Background

Use of pasteurized donor human milk (PDHM) has been recommended as an alternative to formula for preterm or low birth weight infants when mom’s own breast milk (MOM) is unavailable. Studies show that compared to PDHM, formula-fed neonates had better growth rates but were at increased risk of necrotizing enterocolitis (NEC) and feeding intolerance. Notably, most of these studies were conducted in tertiary-level NICUs. The Canadian Paediatric Society recommends PDHM as an alternative to formula for neonates admitted to NICUs. However, at time of study, PDHM was not offered in many community NICUs.

Objectives

The aim of this project is to determine whether the introduction of donor milk in the Level 2B NICU at Grand River Hospital has made a difference in rates of suspected NEC, feeding intolerance, growth, and length of hospital stay.

Design/Methods

We conducted a retrospective pre-post study comparing medical records of neonates in the NICU who met the criteria to receive PDHM 2 years after the introduction of PDHM at our centre (October 2017 to September 2019) to neonates who met the same criteria but were admitted prior to introduction of PDHM (October 2015 to September 2017) and thus received formula. Neonates who received privately purchased donor milk were excluded from our analysis.

Results

Gestational age and birth weight was similar for the PDHM (n=127) and control (n=120) groups. Compared to the PDHM group, formula-fed neonates were more likely to be transferred to a tertiary care NICU for concerns of suspected NEC (8.9% vs. 3.1%, p=0.017). When comparing any feeding intolerance, there was no significant difference between the two groups (p=0.23). Neonates receiving PDHM had higher average daily weight gain (33.9 vs. 28.9, p < 0 .001), but were more likely to receive additional calorie supplementation. There were no differences in length of hospital stay.

Conclusion

The data from our community NICU support the current literature that infants who receive formula are at increased risk for transfer for suspected NEC compared to those who receive PDHM. However, in our centre, there appears to be no difference in rates of feeding intolerance, and neonates fed fortified PDHM appeared to have better growth rates. Results from this study can be used to guide the allocation of health care resources, and can be applied to other community centres. Future studies can look to replicating these results on a larger scale and analyze the cost-effectiveness of PDHM use in community centers.
63 Characterizing Organizational Risk Factors and Clinical Impacts of Unplanned Extubations among Infants in the Neonatal Intensive Care Unit
Authors: Le Blanc Gabriella , Jabbour Elias , Patel Sharina , Zeid Marco , Shalish Wissam , Kazansteva Olga , Beltempo Marc
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Organizational factors in neonatal intensive care units (NICUs) can increase the risk of adverse events, such as unplanned extubations (UPEs). UPE is the premature and unanticipated removal of an endotracheal tube. UPE and subsequent reintubation may increase the risk for lung injury and bronchopulmonary dysplasia (BPD) among preterm infants.

Objectives

First, we aimed to assess the association between daily nursing overtime and UPEs in the NICU. Second, we aimed to evaluate the association between UPE, re-intubation after UPE, and BPD in the sub-group of infants born < 29 weeks’ gestational age (GA).

Design/Methods

We conducted a retrospective cohort study including infants admitted to a tertiary care NICU between 2016-2019. Daily nursing hours were obtained from local administrative databases. Patient data was collected from the local Canadian Neonatal Network database. Association between ratio of daily nursing overtime hours/total nursing hours (OTR) was compared between days with and without UPEs, using logistic regression analyses. Associations between UPE and BPD among infants born <29 weeks requiring mechanical ventilation was evaluated in a 1:1 propensity-score matched (PSM) cohort. Infants were matched based on GA ± 2 weeks, mechanical ventilation days at time of UPE ± 5 days and SNAPII>20.

Results

There were 108/1370 (7.8%) days with ≥ 1 UPE, for a total of 116 UPE events from 87 patients (23-42 weeks GA). Higher median OTR was observed on days with UPE compared to days without (3.3% vs. 2.5%, p=0.01). OTR was associated with higher adjusted odds of UPE (aOR 1.09, 95% CI 1.01-1.18), while other organizational variables were not (Table 1). Among ventilated infants <29 weeks’ GA (n=XX), UPE rate was 31% (59), BPD rate was 42% (81) and re-intubation rate after UPE was 59% (35). In the PSM cohort of infants <29 weeks, re-intubation after UPE, was associated with increased length of mechanical ventilation (aOR 16.45; CI 6.18, 26.72) as well as increased odds of BPD, when compared to infants not requiring re-intubation (aOR 4.97, 95% CI 1.54-18.27) (Table 2).

