bluuebunny/crossref_metadata_2025 huggingface dataset:
19 Treatment of Neonatal Hyperbilirubinemia – Ontario Cohort 2014-2018
Authors: Rasiah Saisujani , Jegathesan Thivia , Campbell Douglas , Sgro Michael
Published: August 2020

Background

Serious complications that could result from severe neonatal hyperbilirubinemia include acute and chronic bilirubin encephalopathy. In Ontario, the incidence of severe neonatal hyperbilirubinemia and its associated treatments in term and near-term infants is currently unknown. Although IVIG therapy has been increasingly discussed in the literature, a recent Cochrane review (2018) indicated that there was a lack of evidence for recommending IVIG therapy for routine use.

Objectives

The purpose of this study was to determine the current incidence of severe neonatal hyperbilirubinemia and its treatments (Intravenous Immunoglobulin (IVIG) therapy, exchange transfusion and phototherapy) most often used in Ontario.

Design/Methods

A population-based retrospective cohort study of all term and near-term infants (≥ 35 weeks’ gestation) born in Ontario from April 2014 to March 2018 was conducted. National and provincial databases including Better Outcomes Registry Network Ontario (BORN) and Canadian Neonatal Network (CNN) were utilized.

Results

Data was collected from 533,084 infants born in Ontario over the 4 years. Of the total infants screened, 29,756 (6%) infants were diagnosed with neonatal hyperbilirubinemia. In terms of treatments, 24,646 (83%) infants received phototherapy, 54 (0.18%) infants received an exchange transfusion and 458 (1.5%) infants received IVIG therapy. In Ontario, neonatal hyperbilirubinemia had a statistically significant increase from 2014 to 2018 (P<0.0001). Although phototherapy was used on almost all neonates with hyperbilirubinemia (83%) there was a significant decrease from 2014 to 2018 (from 88% to 80%) (P<0.0001). Of the babies with hyperbilirubinemia in 2014, 71 (1.06%) infants received IVIG therapy and 15 (0.22%) infants received exchange transfusion. Within 4 years, IVIG therapy incidence had a significant increase from 71 (1.06%) infants to 156 (2.04%) infants (P<0.0001), while exchange transfusion remained relatively constant (P=.315). Exchange transfusion rates allows for the prediction that the rate of severe neonatal hyperbilirubinemia is stable in Ontario.

Conclusion

In conclusion, (severe) hyperbilirubinemia still exists amongst neonates in Ontario, despite the advancements in managing hyperbilirubinemia, indicating the need for better treatments and/or monitoring. There was also a significant rise in the use of IVIG despite the continued debate about its utility. Further research should be conducted nationally to determine the incidence of severe neonatal hyperbilirubinemia and to indicate the usage of IVIG therapy.
23 Current Trends in Canada in Neonatal Palliative Care
Authors: MacLean Gillian , Gallipoli Alessia , Raabis Ayla
Published: August 2020

Background

The area of palliative care in pediatrics has been expanding, as evidence emphasizes the benefits of providing pediatric patients and their families with optimized care in cases of chronic illness and end-of-life. The majority of pediatric deaths occur in infants under one year, with significant portions of these deaths taking place in Neonatal Intensive Care Units (NICU). The expansion of palliative care into neonatal medicine is of significant importance, as symptom management and end-of-life care plays a vital role in providing complete care to these infants. Guidelines that have been put into place can vary significantly between centers. Published studies in neonatal palliative care (PC) describe these challenges, however little data currently exists specific to Canadian NICUs.

Objectives

The primary objective was to gather information about current practice trends and themes around barriers in neonatal PC.

Design/Methods

An anonymous survey was distributed to Canadian Level 3 NICU staff, including neonatologists, neonatal nurse practitioners (NP), and neonatal fellows through the Qualtrics platform. Surveys were distributed through email and responses tracked in the Qualtrics system.

Results

The survey response rate was 57. The majority of respondents were neonatologists (50%), with many having more than 5 years of experience. Provision of palliative care was common with 20/57 respondents being involved in 5 or more cases in the past year.

Only 40% of respondents reported that neonatologists and neonatal NPs received palliative care training at their center. When education did exist, lectures (31%) and workshops (26%) were most common. 97% said their centre would benefit from more education.

53% of respondents said their center had an established guideline around neonatal PC, 20% did not know and 27% answered no. Only 8% of respondents who work at centres with a guideline found that it was consistently followed.

Respondents were asked to identify barriers to implementation at their place of practice. Common responses noted challenges in NICU collaborations with maternal-fetal medicine and palliative care teams, as well as lack of education and providers’ personal beliefs.

Lastly, respondents provided details of their guidelines or common practices in PC which has been collated and summarized.

Conclusion

The results provide a snapshot of the current palliative care practices in academic NICUs across Canada. Overall the results were positive with many centers having a guideline and some provider education. The perceived barriers highlight focus areas for future education and policy development, and emphasize the importance of improved collaboration moving forward.
24 Association of location of intubation procedure and number of tracheal intubation attempts with death or severe neurological injury among very preterm infants
Authors: Debay Anthony , Patel Sharina , Wintermark Pia , Claveau Martine , Olivier François , Beltempo Marc
Published: August 2020

Background

The physiological stress induced by tracheal intubation (TI) is associated with increased risk of neurological injury among very preterm infants. The location of TI procedure and number of attempts required may contribute to adverse outcomes.

