bluuebunny/crossref_metadata_2025 huggingface dataset:
65 Outcomes of Neonates Admitted to the NICU during the COVID-19 Pandemic: Comparison with a Pre-Pandemic Cohort
Authors: Campbell-Yeo Marsha , Bacchini Fabiana , Beltempo Marc , Alcock Lynsey , Shah Prakeshkumar , Bishop Tanya , Campbell Douglas , Chilcott Addie , Comeau Jeanette , Dol Justine , Grant Amy , Gubbay Jonathan , Hughes Brianna , Hundert Amos , Inglis Darlene , Lakoff Alanna , Lalani Yasmin , Luu Thuy Mai , MacMorton Jenna , Mitra Souvik , Narvey Michael , Robeson Karel O'Brien Paula , Science Michelle , Van Woezik Rachel , Whitehead Leah
Published: September 2023

Introduction/Background

The effect of the COVID-19 pandemic on neonatal outcomes is not yet completely understood.

Objectives

To compare the neonatal outcomes of very preterm infants admitted to Canadian NICUs pre- and during the COVID-19 pandemic.

Design/Methods

This retrospective cohort study included infants born <33 weeks and admitted to tertiary Canadian NICUs participating in the Canadian Neonatal Network (CNN) database. The sample included 14,368 infants from two cohorts: 7,280 infants pre-pandemic (April 1, 2018 – December 31, 2019) and 7,088 infants during the pandemic (April 1, 2020 – December 31, 2021). Primary composite outcomes were mortality or major morbidity. Care practices and interventions were compared. Relative risk (RR) comparing the pandemic vs pre-pandemic periods were estimated using generalized estimated equations and adjusted for confounders.

Results

The characteristics of infants admitted before and during the pandemic were not significantly different. The incidence of mortality or major morbidity was similar pre- and during the pandemic (37%, 36% respectively; RR=1.01 [0.92, 1.01]; Table 1). Infant health outcomes were not significantly different between periods. There was a non-significant decrease in the exclusive receipt of mothers’ own milk (MOM) at discharge (45% pre- and 37% during; RR=0.85 [0.68, 1.06]).

Conclusion

There was no difference in clinical outcomes between pre-pandemic and pandemic cohorts. The possibility of lower receipt of exclusive MOM at discharge during the COVID-19 pandemic needs further study.
66 Association of Low Hemoglobin at Birth and Neurodevelopmental Outcomes in Preterm Neonates < 29 Weeks’ Gestation: A Retrospective Cohort Study
Authors: Elkhouli Mohamed , Raghuram Kamini , Elhanafy Thanna , Asztalos Elizabeth , Banihani Rudaina , Shah Prakesh S , Mohamed Adel
Published: September 2023

Background

Low hemoglobin (Hb) at birth is not an uncommon presentation for infants born preterm. The association of early anemia and neurodevelopmental outcomes in extremely preterm infants is not well studied.

Objectives

The objective of this study was to assess neurodevelopmental outcomes at 18-24 months corrected age (CA) of preterm infants with Hb <120 gm/l compared to those with Hb ≥120 gm/l at birth.

Design/Methods

In this retrospective cohort study, infants of <29 weeks’ gestational age (GA) with an Hb result at birth and admitted to one of two Canadian tertiary care NICUs between January 2009 and June 2018, were included. Baseline sociodemographic, antenatal, and neonatal data were compared between groups. The primary outcome was neurodevelopmental impairment (NDI), defined as the presence of one or more of: cerebral palsy; motor, cognitive, or language impairments on standardized testing; or visual or hearing impairment, at 18-24 months. Secondary outcomes included significant NDI (sNDI), death, severe retinopathy of prematurity (ROP) (≥ stage 3), grade III intraventricular hemorrhage (IVH), periventricular hemorrhagic infarction, bronchopulmonary dysplasia (BPD), and composite outcomes of death or NDI. Multivariable logistic regression adjusting for GA, small for GA (SGA), sex, birth centre, and antenatal steroids, was used to determine the association between early anemia and outcomes.

Results

Of the 2351 eligible neonates, 351 (14.9%) had Hb levels <120 gm/L at birth. Baseline characteristics for groups are summarized in Table 1. Of the infants who survived, 1534 (72.5%) had developmental follow-up at 18 to 24 months CA. Low Hb was associated with significantly higher odds of NDI among survivors in univariate analyses but not in multivariable logistic regression (Table 2). The composite outcome of death or NDI was significantly higher in the low Hb group, primarily driven by the higher incidence of mortality. Neonatal death, IVH, ROP, and BPD were significantly higher in the low Hb group.