Conclusion

Higher nursing overtime was associated with increased UPEs in the NICU. Re-intubation was frequently required after a UPE. Among the infants born < 29 weeks’ GA, UPE requiring reintubation was associated with increased total length of mechanical ventilation and increased risk of BPD. Our findings highlight the role of workforce management in improving outcomes in the NICU, through reducing the incidence of UPEs.
71 Adrenal Insufficiency among Children treated with Hormonal Therapy for Infantile Spasms
Authors: Doré-Brabant Gabrielle , Laflamme Geneviève , Millette Maude , Chrestian Nicolas , Osterman Bradley
Published: October 2021

Primary Subject area

Endocrinology and Metabolism

Background

Hormonal therapy is a standard treatment for children with infantile spasms. However, the high doses given and long treatment duration exposes patients to the potential risk of adrenal insufficiency (AI). There is, presently, limited data on occurrence of AI after hormonal therapy in this population.

Objectives

This study aims to quantify the incidence of AI among children with infantile spasms treated with high-dose corticosteroids and/or adrenocorticotropic hormone (ACTH).

Design/Methods

A retrospective chart review of patients less than 2 years old treated for infantile spasms was performed between January 2009 to March 2020 in one pediatric specialized hospital. Variables collected included sex, age, etiology, age at treatment initiation, type of hormonal treatment, dose and duration of treatment, concomitant medication and illness, other corticosteroid uses, hydrocortisone replacement therapy use, adrenal function testing, and signs of AI. Analysis included descriptive statistics, such as incidence and bivariate analysis.

Results

Thirty-one patients met the inclusion criteria and received a total of 33 separated courses of hormonal treatment. Adrenal function following each course of treatment was evaluated in all patients, either by tests or by the presence of adrenal crisis. Oral hydrocortisone replacement therapy was received by 32/33 (97%) children. AI occurred in 25/33 (76% [95% CI 58-89]) children. There was no predictive factor for adrenal insufficiency after hormonal treatment, and no drug regimen (duration or total received dose) was safe. Two patients (6%) presented to the emergency room with an acute adrenal crisis the day following the weaning off of hormonal treatment. They were the youngest children of the cohort, with an age of 1,6 and 2,7 months at the initiation of treatment. All other patients were aged 4 months and older.

Conclusion

This study suggests that adrenal suppression is frequent after standard hormonal therapy regimen for infantile spasms. This can lead to serious complications, such as adrenal crisis, if not supplemented. A routine laboratory assessment of adrenal function should be done after hormonal therapy for all patients. We suggest that hydrocortisone replacement therapy should be given at the end of hormonal therapy and until testing results for adrenal function are obtained, particularly for younger patients.
79 What we know about acute pediatric cannabis poisoning: A scoping review
Authors: Elliott Sarah , Gaudet Lindsay , Hogue Kaitlin , Scott Shannon , Hartling Lisa
Published: October 2021

Primary Subject area

Emergency Medicine - Paediatric

Background

Liberalization of cannabis policy in Canada has led to concerns that increasing access to cannabis and cannabis infused products (e.g. edibles) for adults will have negative, unintended consequences for children.

Objectives

We conducted a scoping review to map the available evidence on the public health implications, clinical management, and experiences and information needs of healthcare providers (HCP) and parents, relating to acute cannabis poising in children.

Design/Methods

We searched three databases (Medline, CINAHL, and PsychINFO) from inception until October 2019. Grey literature was searched up to March 2020. We included all records (primary research, knowledge synthesis, editorials, letters/opinion pieces, government websites and news articles) reported in English or French. We defined acute cannabis poisoning as unintended exposure to cannabis or cannabis product(s) that led to the need for acute medical advice or treatment. A primary reviewer screened all identified publications and a secondary reviewer screened excludes. Records were categorized by area (public health implications, clinical management, experiences and information needs) and mapped based on reported outcomes and record type.

Results

We identified 4644 records and included 158 (knowledge syntheses [n=3]; primary research [n=95]; editorials, commentaries, and letters [n=18]; education or media for HCP [n=15]; and education or media for the public [n=27]). Public health implications were addressed by 129 (82%), often reporting increasing incidence of acute paediatric cannabis poisonings. 116 records (51 [44%] case studies) reported or discussed clinical characteristics and/or management of acute paediatric cannabis poisoning, including signs and symptoms (92%), use of toxicology screening (60%), type of clinical management (52%) and treatment recommendations (36%). Few sources addressed either HCP (n=5) or parent (n=1) experiences or information needs.