Objectives

We aimed to assess the association of location where TI is performed and the number of TI attempts with death and/or severe neurological injury (SNI) among very preterm infants born <33 weeks and intubated in the first 7 days of life.

Design/Methods

Retrospective cohort study of 442 infants born 23-32 weeks gestation, admitted to a Level 3 NICU 2015-2018 within the first 7 days of life. We excluded infants who were moribund and the ones with a major congenital anomaly. Data was collected from the Canadian Neonatal Network database and chart review. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. >1) among infants intubated in the first 7 days of life. Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3-4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders.

Results

Rate of intubation was 46% (202/442). Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with 1 TI attempt and 23% (27/117) among infants with >1 TI attempt. Rate of premedication use for NICU TI was 97% (102/105). Overall, median number of intubation attempts was 1 [IQR 1-2]. Compared to no TI, TI in the NICU (adjusted odds ratio [AOR] 3.39, 95% CI 1.20-10.53) and TI in the DR (AOR 9.28, 95% CI 3.33-29.43) were associated with higher odds of death and/or SNI. DR TI was associated with higher odds of death and/or SNI compared to NICU TI (AOR 2.73, 95% CI 1.23-6.35). Compared to no TI, 1 TI attempt (AOR 5.25, 95% CI 1.93-15.93) and >1 TI attempt (AOR 5.17, 95% CI 1.93-15.69) were associated with higher odds of death and/or SNI. The number of intubation attempts (1 vs. >1) was not associated with death and/or SNI (AOR 0.99, 95% CI 0.47-2.09).

Conclusion

Intubated infants have higher odds of death and/or SNI. Among intubated infants, DR TI is associated with higher odds of death and/or SNI vs. TI in the NICU with premedication. Optimizing non-invasive ventilation in the DR may help reduce brain injury in preterm infants.
25 More than meets the eye: Parental perspectives on the health of their extremely preterm children when they reach 18 months, 5 and 7 years
Authors: Duquette Laurie-Anne , Luu Thuy Mai , Janvier Annie , Mai-Vo Thuy-An , Fortin Aurelie , Thivierge Emilie , Bourque Claude Julie , Pearce Rebecca , Synnes Anne , Jaworski Magdalena
Published: August 2020

Background

Extremely preterm birth is associated with death and a higher risk of adverse long-term outcomes. Neurodevelopmental impairment (NDI) has become the focus of neonatal follow-up and outcome research, with classifications chosen by clinicians and researchers. However, parents were never consulted about this classification.

Objectives

To examine parental perspectives about the health of their ex-preterm infants.

Design/Methods

Over a one-year period, at Sainte-Justine University Hospital’s Neonatal Follow-Up Clinic, all parents of children born <29 weeks’ gestational age, aged between 18 months corrected age and 7 years were approached. They were asked two questions: “Please rate your child’s health from your point of view on a scale from 0 (very poor) to 10 (excellent)” and “If you could improve up to two things about your child’s health and/or development, what would they be?” Responses were analyzed using mixed methods.

Results

249 parental responses were obtained (98% participation rate). On average, parents rated their child’s health to be 8/10 (range 3-10/10, median 8/10). Main themes invoked about areas for improvement were developmental outcomes (65%):“if he could talk and hold his head up himself”; respiratory heath and overall medical fragility (35%): “improve the health of her lungs”; and behavior/emotional issues (21%): “his anxiety”. Twenty-three percent did not wish to improve anything: “I am very happy with his health and development. I hope he continues on the same path.” When examining developmental outcomes more closely, the recurrent sub-themes for improvement were: language/communication (22%), motor/movement (17%) and cognitive/learning (16%): “improving her attention in school”.

Conclusion

When they come to neonatal follow-up, parents generally perceive the health of their extremely preterm children in a positive way. While some parents have no wishes for improvement in their children, many are concerned by their children’s NDI. On the other hand, several parent-important outcomes, such as lung health and overall medical fragility, are insufficiently investigated during follow-up at the present time.
27 Determinants of referral to developmental resources among neonatal follow-up patients discharged from tertiary neonatal unit from 2005 UNTIL 2014
Authors: Saleem Maad , Hayawi Lamia , Barrowman Nick , BenFadel Nadya , Feberova Jana , Daboval Thierry
Published: August 2020

Background

Lower gestational age or birth weight and higher rate of neurodevelopmental impairment have been commonly linked to higher need for developmental resources in premature infants. Existing evidence on need for developmental support in premature infants is limited in description of the needs, timing and method of assessment.

Objectives

To identify predictors for the needs for developmental resources among high-risk groups of infants born less than 29 weeks or with a birth weight (BW) less than 1250 grams. Secondarily, to compare the need of referrals to developmental resources and the rate of neurodevelopmental impairment defined as cerebral palsy, global developmental delay, blindness and deafness for this high risk population.