Conclusion

In preterm infants of <29 weeks’ GA, low Hb at birth was not associated with significant NDI outcomes at 18-24 months. However, low Hb was associated with higher odds of death, severe IVH, severe ROP, and BPD.
68 Multimodal Monitoring of Hemodynamics in Extremely Low Birth Weight Preterm Infants in a Canadian Tertiary Level Unit: Non-Blinded Randomized Control Trial/MUSE Trial
Authors: Lalitha Renjini , Kumaran Kumar , Bitar Eyad , Surak Aimann , Hyderi Abbas , Hicks Matthew , Cheung Po-Yin , Pepper Dawn
Published: September 2023

Introduction/Background

Current approaches for the evaluation and treatment of transitional circulatory issues in preterm infants based primarily on blood pressure (BP) may be harmful. It is essential that these approaches are adequately investigated. This study tests a detailed hemodynamic approach with a multimodal assessment compared to standard approach, using a Vasoactive Ventilation Renal score (VVR) that incorporates inotrope use, ventilation support, and renal function along with inotrope use reflecting cardiorespiratory-renal health.

Objectives

To determine whether multimodal hemodynamic monitoring will improve cardiorespiratory-renal health as evidenced by decreasing VVR in preterm infants at one week of life.

Design/Methods

This was a randomized control trial of preterm infants born <29 weeks gestational age who were admitted to a tertiary neonatal intensive care unit between 15 Feb 2019 and 31 Dec 2021. Eligible infants were randomly assigned for the first 72 hours of life to either a multimodal assessment arm (consisting of early targeted neonatal echocardiogram, continuous cerebral near infrared spectroscopy [NIRS] and clinical-biochemical data) or to a standard arm (using clinical-biochemical data only). A comprehensive study guideline was used for hemodynamic assessment in the multimodal arm. Univariate and multivariate analyses compared the two arms.

Results

298 infants were screened during the study period and 147 were randomly assigned (75 multimodal arm, 72 standard arm). 68 in the multimodal and 64 in the standard arm were included in the preliminary analysis (Figure 1). Baseline characteristics were similar in both arms (Table 1). The mean VVR scores within 7 days of life were 16.5(SD 15.4) and 18.9(SD 20.2) in the multimodal and standard arm respectively (p=0.451). Mean Ventilation Index scores in the first 72 hours of life were 16.2(SD 15.7) and 17.9(SD 15.5) respectively (p=0.552, Table 1). Peak VVR scores >53 at 7 days were significantly higher in the standard arm (11.1%) than in the multimodal arm (0%), p= 0.005. Outcomes of death, severe intraventricular hemorrhage and length of hospital stay were not statistically different. However, there was a trend toward decreased inotrope use in the multimodal arm compared with the standard arm (16.2% vs. 23.4% respectively, p=0.294).

Conclusion

In preterm infants, multimodal hemodynamic assessment during the transitional period was not associated with decreased VVR scores that signify improved cardiorespiratory-renal health, but led to lower incidence of VVR score greater than 90th centile and a decreasing trend in inotrope use in the first week of life.
72 Criteria for Discharge of Preterm Infants in Canadian Neonatal Intensive Care Units
Authors: El-Naggar Walid , Fieldhouse Elise , McCord Helen
Published: September 2023

Background

Discharging to home is a milestone that impacts preterm infants, their parents, and the neonatal intensive care units (NICU). Standardized discharge programs that are individualized for family needs can ensure a safe transfer of care to parents, decrease the length of hospital stay and costs, and improve parental satisfaction.

Objectives

To assess the degree of variability in discharge criteria for preterm infants <34 weeks’ gestation across Canadian NICUs, explore different institution-specific guidelines, and evaluate the degree of adherence to Canadian Paediatric Society (CPS) guidelines.

Design/Methods

A clinical representative for each of 117 level 2, 3 and 4 Canadian NICUs was contacted via email to participate in an anonymous survey link (OPINIO) regarding their discharge criteria for preterm infants. French and English versions of the survey were available.

Results

Ninety-eight respondents (83.7%), representing all Canadian provinces and the NWT, completed the survey (Figure 1). The majority of the responders were nurse practitioners (42.8%) and neonatologists (30.7%) with >5 years of experience (87%). 63% of responses came from level 3 and 4 NICUs. Most respondents (80.6%) lacked written guidelines in their units for discharging preterm infants. 60.2% did not have a dedicated discharge coordinator, and 45% did not have a post-discharge clinic. Table 1 summarizes the different discharge practices.

Conclusion

There is a significant heterogeneity in discharge practices for preterm infants in Canadian NICUs, despite the presence of CPS guidelines. This survey provides a basis for benchmarking and knowledge-sharing, but more research is needed to guide best evidence-based practice.