Conclusion

The increasing incidence of acute cannabis poisonings and liberalization of cannabis legislation is clear, however, evidence around the clinical management is limited. Rigorous studies of suggested clinical treatments are needed to develop an evidence-base from which data can be synthesized and appraised, in order to drive the development of clinical recommendations. Additionally, further research exploring HCP and parent experiences and information needs around cannabis poisoning is warranted.
88 Family Absence at the Bedside during the COVID-19 Pandemic
Authors: Dharmaraj Blossom , Diskin Catherine , Orkin Julia , Agarwal Tanvi , Parmar Arpita , Karmali Karima , Friedman Jeremy
Published: October 2021

Primary Subject area

Hospital Paediatrics

Background

Child and family-centered care, a partnership approach to health care decision-making, is central to paediatric practice. To reduce transmission of SARS-CoV-2, healthcare institutions implemented policies to protect staff, patients and families. Family presence at the bedside was reduced to one caregiver, except in special circumstances requiring pre-approval by hospital leadership.

Objectives

We explored the impact of the COVID-19 pandemic on paediatric healthcare delivery, focusing on family presence. We describe the clinician's experience of restricted family presence during the COVID-19 pandemic in a paediatric hospital.

Design/Methods

Physicians, trainees, and nurses at The Hospital for Sick Children completed surveys between March-August 2020 to identify patients they perceived to have experienced a suboptimal quality of care or health-outcome related to changes that had occurred as a result of the pandemic and describe the impact. Data were analyzed via case report and thematic analysis. As part of a larger study, here we report on cases related to family presence in the hospital.

Results

A total of 212 clinicians reported 116 cases; eighteen cases specified an impact on child and family-centered care. Nine cases related to patient experiences and nine to family experiences of the restricted family presence policy. Clinicians reported a perceived distress in patients due to family members not being present. 6267 family restriction exemption requests were received. Cases described families who opted for a different location for end-of-life care so that extended family could be present. Further cases highlighted how important conversations such as disclosure of diagnosis involved one parent present and the other joining remotely. Siblings were also reported to be impacted by visitor restrictions and closure of the sibling play area. Exclusions were also reported to be challenging for children with complex medical needs and technology dependency whereby two-caregivers were often required. Clinicians reported experiencing stress and moral distress as part of being required to support family restriction policies, impairing their ability to provide care.

Conclusion

Family presence policies are a critical component of child and family-centered care and have been impacted by the pandemic as described both by family and clinician stress. Recommendations based on these findings would include: facilitating two-caregiver presence to support shared decision making, regular remote meetings to communicate information with families in cases where they cannot be physically present; using remote technology or implementing allotted visitation time for siblings, reviewing exceptions to caregiver restrictions, and mental health supports for clinicians such as peer-support groups, or wellness workshops.
89 The Unintended Consequences and Impact of the COVID-19 Pandemic on Patients, Families and Clinicians in a Children’s Hospital
Authors: Diskin Catherine , Orkin Julia , Dharmaraj Blossom , Agarwal Tanvi , Parmar Arpita , Friedman Jeremy
Published: October 2021

Primary Subject area

Hospital Paediatrics

Background

The coronavirus (COVID-19) pandemic has broad implications for children and families. Healthcare experience and delivery has changed significantly, and changes will likely continue for some time. Particular attention has been paid to delays in accessing timely pediatric care leading to unintended morbidity.

Objectives

This study aimed (1) to describe the broader spectrum of unintended negative consequences by describing the courses of care altered by the COVID-19 pandemic from the clinician's perspectives and (2) to identify thematic similarities to inform clinical practice change.

Design/Methods

All full-time doctors, dentists, and nurse practitioners working at a tertiary care children’s hospital in Canada were surveyed every two weeks throughout the initial phase of the COVID-19 pandemic. We asked them to identify and describe clinical cases in which they perceived a negative outcome associated with hospital or societal changes due to the COVID-19 pandemic. Analysis followed a qualitative case series methodology using a narrative synthesis approach to determine similarities and associated themes.

Results

Two-hundred and twelve clinicians reported 116 cases. Several broad themes emerged, including (1) timeliness of care, (2) disruption of child and family-centred care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic. Within each of these themes, subthemes emerged, highlighting its impact on (1) patients, (2) their families and (3) healthcare providers. Table 1 provides examples of cases within each theme.