Design/Methods

We conducted a retrospective chart review of premature infants < 29+0 weeks GA or BW < 1250 grams born between January 2005 and December 31st 2014, who had at least one visit at the neonatal follow up clinic. Univariate and multivariate logistic regression analyses were conducted to examine potential predictors for referral to developmental resources.

Results

The study included 687 infants. Within this high risk population, 579 (85.0%) of infants were referred, of these 153 (26.4%) had one referral, 132 (22.8%) had 2 and 294 (50.8%) had 3 or more referral/s to developmental resources. Most frequent referrals were for speech therapy (339, 50.0%) physiotherapy (319, 46.8%) occupational therapy (262, 38.3%) and infant development program (232, 34.1%). The rates of referral to developmental resources decrease with increasing gestational age. Multivariate logistic regressions showed that gestational age (OR: 1.19, 95% CI: 1.05 - 1.35), birth weight (OR: 0.87, 95% CI: 0.77 - 0.99), female gender (OR: 0.70, 95% CI: 0.49 - 0.99), intraventricular hemorrhage grades III-IV (OR: 3.02, 95% CI: 1.28 - 7.16), and days on mechanical ventilator (OR:1.03, 95% CI: 1.01 - 1.05) were predictors for 2 or more referrals to developmental resources. Cerebral palsy was present in 4.4 % of the study population, deafness in 4% and blindness in 0.6%. The rate of referral to developmental resources was 54 (98.2%) among infants with neurodevelopmental impairment (NDI) compared to 522 (83.9%) in infants without NDI (p value= 0.01).

Conclusion

There is substantial need for developmental support among high-risk premature infants. Infants without neurodevelopmental impairments still need significant developmental resources to achieve their outcome.
28 Association of serum sodium concentration, fluid balance and weight loss with bronchopulmonary dysplasia in very preterm infants
Authors: Soullane Safiya , Patel Sharina , Sant’Anna Guilherme , Claveau Martine , Wazneh Laila , Beltempo Marc
Published: August 2020

Background

Bronchopulmonary dysplasia (BPD) affects 20% of very preterm infants born <33 weeks gestational age (GA). In this subgroup of neonates, postnatal fluid adaptation may be inefficient due to kidney immaturity, resulting in increased pulmonary interstitial fluid content, lung damage and impaired air-gas exchange. Early postnatal fluid status might contribute to the risk of developing BPD and requires further investigation.

Objectives

To investigate the association of three indicators of early postnatal fluid status (median serum sodium concentration, cumulative fluid balance and maximum percentage weight loss) measured over the first 10 days after delivery with death and/or BPD in infants born <33 weeks.

Design/Methods

This retrospective cohort study included infants born 23-32 weeks GA, admitted to the Montreal Children’s Hospital’s NICU from 2015-2018. Neonates moribund on admission, with any major congenital malformation and/or admitted to the NICU >1 day after birth were excluded. Data was collected from the Canadian Neonatal Network database and individual chart review. BPD was defined as oxygen therapy or respiratory support at 36 weeks’ corrected GA. Unadjusted comparisons were made using the Wilcoxon test. Associations between exposures (median serum sodium concentration, cumulative fluid balance and maximum percentage weight loss in the first 10 days after delivery) and outcomes (death and/or BPD) were assessed using multivariable logistic regression analyses adjusting for sex, steroid use, GA, small-for-gestational-age status, Apgar at 5 min<7, surfactant use and mode of delivery.

Results

Among 439 eligible infants, 125 died and/or developed BPD (29%). Median serum sodium concentration was 139 mmol/L (IQR 136-141) among BPD-free survivors and 136 mmol/L (IQR 134-139) among infants with death and/or BPD (p<0.001). Cumulative fluid balance was 4.09 dL/kg (IQR 2.98-4.78) among BPD-free survivors and 4.88 dL/kg (IQR 3.96-5.95) among infants with death and/or BPD (p<0.001). Maximum percentage weight loss was 8.5% (IQR 5.4-11.6) among BPD-free survivors and 9.2% (IQR 4.9-12.9) among infants with death and/or BPD (p=0.41). Adjusted odds ratios (95% confidence interval) are presented in Table 1.

Conclusion

Among very preterm infants, higher cumulative fluid balance in the first 10 days after delivery is associated with higher odds of death and/or BPD. Thus, targeting lower cumulative fluid balance may improve BPD-free survival.
33 NeoCHIRP: A Collaborative Care Model for Intestinal Rehabilitation in the NICU
Authors: Dhaliwal Keerat , Albersheim Susan , Casey Linda
Published: August 2020

Background

Many children with intestinal failure (IF) start their course in the NICU with medical or surgical conditions limiting enteral feeding. Multidisciplinary intestinal rehabilitation teams have improved outcomes in pediatric IF patients, but this is not well described in neonates.

Objectives

NeoCHIRP represents a unique IR Team; this study describes its roles in collaborating neonatal and IR care.

Design/Methods

Retrospective descriptive chart review of neonates at risk for IF in one NICU, of patients admitted between April 1, 2013 and March 31, 2019. All neonates at risk for IF were evaluated weekly by a multidisciplinary Neonatal Children’s IR program in the NICU (NeoCHIRP) that is composed of surgeons, dieticians, neonatologists, IR paediatrician, nurses and patient families, to evaluate nutritional status, and provide recommendations. Data collected included weight, patient characteristics, number of NeoCHIRP visits, type of recommendations, cholestasis interventions, successful oral tolerance, and survival.