Potential competing interests

Dr. El-Naggar served as a consultant for Aerogen Pharma Limited and is a site investigator of its funded study: A Partially-Blind, Randomized, Controlled, Parallel-Group, Dose-Ranging Study to Determine the Efficacy, Safety and Tolerability of AeroFactTM (SF-RI 1 surfactant for inhalation combined with a dedicated drug delivery system) in Preterm Infants at Risk for Worsening Respiratory Distress Syndrome.
82 Management of Very Severe Iron Deficiency Anemia: Is Transfusion Always Necessary?
Authors: Ramic Lana , Speckert Matthew , Leung Elaine , Boggs Samantha
Published: September 2023

Background

Paediatric iron deficiency anemia (IDA) is a common condition in Canadian children; however, little is known about the natural history of extreme cases. This deficit makes it challenging to determine how to approach management when these patients present acutely to the emergency department (ED).

Objectives

To describe the clinical features and management of children presenting to the ED with very severe IDA with hemoglobin < 40 g/L.

Design/Methods

Retrospective chart reviews were performed for paediatric patients with IDA and hemoglobin < 40 g/L over a 5-year period (June 2017 – June 2022) at a Canadian tertiary care children’s hospital.

Results

Chart reviews were completed for 19 patients. The mean case rate was 3.1 patients annually (SD 2.14) with 11(58%) presenting in 2021–2022. Patients were young (median age 24 months; IQR 18–32) and predominantly female (79%). Nutritional deficiencies were the most common etiology (n=16, 84%). Median presenting hemoglobin was 25 g/L (IQR 22–36 g/L). The most common clinical features documented at presentation were pallor (n=19, 100%), tachycardia (n=17, 89%), and systolic ejection murmur (n=14, 74%). Thirteen (68%) patients had a ferritin measured in ED, 11(58%) had a chest x-ray, four (21%) had a lactate measured. One (5%) patient had an echocardiogram, and four (21%) had bedside cardiac ultrasounds documented. Eight (42%) patients with median hemoglobin 35 g/L (IQR 25–36 g/L) were managed without blood transfusion (PO iron only: n=3, 16%; IV iron only: n=5, 26%). Of the 11 (63%) patients who received blood, 2 (18%) had transfusion-related adverse events, with one patient undergoing intubation for transfusion-associated circulatory overload while admitted. All patients (100%) were initiated on oral iron supplementation. Ten patients (53%) received intravenous (IV) iron (dose 5–7 mg/kg) with one experiencing a mild reaction. Fifteen patients (79%) were hospitalized, with two (10%) admitted directly to the Paediatric Intensive Care Unit. Median duration of hospitalization was 5 days (IQR 2–9 days). Patients followed after transfusion-free management (n=5) demonstrated median hemoglobin increase of 21 g/L (IQR 20–32 g/L) within 12 days. No patient returned to the ED for anemia within 30 days.

Conclusion

Paediatric patients with very severe IDA do not always require transfusion. Some patients were effectively managed with IV iron alone. Investigation and management of these patients appears heterogenous. Given the risks of blood transfusion and the increased availability of IV iron, guidelines outlining evidence-based management of severe IDA are needed. These guidelines should promote optimization of iron therapy and guide judicious administration of blood transfusion.
84 Late-onset Anemia in Neonates with a Positive Direct Coombs Test: A Retrospective Descriptive Study
Authors: Tremblay Arnaud , Thibault Marlène , Racette Christine
Published: September 2023

Background

Hemolytic disease of the newborn is a well-known phenomenon in paediatrics. It occurs when maternal blood group antibodies cross the placenta and react with the fetus’ red blood cells, ultimately leading to their destruction. Late-onset anemia occurs between 7-90 days of life. Its incidence is not well defined in the literature; however, it can lead to deleterious outcomes. Some experts recommend a complete blood count assessment within the first month of life in all newborns with a positive direct Coombs test (DCT).

Objectives

This study aimed to describe the screening practices and epidemiology of late-onset anemia in infants with a positive DCT in a tertiary-care paediatric centre.

Design/Methods

We performed a retrospective descriptive study that included all newborns of ≥ 35 weeks of gestational age with a positive DCT born between January 1st 2018 and December 31st 2020. Patients were identified retrospectively through the blood bank records and were excluded if they were transferred from another centre or if they had significant comorbidities.