Conclusion

The broad consequences of the COVID-19 pandemic impact patients, families, healthcare providers and the healthcare system. Understanding this breadth is necessary as we strive to deliver safe, high quality, family-centred pediatric care in this new era. As the pandemic continues, we need to consider carefully how to provide elective and ambulatory care, including surgery, in this era of social distancing. Particular attention is needed to understand particular aspects, including vulnerable children and the clinician experience of the COVID-19 pandemic.
93 Timing and frequency of head ultrasound screening to identify severe neurological injury among very preterm infants
Authors: Patel Sharina , Martel-Bucci Andrea , Wintermark Pia , Shalish Wissam , Claveau Martine , Beltempo Marc
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Universal head ultrasound (HUS) screening for severe neurological injury (SNI) injury is recommended for infants born < 32 weeks’ gestational age (GA). However, the risk of SNI varies inversely with GA at birth and other known risk factors; therefore targeted screening may be more appropriate.

Objectives

The objective of the study is to develop a risk-stratified HUS screening protocol for infants born < 32 weeks’ to identify SNI accurately while minimizing resource use.

Design/Methods

Retrospective cohort study of infants born 23-31 weeks’ admitted to a tertiary NICU between 2011-2017. Patient characteristics were extracted from the Canadian Neonatal Network database. All HUS were individually reviewed by a trained abstractor and grouped based on date of exam relative to birth: ≤ 3 days, 4-7 days, 8-14 days, 28-42 days and 35-42 weeks’ corrected GA. Severe neurological injury was defined as intraventricular hemorrhage grade ≥ 3 and/or periventricular leukomalacia on HUS. Logistic regression models were used to identify perinatal risk factors for SNI and determine the number and timing of HUS with highest diagnostic accuracy.

Results

Of 651 infants included, 72 (11%) developed SNI. Independent risk factors for SNI were GA <29 weeks (AOR 3.09, 95% CI 1.65-6.08), vasopressors (AOR 2.95, 95% CI 1.24-6.80) and mechanical ventilation on day of admission (AOR 2.22, 95% CI 1.23-4.11). Infants were grouped into three screening groups based on their exposure to these risk factors (Table 1). Diagnostic accuracy of 63 models of combinations of HUS time points were assessed, and a screening protocol was developed based on the specific time points of HUS that maximized diagnostic accuracy (area under the ROC curve >0.9) while minimizing number of HUS for each screening group (Table 2). Using this protocol could reduce the total number of HUS performed by 920 (40%) and median number of HUS per infant from three (IQR 2-4) to 2 (IQR 1-2; p < 0 .001).

Conclusion

Implementation of a risk factor-based HUS screening protocol may reduce resource use while maintaining high diagnostic accuracy for SNI, and reflects choosing wisely in the NICU.
106 Understanding the Impact of COVID-19 on Healthcare for Medically-Complex Children and Youth
Authors: Baumbusch Jennifer , Lloyd Jennifer E V , Bennett Shawna
Published: October 2021

Primary Subject area

Complex Care

Background

COVID-19 and associated pandemic measures have disproportionately affected already vulnerable populations, including medically-complex children and youth. In Canada, about one percent of children and youth aged 0 to 18 years (inclusive) are medically complex, which is characterized by having complex, chronic conditions that require specialized care, high healthcare service usage, and functional dependence. In addition to being high users of formal healthcare services, it is estimated that parents spent an average of 52 hours per week providing unpaid care.

Objectives

As part of a larger study exploring the effect of the pandemic on these children and their families, the impact on healthcare usage by this population was investigated.

Design/Methods

In August 2020, a web-based cross-sectional survey was conducted with parents of medically-complex children and youth in British Columbia, Canada. A convenience sample was recruited through posting advertisements on social media platforms, word of mouth, and amplifying the study via the media. The survey, co-created with parent co-researchers, was comprised of 93 questions. It was divided into three sections that focused on pre- and post-pandemic questions about a) medically complex child(ren), b) family/household/community characteristics, and c) respondent demographics. Data were analyzed using descriptive statistics.

Results

Results illustrate the largely negative impact of the pandemic on this population’s healthcare usage. The survey was completed by 156 parents, mainly mothers (92.3%) who reported information for 188 medically complex children and youth. The children ranged in age from 0 to 18 years, with an average age of 9.5 years, and 58.0% were boys. Between February and August 2020, 30.3% of children had visited the emergency department and the same percentage had parents who avoided taking them in circumstances where they typically would have. 36.2% of the children had been admitted to hospital during that period. The children typically saw an average of four medical specialists and during the pandemic 63.8% had a specialist appointment cancelled or postponed by the clinic. During this time, there was also a steep decline or stoppage of all allied health therapies.