Results

There were 163 patients, 105 males, 58 females with 1-27 weekly visits (mean= 9.1) and gestational age between 23-43 4/7 weeks (median= 35). There were 153 survivors discharged from the NICU and 10 deaths (3 from IF related complications.) Enteral autonomy was achieved by 139/163 patients (85.3%.) Common recommendations made were enteral feeds (96.3%), parenteral nutrition (95%) or sodium management (93.9%.) Recommendations for oral stimulation were made in 79.1%, of which 40.5% (66/163) were exclusively orally fed and 20.2% partially orally fed by discharge. Cholestasis interventions were made in 66.9% and conjugated bilirubin (CB) <15 at discharge in 93 patients (range 0-123, mean 12.9 median 2) with only 23/163 patients with CB >30 at final visit. Evaluation of patient weights showed increased z-scores in only 23/153 (15%) from birth to discharge versus increased z-scores in 51/141 (36.2%) from NeoCHIRP consult to discharge.

Conclusion

A Multidisciplinary Neonatal Intestinal Failure Team is a useful collaborative model to support NICU medical management, by minimizing poor weight gain, cholestasis and oral aversion. Recommendations made for all NeoCHIRP patients in enteral, parenteral and sodium management resulted in improved weight gain of patients.
37 Growth and neurodevelopment in early childhood of preterm infants with complex congenital heart defects following open cardiac surgery
Authors: Cheung Po-Yin , Hajihosseini Morteza , Dinu Irina , Switzer Heather , Robertson Charlene M T
Published: August 2020

Background

Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks of gestational age and received neonatal open cardiac surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. Specific details related to the neurodevelopmental outcome of these infants remain unpublished.

Objectives

To describe the growth, disability, functional, and neurodevelopmental outcome in early childhood of preterm infants (born at <37+0 weeks gestation) with CCHD and neonatal OHS.

Design/Methods

We studied all infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. In the Western Canadian Complex Pediatric Therapies Follow-up Program, comprehensive neurodevelopmental assessments at a corrected age of 18-24 months were done by multidisciplinary teams at the original referral sites. In addition to demographic and clinical data, standardized age-appropriate outcome measures included physical growth with calculated Z-scores, disabilities including cerebral palsy, visual impairment, sensorineural hearing loss; adaptive function (Adaptive Behavioural Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III).

Results

From 1996 to 2016, 115 preterm infants (34±2 weeks gestation, 2339±637g, 64% males) with CCHD had OHS with 11(10%) deaths before first discharge and 21 (18%) by 2 years. Prior to the first surgery, 7 (6%) neonates had cerebral injuries. Overall, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. All 94 surviving infants received comprehensive evaluation at 2 years corrected age; Eighteen (19%) had congenital syndromes who had worse functional and neurodevelopmental outcomes compared to those (n=76) without syndromal abnormalities (SA) (Table).

Conclusion

For preterm neonates with CCHD and early OHS, the mortality was significant, but the short-term neonatal morbidity was not increased. Compared with published preterm outcomes, the early outcome suggests more cerebral palsy but not sensorineural hearing loss, and greater neurodevelopmental delay. This information is important for management care of the infants, parental counselling and the decision-making process.
39 Early Higher Parenteral Lipid Intake Decreases Extra-Uterine Growth Restriction in Very Low Birth weight Infants: A Randomized Controlled Trial
Authors: Alburaki Wissam , Alshaikh Belal , Yusuf Kamran
Published: August 2020

Background

Approximately 43-65% of very low birth weight (VLBW) infants develop extra-uterine growth restriction (EUGR).

EUGR is associated with a significant increase in the risk of neurodevelopmental impairment.

Inadequate early postnatal nutrition results in excessive weight loss that cannot be explained by the physiologic contraction of body water alone.

EUGR and postnatal growth failure are usually associated with negative early energy and nitrogen balance in the first week of life.

Growth trajectories after initial weight loss have similar slopes regardless of gestational age, which indicates that the early excessive weight loss is a lead cause for EUGR.

Objectives

To study whether an early and higher parenteral lipid intake in the first week after birth would decrease the percentage of weight loss and subsequently the incidence of EUGR.

Design/Methods

This was a randomized, open-label, control trial of appropriate-for-gestational age VLBW infants admitted to our level III NICU.

Lipid intake in the control group started at 0.5-1 g/kg/day and was increased daily by 0.5-1 g/kg/day until 3 g/kg/day was reached.

The intervention group was started on 2 g/kg/day then increased to 3 g/kg/day the following day.

Triglyceride levels were measured the day after the start and after each increase in lipid intake.

Results

Among the 176 infants assessed for eligibility, eighty-three were included in the trial.

There were no significant differences between the control and the intervention group in mean gestational age (27.3 ± 2.4 vs. 27.1 ± 2.3 weeks respectively) or birth weight (1011 ± 250 vs. 1019 ± 271 g respectively).