Results

A total of 284 patients were included. Forty percent had an ABO incompatibility, 30.6% a Rhesus incompatibility, 24.3% more than one incompatibility, 2.5% rare incompatibilities, and 2.1% had undetermined incompatibility. During their neonatal hospitalization, 74 patients (26.1%) required phototherapy, 4 patients (1.4%) received IVIG and 2 patients (0.7%) received red blood cells transfusions. Three patients (1.1%) were discharged with iron supplements. As for screening practices, 47 patients (16.5%) were prescribed a follow-up hemoglobin assessment at discharge. On chart review, hemoglobin value was available in the first 3 months of life in 72 patients (25.4%), showing late-onset anemia in 20 of these infants (27.8%). Among possible risk factors to encounter late-onset anemia, neither DCT positivity intensity nor type of blood incompatibility had any statistical significance. Newborns who required phototherapy had an OR of 3.37(1.16-9.85) to develop late-onset anemia. This OR was 10.89(2.50-47.32) for those who were anemic during their neonatal period, 2.68(0.16-45.07) for those who received IVIG, and 8.03(0.08-759.44) for those transfused in the neonatal period. Outpatient hemoglobin measurements during the first three months of life led to 6 patients (2.1%) being prescribed iron supplements and one patient (0.4%) receiving a red blood cells transfusion.

Conclusion

This study showed that late-onset anemia is relatively common among newborns with a positive DCT. However, this phenomenon is not routinely screened in our centre and further studies are needed to determine its clinical significance and best screening practices.
89 Frequency and Impact of PANDAS/PANS Diagnosis in Canada
Authors: Goren Rachel , Shouldice Michelle , Kronenberg Sefi
Published: September 2023

Background

Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS/PANS) are defined by abrupt onset and episodic course of neuropsychiatric symptoms associated with infection. There are challenges in the application of published diagnostic criteria, and the frequency of diagnosis is unknown. To date, there is little data on clinical practice patterns in diagnosis, assessment and treatment.

Objectives

The aim of this study was to estimate and characterize the frequency and impact of the diagnostic label of PANDAS/PANS in Canada.

Design/Methods

Through established CPSP methodology, over 2,800 paediatricians and subspecialists were surveyed for children seen in the previous month who had received the diagnostic label of PANDAS/PANS. Respondents completed a detailed questionnaire on demographics, clinical presentation, diagnostic evaluation and interventions.

Results

Between December 1, 2019 and November 30, 2021, 84 reported cases received the diagnosis of PANDAS/PANS. The majority were female (48/84, 57%), with mean age of symptom onset 9.4 years (range 3 to 16 years). Of the 84 cases, 82% (69/84) had OCD and/or acute food refusal, 39% (33/84) had tics and 32% (27/84) had both OCD and tics. Symptom onset was described as sudden in 22% of cases. The vast majority of cases had at least two neuropsychiatric symptoms (80/84, 95%). Infection was associated with symptom onset (22/84, 26%) or exacerbation (25/84, 30%) in less than one-third of cases. Healthcare utilization included emergency-department visits (29/84, 35%) and inpatient admissions, both medical (8/84, 10%) and psychiatric (8/84, 10%). Three quarters (52/68, 76%) of cases had five or more health care visits since symptom onset and 31% (24/78, 31%) accessed more than five health care providers. Medical treatments were provided in 95% (80/84; antibiotics, NSAIDS, steroids, IVIG or rituximab), 95% (80/84) received psychological and/or psychiatric treatments, and more than 50% (42/84) of patients saw a complementary/alternative health provider. Almost all cases (84/85) experienced significant negative impacts, including family stress, mental health concerns, or conflict (54/84, 64%); school absences (43/84, 51%); and withdrawal from activities/friends (33/84, 39%). In forty-one percent (33/81) of cases, there was a significant discrepancy in the certainty of diagnosis, with families significantly more certain than reporting physicians.

Conclusion

PANDAS/PANS are rare diagnoses, associated with a significant burden on children, families and the healthcare system. In reported cases, there was significant practice variation in diagnosis, assessment and treatment, with frequent uncertainty about the diagnosis. Education and clinical practice guidelines are needed, targeting a range of practitioners.
96 Foreign Body Aspiration in Children: A Review of the Public Health Prevention Guidelines by Analyzing the Circumstances of Choking Episodes in a Canadian Tertiary Centre from 2006 to 2020
Authors: Veilleux Justine , Daigneault Patrick , Bellavance Sandrine
Published: September 2023

Background

Choking and foreign body aspiration are major causes of morbidity and mortality in infants and young children. To prevent choking episodes and their complications, many associations, from the Canadian Paediatric Society to National Public Health Institutes, have suggested prevention guidelines for parents and health professionals. They specify what types of food should be restricted in young children, such as nuts and raw hard vegetables, and give advice on surveillance. Yet, every year, children are admitted to our centre following a choking episode that requires a bronchoscopy under general anesthesia.

Objectives

Our objective was to identify the risks factors associated with choking episodes in children and compare them with actual prevention guidelines to determine if public health recommendations are still adequate.

Design/Methods

This retrospective study included all patients, from 0 to 17 years old, who presented to our tertiary centre between April 2006 and December 2020 and underwent a bronchoscopy under general anesthesia for a suspicion of foreign body aspiration. Data on demographic characteristics of the patients, the circumstances of the episodes and on severity criteria were collected from the patients’ electronic files and compared to the prevention guidelines.