Conclusion

These results demonstrate a lack of pandemic preparedness to ensure continuity of services. Consequently, medically complex children and youth may be missing key interventions to address ongoing health issues and maintain functional abilities. More proactive planning and coordination are needed to ensure that future situations will not lead to lack of access or therapy for this vulnerable group.
112 Impact of the COVID-19 pandemic on emergency department visits at a university medical centre
Authors: Mallette Viviane , Cyr Claude
Published: October 2021

Primary Subject area

Emergency Medicine - Paediatric

Background

The new coronavirus, SARS-Cov-2, responsible for a global pandemic, led to the declaration of a health emergency and the implementation of large-scale public health measures by governments in 2020. Those measures, combined with the overlapping symptoms of COVID-19 disease and common viral infections in children, have led hospitals to prepare for possible changes in volume of emergency room visits by children.

Objectives

This study aims to determine the effect of the pandemic and governmental restrictions on the use of the emergency department by pediatric patients at a university medical centre, as well as to assess the impact on the severity of initial presentations.

Design/Methods

A single-centre study was conducted at a university hospital among children aged 0 to 17 who visited the emergency room. We used interrupted time series analysis to compare the average of pre-COVID-19 data (from January 1 2017, to December 31 2019) with data from the first wave of the COVID-19 pandemic (from January 1 to September 2020). Emergency room visits, initial triage codes, and admission and pediatric consultation rates were analyzed to assess whether there was a significant difference between periods.

Results

An important increase in total daily visits (+11.18, 95% CI [6.23-16.14]) was first observed with the emergence of COVID-19 cases in Canada. Then, during the strict confinement, which corresponds to an active period of COVID-19, we detected a significant drop in daily visits (-25.64, 95% CI [-30.4 to -20.66]), which continued while progressively loosening restrictions. The proportion of admissions and pediatric consultations rose slightly only throughout the time of intensive health measures (respectively +4.07% and +3.32%), but no changes in the severity of the triage codes at the emergency department were observed for all periods. Traumatic injuries also saw a significant decrease (p=0.018) when comparing data by groups of diagnosis.

Conclusion

These results show a significantly lower number of children’s visits to the emergency room of a university medical centre, and a transient increase in pediatric care with little impact on the immediate severity of the initial presentations during strict government health measures in the first wave of COVID-19. These measures also had a beneficial effect in reducing the number of traumatic injuries.
120 The Experience of Housing Need Amongst Families Caring for Children with Medical Complexity: A Qualitative Study
Authors: Moore Clara , Hounsell Kara Grace , Zahavi Arielle , Arje Danielle , Weiser Natalie , Esser Kayla , Netten Kathy , Soscia Joanna , Cohen Eyal , Orkin Julia
Published: October 2021

Primary Subject area

Complex Care

Background

Caregivers of children with medical complexity (CMC) face many financial, social and emotional stressors related to their child’s medical condition(s). Previous research has demonstrated that financial stress among this population can have an impact on their housing situation. Families of CMC may face other unique housing challenges such as disability accommodations in the home and housing space and layout.

Objectives

The primary aim of this study was to explore families’ perspectives and experiences of housing need, and its relationship to their child’s health status as it pertains to CMC.

Design/Methods

We conducted a qualitative study using semi-structured interviews to identify themes surrounding families of CMC’s experiences of housing need. Parents of CMC were recruited through purposive sampling from the Complex Care Program at a tertiary pediatric health sciences centre. Recruitment ceased when thematic saturation was reached, as determined by consensus of the research team. Interviews were recorded, transcribed verbatim, coded, and analyzed using thematic analysis.

Results

Twenty parents completed the interview, of whom 89% were mothers and 42% identified a non-English language as their first language. Two major themes and five subthemes (in parentheses) were identified: 1) the impact of health on housing (housing preferences, housing possibilities, housing outcome as a trade-off) and 2) the impact of housing on health (health of the caregiver, health of the child). Some parents reported that their child’s medical needs resulted in specific preferences regarding the location and layout of their home. Parents also indicated that their caregiving role often affected their income and home ownership status, which in turn, affected their housing possibilities. Thus, the housing situation (location and layout of the home) was often the result of a trade-off between the parent’s housing preferences and possibilities.

Conclusion

Housing is a recognized social determinant of health. We found that among CMC, health also appears to be a significant determinant of housing as families reported that the health of their child impacted their housing preferences and the options available to them (possibilities). To support the health of CMC and their families, policies targeting improved access to subsidized housing, improved sources of funding and regulations allowing families who rent to make accessibility changes are vital. Future research should investigate the impact of household income on housing need and identify interventions to support appropriate housing for CMC.