Infants in the intervention group were started on lipid earlier (13.8±7.8 vs. 17.5±7.8 h; p=0.03) and had higher cumulative lipid intake in the first 7 days of age (13.5±4.2 vs. 10.9±3.5 g/kg; p=0.004) that led to a protein to energy ratio; closer to the recommended values.

Total fluid intake was similar between the two groups.

Infants in the intervention group had a lower percentage of weight loss (10.4±3.6 vs. 12.7±4.6; p=0.02).

The mean triglyceride level was higher in the intervention group (1.91± 0.79 vs. 1.49±0.54 mmol/L; p= 0.01), however, hypertriglyceridemia was similar between the two groups at 2 and 3 g/kg/day of lipid intake. Enteral energy and protein intake calculated weekly between the time of parenteral nutrition discontinuation and 36 weeks corrected gestational age (CGA) were similar between the 2 groups.

EUGR at 36 weeks CGA was significantly lower in the intervention group (38.6% vs. 67.6%; p=0.01).

Conclusion

In VLBW infants, the provision of an early and higher dose of parenteral lipid in the first week of life results in less weight loss and lower incidence of EUGR.
42 The Impact of Home Respiratory Support on Developmental Outcomes in Very Preterm Infants
Authors: McRae Lindsay , Kieran Emily , Luu Thuy Mai , Shivananda Sandesh , Synnes Anne
Published: August 2020

Introduction/Background

Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity and may require prolonged home respiratory support. BPD is associated with worse neurodevelopmental outcomes but the impact of home respiratory support on neurodevelopmental outcomes, rehospitalization rates and association with caregiver sociodemographics is less well studied.

Objectives

This study examines the impact of home respiratory support on neurodevelopmental outcomes in very preterm infants at 18-24 months corrected gestational age.

Design/Methods

This linked Canadian Neonatal Network and Canadian Neonatal Follow-Up Network (CNFUN) multicenter cohort study of infants born April 1, 2009-December 31, 2016 at <29 weeks’ gestational age assessed at 18-24 months corrected age at a CNFUN site compared significant neurodevelopmental impairment rates, rehospitalization rates and sociodemographics in children with and without home respiratory support using Chi-square and student t-tests.

Results

Of the 3918 infants, 622 (15.9%) received home respiratory support. As expected, infants on home respiratory support had a lower gestational age (mean 25.5 vs 26.5 weeks, p < 0.01), lower birth weight (mean 781 vs 955 grams, p < 0.01), longer NICU stay (mean 118 vs 76 days, p < 0.01) and more comorbidities: late onset sepsis (35.1% vs 22.9%, p < 0.01), NEC ≥ stage 2 (8.9% vs 5.9%, p = 0.01), grade 3-4 IVH or PVL (12.7% vs 8.4%, p < 0.01) and ROP ≥ grade 3 (28% vs 10.8%, p < 0.01). Infants on home respiratory support had higher significant neurodevelopmental impairment rates defined as Bayley-III motor, cognitive, language scores <70, nonambulatory cerebral palsy (GMFCS ≥ 3), hearing and/or visual impairment rates (Table 1), rehospitalization rates (63.3% vs 29.2%, p < 0.01) and >3 rehospitalizations (19.8% vs 5.0%, p < 0.01). With home respiratory support, fewer families had paid employment and more were on social welfare.

Conclusion

Children born preterm who are discharged home on respiratory support, compared to those without home support, are more likely to experience neurodevelopmental impairment and rehospitalization, and may have an adverse impact on family income. This is important for discharge planning and follow-up care of these high risk children.
44 Management of Neonatal Hypoglycemia using Dextrose 40% Oral Gel in Term and Late Preterm Neonates
Authors: Zhou Kim , Pang Adrienne , Huang Tianhua
Published: August 2020

Introduction/Background

Oral dextrose gel has been shown to be an effective first-line treatment for neonatal hypoglycemia (NH) in full term and late preterm neonates in New Zealand (Harris et al., 2013). The use of dextrose gel in NH has not been evaluated in a Canadian setting. Dextrose gel preparations in Canada are not designed for neonates, and significant variations in dextrose concentration have been reported (Solimano et al., 2019). In October 2018, we instituted a new clinical guideline for the use of dextrose gel to treat NH.

Objectives

Primary Objective: To determine if the use of dextrose gel is effective in treating infants with NH, and if it leads to higher rates of breastfeeding and lower rates of formula supplementation at discharge.

Secondary Objective: To determine if the use of dextrose gel leads to a decrease in NICU admissions due to NH.

Design/Methods

We performed a retrospective cohort study of all neonates treated for hypoglycemia during a six month period before and after implementation of a clinical guideline involving dextrose gel (January 1 – June 30, 2018 and 2019). Equivalent timeframes were used with a two month washout period during guideline implementation.

Results

A total of 269 neonates were treated for hypoglycemia - 109 in the formula group and 160 in the dextrose group. The two study cohorts shared similar baseline characteristics. The timing and severity of the first episode of hypoglycemia were similar in both groups, but the median blood glucose following treatment was higher in the formula group (median 3.3 mmol/L, p<0.05). The proportion of neonates who experienced a second episode of hypoglycemia and the rate of NICU admission for IV dextrose appeared to be higher in the dextrose group, although the differences were not statistically significant. There was no statistical difference in the average volume of formula used per feed at discharge, the rates of exclusive breastfeeding at discharge, or the average quality of breastfeeding as measured by the LATCH score.