Results

One-hundred and ninety-one patients with a history of suspected foreign body aspiration were included. Among them, 101 had a positive bronchoscopy. Close to 65% of patients were boys. The mean age at presentation was 31,5 months. Food was the most common type of foreign body, causing 73,3% of all choking episodes. Close to 70% of those choking episodes involved nuts, seeds or raw hard vegetables. 84,5% of those events happened at home, and 79,4% of choking episodes happened under the surveillance of one or both parents. Thirty patients ended in the paediatric intensive care unit where they spent an average of 6,47 days.

Conclusion

Our results show that most choking episodes in children result from a non-respect of actual recommendations. They involve types of food and circumstances that are already restricted by the prevention guidelines. It highlights the need for better parent education and should inspire clinicians to make some time to address choking hazards with families.
98 Seeing the Unseen– A Retrospective Review of the Demographic Characteristics of a Place-based, Inner-City Social Paediatrics Program
Authors: So Judy , Sun Sunny , Kim Annie , Nemati Saina , Kim Michelle , McIntosh Gwyneth , Pikksalu Kristina , Loock Christine , Carwana Matthew
Published: September 2023

Background

Social paediatrics is a holistic approach to child and youth health that considers the society and environment the child lives in, and aims to address social determinants of health (SDoH) to improve health equity. Place-based social paediatrics clinics minimize health disparities through outreach programs, navigational support, and facilitating access to specialty care services. This model of care was developed in the past few decades as it became widely accepted that SDoH and adverse childhood events have a direct impact on child health. Typical clinic demographics and most prevalent care needs are not well described.

Objectives

Identify key demographic features and common diagnoses seen by a social paediatrics program’s primary and specialty care services.

Design/Methods

Ethical approval was obtained from institutional REB. A retrospective chart review of patients accessing the program between Jan 1, 2018 and April 30, 2021, with no additional exclusion criteria, was conducted. Demographic information, factors influencing SDoH, and past medical history were collected. Basic descriptive statistics were used for analysis of the data collected.

Results

144 charts have been reviewed to date. The mean age in years at initial assessment was 6.22 (0.07–25.84). The most commonly documented ethnicity was Indigenous (30%), followed by Latinx (8%) and Middle Eastern (8%); 45% of patients were unspecified, as race is not consistently collected in Canadian health records. Poverty was mentioned as an issue in 52 (36%) patients’ charts, ministry involvement noted in 29 (20%), and substance use in 45 (31%) of households. 74 (51%) of charts had evidence of at least one adverse SDoH (e.g. financial and/or housing instability, food insecurity) that could negatively influence health equity. The most frequently documented diagnoses were skin disorders (38%), ADHD (31%), upper respiratory tract infections (29%), learning disability (27%), and speech delay (25%). Developmental disorders were diagnosed in 79 (55%) patients and 45 (31%) had at least one incidence of being seen by a nurse practitioner or general paediatrician for a mental health concern.

Conclusion

Place-based, equity-oriented social paediatrics clinics see more socially and developmentally complex individuals than traditional paediatric clinics or community health programs. Data analysis of the population seen by our inner-city program found 55% and 31% of patients had developmental and mental concerns, respectively. This suggests that clinicians planning or working in similar programs should be prepared to support neurodevelopmental, mental health, and common medical conditions (e.g. skin disorders and infections).
100 Exploring the Experiences of Refugee Claimant Youth and their Caregivers with Navigating Healthcare in Canada
Authors: Newbube Chioma , Parmar Puneet , Suleman Shazeen , Taylor Martha
Published: September 2023

Background

In 2022 alone, 27,000 refugee claimants entered Canada, seeking protection. Although refugee claimants are ineligible for provincial health insurance programs, the Interim Federal Health Program (IFHP) provides coverage for basic medical care and supplemental services. However, previous studies have shown that only 24% of paediatricians are registered for IFHP, suggesting limited access for refugee claimant youth (RCYs), who are already at increased risk of poor health outcomes. It is important to understand the perspectives and needs of RCYs and their caregivers to develop interventions to improve their access to care, but to date, no study has examined their experiences directly.

Objectives

This study aims to explore how RCY, their caregivers, service providers and health care providers understand and utilize the healthcare system after arrival in Canada.

Design/Methods

This was a qualitative study that was rooted in community-based participatory action methodology. In-depth interviews (IDIs) were conducted with RCYs (age 10-18), their caregivers, community service providers (ie. settlement workers) and health care providers (HCPs) that worked with RCYs in a large urban Canadian city in English, and with an interpreter, recorded and transcribed. Transcripts were coded using inductive coding methods, and analyzed within and across stakeholder groups using thematic analysis.

Results

A total of 27 IDIs were conducted (8 HCPs, 9 community service providers, 5 caregivers, and 5 RCYs). Youth and their caregivers had little to no understanding of how the healthcare system operated in Canada, including how IFHP provided coverage. Most explained that their limited knowledge about the healthcare system was provided informally through social contacts, or their community service providers, who in turn expressed limited understanding of IFHP coverage and difficulty finding IFHP registered providers. Although healthcare providers similarly found IFHP difficult to navigate, they did not appreciate how little RCYs and their families understood the healthcare system, nor the difficulties placed on community service providers. RCYs stated that a youth-oriented, multi-lingual resource that explained how to access care in Canada would be a useful tool to help them feel empowered to advocate for themselves and their families.

Conclusion

Although policies exist to provide coverage for medical care for RCYs, there are many barriers that prevent them from accessing care, including limited knowledge of the system and few navigational supports. Our findings suggest that working with RCY themselves to co-develop a youth-centred approach to understanding the healthcare system may increase youth empowerment and access to care.
101 The Impact of Sociodemographic Factors on Youth Academic Achievement During the COVID-19 Pandemic in Ontario, Canada
Authors: Freeman Sloane , Minhas Ripudaman , Hove Jennifer , Guimonda Timothy
Published: September 2023

Background

The COVID-19 pandemic interrupted education and widened socioeconomic disparities. In Ontario, schools were closed for 28 weeks, longer than any other state, province, or territory in North America. School interruptions and remote learning are known to have short and long-term negative effects, which differ by socioeconomic status, on students’ academic outcomes.

Objectives

The objective of this study was to determine whether the COVID-19 pandemic was associated with a greater achievement gap between disadvantaged and non-disadvantaged secondary students in Ontario, Canada.

Design/Methods

We conducted a population-based observational study comparing scores from Ontario’s Education Quality and Accountability Office (EQAO) standardized Grade 9 Assessment of Mathematics from 2018-19 (pre-COVID year) and 2020-21 (COVID year). Our outcome measure was the EQAO Grade 9 Assessment of Mathematics dot scores. The primary analysis used a mixed-effects multilevel model (with random effects for school board) to calculate the interaction between year and neighborhood family income on math scores (difference in income slope between years) while controlling for confounders. Secondary analyses examined other risk factors (e.g. parental education, newcomer status, and lone-parent home) and their impact during the pandemic.

Results

In the COVID year, 3,485 of 42,920 eligible Ontario Grade 9 students (8.1%) participated in the EQAO Grade 9 Assessment of Mathematics from 38 of 72 school boards. In the pre-COVID year, within those same 38 school boards, 42,640 of 43,230 eligible Grade 9 students (98.6%) participated in the math assessment. We found that in the pre-COVID year, every one standard deviation increase (or decrease) in mean log-adjusted neighborhood income resulted in a mean increase (or decrease) in test score of 0.088 (95% CI, 0.078 to 0.097; p<0.0001). The effect of income on test score decreased in the COVID year (delta between years, -0.047, 95% CI, -0.060 to -0.033; p<0.0001).

Conclusion

This population-based observational study demonstrated that neighborhood family income impacted academic performance less in the COVID year compared to the pre-COVID year. The impact of other sociodemographic factors on academic achievement were also modified in the COVID year compared to pre-COVID. Determining how sociodemographic risk factors affected academic achievement during the pandemic may help inform educational recovery strategies and improve educational outcomes for children facing social inequities.
C4 (Clinical Case) Vascular Ehlers-Danlos Syndrome in the Paediatric Population: A Case Report of an Internal Bleed Caused by Ruptured Pseudoaneurysm
Authors: Alkindi Nour , Andijani Abdurahman , Zavalkoff Samara , Muchantef Karl
Published: September 2023

Introduction/Background

Ehlers-Danols syndrome (EDS) is a connective tissue disease characterized by joint hypermobility, skin hyperextensibility and tissue fragility. EDS has six types. Type IV EDS: vascular EDS (vEDS), is rare but also the most malignant.

Case Description

We report a 15-year-old boy with a previous history of spontaneous colon perforation and two left shoulder dislocations. He presented with sudden onset abdominal pain, vomiting, dizziness, and lethargy with a Glasgow coma scale of 13. His abdomen was soft but mildly tender. He had a capillary refill of 3 seconds with cold extremities, was found to be in a hypotensive shock state requiring resuscitation with fluids and inotropes, as well as intubation and mechanical ventilation. His hemoglobin dropped by 30 g/L in 6 hours. Therefore, an abdominal ultrasound was done, revealing an intrabdominal hematoma. CT scan of the abdomen confirmed a ruptured fusiform pseudoaneurysm of the accessory left hepatic artery. This was successfully managed by coil embolization, see F1 and F2, below. Genetic workup was positive for the pathogenic COL3A1 gene that presents phenotypically as Ehlers-Danlos syndrome, particularly type IV.