Conclusion

This is the first study evaluating dextrose gel in the management of NH in Canada, and it did not identify any significant advantage over formula-based treatment, with some parameters demonstrating an inferior response. With the latest Canadian Paediatric Society hypoglycemia guidelines recommending the routine use of dextrose gel, further studies are urgently needed to evaluate the efficacy of Canadian preparations, and advocacy is needed at a national level to create a paediatric-specific formulation.
47 Increase Clinic Attendance Among Adolescents and Young Adults: A novel cost-effective method
Authors: Jegathesan Thivia , Roth Megan , Florence Melissa , Mistry Niraj , Bonifacio Herbert J , Sgro Michael , Baker Jillian
Published: August 2020

Background

Transition clinics have been introduced to address the unique needs of adolescent and young adult (AYA) populations, however clinic attendance continues to be an issue. Although poor clinic attendance among the AYA population has been well known, solutions to address this has been limited. Some factors that have been associated with missed appointments include forgetfulness, negative previous clinic experiences and clinic schedules. With widespread use of digital technologies among AYA, the application of digital solutions to increase attendance at healthcare appointments has been explored, but little is known on its effectiveness.

Objectives

To determine the effect of text messaging appointment reminders on uninformed no show rates in an AYA transition clinic. Uninformed no show rate was defined as an absence from clinic (not related to a medical emergency) without communication with the clinic.

Design/Methods

A pilot prospective cohort study with a retrospective control group was conducted in an AYA general hematology transition clinic. In order to establish the current no show rate at the clinic, a retrospective review of AYA patients who attended the clinic between April 2013-August 2015 was conducted. Thereafter, all patients who had an appointment scheduled between February 2016 and December 2017 were included in the study and received a text message reminder of their appointment 48 hours prior to their appointment. Monthly uninformed no show rates were collected, and a student’s t-test was conducted to determine if there was a significant difference in uninformed no show rates before and after the introduction of text message reminders.

Results

Eighty-six participants consented to participate in the study and received a text message reminder of their appointment. From April 2013- August 2015 a total of 51 clinic days with 236 appointments occurred. During this time the mean uninformed no show rate was 39.9%. SMS appointment reminders were sent from February 2016 to December 2017 for 48 clinic days for a total of 206 clinic appointments. The mean uninformed no show rate after the introduction of text message appointment reminders was 22.6%. The introduction of text messaging appointment reminders significantly (p<0.01) decreased uninformed no show rates by 17.3%.

Conclusion

Text message reminders are an effective low cost method in reminding AYA patients about their appointments. By using innovative, cost effective and practical strategies like text messaging reminders to increase clinic attendance, we not only improve the care of our patients but also reduce the financial and clerical burden to the system resulting from missed appointments.
48 Paediatric intubation in an adult-based community hospital emergency department (ED)
Authors: Kukreti Vinay , Nonoyama Mika , Papaconstantinou Efrosini , Heath Jane , Kozlowski Natascha , Tsimelkas Sarah , Leach Courtney
Published: August 2020

Background

Airway intubation is a high-risk procedure, especially in the paediatric population. Training ED healthcare providers is challenging because it is rare. Success and adverse events (AEs) could be due to patients’ illness, the health professional intubating, and hospital factors.

Objectives

Describe paediatric intubations in an adult community-based hospital, with primary outcomes being first-pass success and AEs. The secondary objective is to determine what factors are association with intubation success and related AEs.

Design/Methods

Retrospective chart review of patients < 18 years intubated in the ED between Jan 1, 2006 and Mar 31, 2017 (demographics, intubation details, physiologic outcomes). Analysis: descriptive and comparative statistics (intubations with vs. without AEs), p<0.05 significant.

Results

n=121 intubations occurred in the ED over the 10-year period. Mean (standard deviation) age 6.9 (6.8) years. First pass success occurred in n=76 (62.8%), and 33 (27.3%) second pass success. There was n=22 (18.2) minor AEs, n=3 (2.5) major AEs. There were no significant differences between profession intubating and first pass success (p=0.384), or AEs (p=0.472), Table 1. Indications for intubation included respiratory and/or oxygenation failure n=54 (44.6%), airway protection n=51 (42.2%), airway obstruction n=4 (3.3%), cardiopulmonary arrest n=2 (1.7%) [n=9 missing]. Use of specialized equipment was used in n=19 of the intubations, n=12 on first attempt, 8 second attempt, 4 third attempt. No accidental extubations occurred, but the ETT was repositioned in n=33 (27%) after first intubation.