Discussion

COL3A1 encodes pro-alpha1 chains of type III collagen. Inheritance is autosomal-dominant. It can present as a de novo variant with a negative family history, as was the situation for our patient. Estimated affected people with de novo variant vEDS is 33%-50%. Clinical diagnosis of vEDS involves one major and several minor criteria (2017). Major criteria include arterial aneurysms, dissection, or rupture; intestinal rupture; uterine rupture during pregnancy; family history of vEDS. Minor criteria include easy bruising; thin skin and visible veins; facial characteristics including prominent eyes, narrow nasal bridge, thin lips; club foot, congenital hip dislocation; inguinal hernia and pneumothorax. Our patient had two elements from the major criteria: arterial pseudoaneurysm and intestinal rupture.

Conclusion

vEDS has high morbidity and mortality due to the risk of spontaneous internal organ/vessel injury. This can be mitigated by increased awareness of systemic manifestations of vEDS and a high index of suspicion by both primary care and emergency physicians. Once diagnosed, surveillance is crucial, including regular blood pressure monitoring, frequent non-invasive imaging to identify emerging vascular lesions, and pregnancy counselling for potential uterine rupture and avoiding trauma, collision sports, and lifting heavy items.
C5 (Clinical Case) Coccobacillary Meningitis and Septic Embolic Infarcts in an Ex-Preterm Infant: An Unexpected Pathogen
Authors: Burke Karina , Algain Sulwan , Abdulsatar Farah , Almutawa Fatimah , Tay Keng , Barton-Forbes Michelle
Published: September 2023

Introduction/Background

Pasteurella multocida causes life-threatening zoonotic invasive infections in immunocompromised individuals and those at extremes of age (neonates and elderly). Bacteremia, meningitis, and endocarditis are serious complications that are associated with up to 25-30% mortality.

Case Description

A 7-week-old ex-34-week preterm female infant presented with a one-day history of fever, irritability, and poor feeding without exposure to sick contacts. Household contacts included a constantly drooling Shi Tzu dog. Examination revealed an irritable, febrile infant with a bulging fontanelle and scant purulent eye discharge. No focal neurological deficits, skin rashes or murmurs were appreciated. Empiric antibiotics were initiated following a full work-up for sepsis.

Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis with 7608 x106L nucleated cells (95% neutrophils), protein 7360 mg/L, glucose <0.2 mmol/L and gram-negative coccobacilli. Blood and CSF cultures grew Pasteurella multocida, prompting a switch to crystalline penicillin. An echogenic mitral valvular mass was identified in the absence of underlying cardiac defects. Head imaging confirmed ventriculitis with multiple small infarcts. No sequelae of abscess, hydrocephalus or hearing loss were demonstrated after the completion of 6 weeks of penicillin therapy.

Discussion

Haemophilus influenzae, serotype b, is the typical cause of coccobacillary meningitis in a 7-week-old infant. In addition to non-b serotypes, non-typeable species which cause conjunctivitis may also cause invasive disease in young infants. The resultant growth of P. multocida from cultures was, therefore, unexpected, particularly given there were no preceding animal bites or scratches. In vulnerable hosts, this pathogen can be transmitted across skin or mucous membranes after close animal contact, such as licking and sniffing. The constant drooling and spraying of saliva from the pet dog, a flat-faced breed known to have stenotic nares and chronic nasal secretions, likely provided an opportunity for mucosal contamination. This infant’s young age, prematurity, and exposure to a flat-faced dog placed her at high risk for Pasteurellosis, which manifested as complicated meningitis and endocarditis.

Conclusion

Pasteurella infections most often arise as local infections following an animal bite or scratch, are rare but important causes of life-threatening severe coccobacillary invasive infection, even without preceding trauma, in young infants. Families of at-risk individuals who own pets should have adequate education about zoonotic infections that address risk factors, including animal breed and behaviour, presenting features and preventive strategies to reduce the potential for serious morbidity and even mortality.
C6 (Clinical Case) A 5-Year-Old with Headbanging and Hemiparesis
Authors: Foulds Jessica , Morel Terra , Mailo Janette
Published: September 2023

Introduction/Background

A 5-year-old boy had a medical history of Phelan-McDermid syndrome; and with that associated autism spectrum disorder; severe, medication-resistant headbanging; and type 1 diabetes. He presented to community hospital with acute onset inability to walk, irritability, and vomiting.