Conclusion

Pediatric intubation in an adult community-based hospital is rare. Success rate of intubation on first attempt is low with minor AEs. There was no significant difference between the type of health professional intubating. These results will inform the development of tools and education for paediatric advanced airway management in adult community-based hospitals, and enhance patient outcomes in the ED.
49 Rooming-In to Treat Neonatal Abstinence Syndrome
Authors: Piteau Shalea , Vyas Meera , Papadakos Peter
Published: August 2020

Background

Ontario has been facing a steady rise in the number of individuals abusing narcotics. Newly implemented rooming-in programs in Ontario have allowed infants of opioid-dependent mothers to stay in the same room as their mother while the infant continues to be monitored for signs of neonatal abstinence syndrome (NAS).

Objectives

To retroactively review the impact of a rooming-in program for babies at risk of NAS on the need for pharmacologic treatment and length of stay in one community hospital site in Belleville, Ontario.

Design/Methods

Belleville General Hospital developed a rooming-in program for newborns at risk of NAS in July 2015. Prior to its inception, the standard of care was to admit these infants to the special care nursery for monitoring and treatment. Charts were reviewed to collect data on infants born to mothers using opioids in the 24 months prior to (July 2013 – June 2015) and after (July 2015 – June 2017) the implementation of our program. The two groups were compared for the primary outcomes studied, including the number of babies started on morphine and length of stay in hospital. Secondary outcomes were also examined, including breast feeding rates, resource intensity weight, and total hospital cost.

Results

Rooming-in is associated with a reduction in the need for treatment with morphine, shorter length of stay in hospital, improved breast feeding rates, and lower total hospital cost.

Conclusion

Our study demonstrates that rooming-in programs for babies born to mothers using opioids have benefits in terms of quality of care and health care resource utilization. These findings add to the existing literature on NAS that rooming-in can be successfully implemented in a community hospital.
73 Sleep Duration and Internalizing Symptoms in Children
Authors: Wu Liliana , Charach Alice , Keown-Stoneman Charles , Birken Catherine , Constantin Evelyn , Maguire Jonathon , Stremler Robyn
Published: August 2020

Background

Emotional problems such as anxiety and low mood have been associated with sleep problems in children.

Objectives

This study’s objective was to assess the association between sleep duration and internalizing symptoms in children age 5-12 years (y). Next, we evaluated whether meeting the National Sleep Foundation’s guidelines for sufficient sleep (≥10 hours, age 3-5; ≥9, age 6-12) is associated with internalizing symptoms.

Design/Methods

A cross-sectional study in N = 800 healthy children ages 5-12y, recruited from primary care physicians’ offices in Toronto, Canada was conducted through TARGet Kids! research network. Using linear regression, we investigated the association between parent reported sleep duration (hours) and parent reported internalizing symptoms using the Strengths and Difficulties Questionnaire (SDQ), controlling for child age, sex, zBMI, family composition, and maternal education.

Results

The adjusted model showed an inverse association between sleep duration and internalizing symptoms (β estimate = -0.33 (95%CI -0.57, -0.07), p=0.011). Of children aged 6-12y, 36 (6%), and of those aged 5y, 28 (14%) did not meet guidelines for sufficient sleep. Insufficient sleep was inversely associated with internalizing symptoms (β estimate = -0.70 (-1.38, -0,02), p=0.044). However, the association attenuated slightly once adjusted for child age, sex, zBMI, family composition, and maternal education (β estimate = -0.64 (-1.38, 0.10), p=0.088).

Conclusion

There is evidence that a parent reported decrease in sleep of 3 hours is associated with a small (1 point) increase on the internalizing scale in children between 5 and 12 years. The primary limitation is that sleep duration and internalizing symptoms were reported by parents.
79 Acceptability and impact of psychosocial screening in the emergency department
Authors: Hankinson Elizabeth , Doan Quynh , Wright Bruce , Atwal Amanbir , Virk Punit , Azizi Hawmid , Stenstrom Rob , Black Tyler , Gokiert Rebecca , Newton Amanda
Published: August 2020

Background

Psychosocial concerns in youth are prevalent and undertreated. Early identification through screening may promote appropriate management before youth present in crisis.

Objectives

Our primary objective was to assess the acceptability of psychosocial screening in the pediatric emergency department (ED) setting. Secondarily, we report the prevalence of psychosocial issues among youth with non-psychiatric ED presentations, and the impact of screening on mental health resource-seeking behaviour.

Design/Methods

We conducted a prospective cohort study of youth aged 10-17 years at two pediatric EDs. Youth with a mental health-related reason for visiting the ED were excluded. Eligible and consenting youth (and their families) completed a comprehensive psychosocial self-assessment delivered on an electronic tablet, followed by standardized clinician assessment. Consent to participate in the study was used as a proxy measure for acceptability of screening. Participants with identified psychosocial resource needs were followed up at 30 days with a semi-structured telephone/email interview to assess whether they had sought recommended resources and to explore barriers to accessing care.

Results

Of the 1432 eligible youth given the opportunity to enrol, 795 consented. Among the 637 youth who declined enrolment, 467 specified that they declined for reasons other than not wanting to conduct a psychosocial self-assessment. This suggests that at least 55.5% (95% CI = 52.9%, 58.1%) and up to 88.1% (95% CI = 86.4%, 89.8%) find screening acceptable.

Among the 760 participants who completed clinician assessment, 276 (36.3%) were identified as having a psychosocial resource need. Resources were already in place for 105 youth, leaving 171 (22.5%) with newly identified or unmet psychosocial needs. Only 41 (33.1%) of the 124 participants and/or their families who completed a 30-day follow up interview reported attempting to access the recommended resources, despite 92 (74.2%) stating they agreed with the original recommendations. The most common reason for not accessing care was the belief that the recommendations were not yet necessary or were not a priority. Of those who had attempted to access resources, 18 (43.9%) were unsuccessful at the time of interview, with the most common barrier being access delay (e.g. on a waitlist).

Conclusion

We found that previously unidentified/unmet psychosocial needs are prevalent among youth in the ED, and that screening is generally acceptable. However, a limited number of those who screened positive attempted to access resources, and when they did, access was often unsuccessful or delayed. More work is needed to address barriers to timely psychosocial care.
91 Mental Health Burden of Adolescents with Dysautonomia
Authors: Galvin Claire , De Souza Astrid , Potts Jim , Sneddon Penny , Sanatani Shubhayan , Armstrong Kathryn
Published: August 2020

Background

Dysautonomia of Adolescence (DAOA) results from a dysregulation of the autonomic nervous system during puberty and affects multiple organ systems in the body. Symptoms have a significant impact on quality of life (QoL) with many adolescents reporting a poorer QoL compared to other pediatric chronic illness populations. Furthermore, there is a paucity of research looking at underlying mental health conditions in patients with DAOA that might be contributing to poor QoL.

Objectives

The aim of this review was to characterize the underlying mental health status of patients with DAOA followed in a tertiary care DAOA Clinic.

Design/Methods

Single-centre retrospective chart review (January 2017-November 2019) of all current patients followed in a tertiary care DAOA Clinic. Mental health challenges were classified as significant symptoms reported and/or formal diagnosis of anxiety, depression, attention deficit hyperactivity disorder, obsessive compulsive disorder, eating disorders, somatization, mood disorders, suicidal ideation, and self-harm. Frequency tables were generated for all categorical variables.

Results

Seventy-three patients are currently being followed in the DAOA clinic. Fifty-five of 73 (75%) had some form of mental health challenge including 11 (15%) which had a history of suicidal ideation and/or self-harm, 12 (17%) had no mental health concerns, and 6 (8%) are unknown.

Of the 55 patients with a mental health challenge, 27 (49%) were diagnosed with a mental health condition prior to formal DAOA diagnosis and 10 (18%) were diagnosed after DAOA diagnosis. Eighteen (14%) reported symptoms of a mental health challenge but no confirmed mental health diagnosis. A breakdown of mental health symptoms and diagnoses are shown in Table 1.

Of the 73 current patients, 41 (56%) accessed psychology services either through the DAOA Clinic or in the community, 9 (12%) have been referred to other health care services, and 8 (11%) did not access services. Psychiatric services were required by 15 patients (21%).

Conclusion

Three-quarters of DAOA patients report some mental health challenges. This emphasizes the need for psychology to support patients with DAOA. It is unclear as to whether a mental health challenge exacerbates symptoms of DAOA or DAOA symptoms negatively impact their mental health.
93 “I don’t want them to think that what they said matters”: How Adolescents with Severe Obesity Cope with Bullying
Authors: Ye Linlei , Walsh Orla , Dettmer Elizabeth , Regina Andrea , Christian Jennifer , Hamilton Jill , Toulany Alene
Published: August 2020

Background

Adolescents with severe obesity are subject to a high prevalence of weight-based victimization that may contribute to mental health symptoms. The ability to better cope with this victimization could potentially modulate the psychological sequelae. This is the first qualitative study to address the paucity of literature focusing on how adolescents with severe obesity cope with victimization.

Objectives

To explore how adolescents with severe obesity cope with weight-related victimization and how it subsequently affects their psychological well-being.

Design/Methods

This was a qualitative research study using an interpretive phenomenological analytic approach. One-on-one semi structured interviews were completed with 19 adolescents (73% female) aged 16 – 19 years, enrolled in a tertiary hospital weight management program. A diverse array of patient experiences of weight-based victimization were sought to explore their coping mechanisms and how the experiences affected them. The interviews were transcribed and sequentially independently analyzed by the research team until thematic saturation was achieved.

Results

The majority of participants (89.5%) described being a victim of weight-based victimization and highlighted its significant emotional impact. Two key themes were identified that captured the various coping strategies used by participants. The minority (52.9%) described approach coping strategies where they acted on the source to invoke change by standing up for themselves, helping others in similar situations or becoming a bully themselves. Whilst the majority (94.1%) used avoidant coping strategies such as feigning a strong exterior façade, denial, isolation and self-harm. Nearly half (47.1%) used both strategies. It is possible that the study participants did not feel they had control over the weight related bullying, and therefore, were more likely to choose avoidant coping styles.

Conclusion

Adolescents with severe obesity commonly use avoidant coping strategies to passively regulate emotions, including problem avoidance, wishful thinking, self-criticism and social withdrawal to cope with weight-based victimization. As part of a comprehensive approach to the management of adolescents with severe obesity, counseling should be offered on how to use alternative coping mechanisms in the face of weight-based victimization.