Case Description

On examination he had left arm weakness and truncal ataxia. CT head identified a left cerebellar infarction. He was transferred to the local children’s hospital, and CT angiogram showed left PICA proximal occlusion. Due to diagnostic delay, the infarct was not amenable to endovascular intervention. Initial management was neuroprotective care, and given his history of headbanging and the risk of further trauma, only ASA monotherapy. MR brain visualized a left vertebral artery dissection, the stroke’s likely cause. Other causes were ruled out with normal echocardiogram and thrombophilia work-up, including antiphospholipid panel. Genetic analysis was negative for connective tissue diseases, bleeding or clotting disorders.

On day 5 of admission, he acutely developed worsened left arm weakness and inability to bear weight. Repeat brain imaging showed new bilateral medial thalamic infarcts and diffusion restriction within the right putamen. Given this progression, despite the risk of bleeding, heparin was initiated. On day 9, repeat CT head identified a new lacunar infarct.

On day 14, repeat MRI confirmed clinical stability, and he was switched from heparin to enoxaparin. After 27 days, he was discharged for home-based rehabilitation. His three-month follow-up MRI was stable, and anticoagulation was discontinued, while he remained on ASA only.

Discussion

There is no known association between Phelan-McDermid syndrome and cerebrovascular diseases. However, self-injurious behaviour, such as head banging, is not uncommon in the paediatric population, particularly among neurodiverse patients. These behaviours, in and of themselves, can cause significant injury and morbidity. The case shows how severe headbanging may have caused vertebral artery dissection with thromboembolic consequences. As such, for patients who demonstrate self-injurious behaviour, it is important to counsel these patients and families on potential harms, and inform efforts to mitigate risk, where possible.

In cases of acute change to neurological status, stroke should remain on the differential diagnosis, and brain imaging should be considered. Time to central imaging affects therapeutic opportunities, as exemplified in this case where, due to delays in obtaining imaging, endovascular therapy was not an option for the patient.

Conclusion

Many children engage in self-injurious behaviour that can, as in this case, cause devastating consequences. Clinicians should remain wary of change in neurologic status and have low thresholds for central nervous system imaging, especially for patients with non-verbal communication.
R2 (Resident Advocacy Project) Reducing the Risk of ATV-related Harm in Saskatchewan Children
Authors: Zucchet Alyssa , Leis Karen
Published: September 2023

Rationale and Objectives

All-terrain vehicles (ATVs) are the second highest cause of transport-related hospitalizations, emergency room visits, and disabilities in Saskatchewan citizens of all ages. Saskatchewan law restricts the use of ATVs by children aged 12-16 and bans the use of ATVs by children under the age of 12 on public land. Previous CPS status reports had found this level of legislation inadequate. Clinically, we certainly see many children enter Saskatchewan hospitals for ATV-related injuries, and previous attempts at education campaigns and government lobbying have not been successful. There is limited Saskatchewan information on this issue, so we first sought to gather data to identify where social and legislative advocacy efforts should be directed.

Project Description

We partnered with the Saskatchewan Prevention Institute, a non-profit organization working to prevent injuries in children, as they have worked on ATV safety over the years with community partners as well as government. We completed a retrospective chart review to describe the prevalence and outcomes of ATV accidents in children and youth (aged 20 and under) presenting to hospitals in Saskatoon from 2016 to 2021. Armed with this data, we will be able to improve education campaigns as well as share information with key stakeholders, and hopefully effect change.

Outcomes

During the study period, 354 children presented to hospital after an ATV accident (most aged 12-16 years). Over 90% of children using dirt-bikes were wearing a helmet compared to 48% of children using four-wheeled ATVs (quads, side-by-sides, and other ATVs). Accidents involving quads resulted in an average hospital stay of 10 days, compared to 2 days for cases involving dirt-bikes. Finally, the type of injury was significantly associated with the patient’s health region of residence. For example, children living in the North and Far North Saskatchewan accounted for the highest proportion of moderate/severe head injuries (76.19%) and polytraumas (50%).

Discussion/Future Directions

This data suggests that there is a potential knowledge gap in public knowledge regarding the risks of children using ATVs; that there may be barriers to helmet use; and, most strikingly, that there is a disproportionate number of severe injuries occurring in northern Saskatchewan. New public education initiatives are now in development based on these findings. There are many stakeholders to consider, and we are aiming to share our data so that evidence-based policy decisions can be made. We are currently drafting a letter to relevant ministries, and hope to have more progress to share in the near future.
R3 (Resident Advocacy Project) Evaluation of a Novel COVID-19 Vaccine Consult Service
Authors: Gibbs Danielle , Orkin Julia , Dharmaraj Blossom , Cinq-Mars Lise , Clarke Lindsay , Russett Genevieve , Solomon Donna , Boyce Allison , Beasley Patricia
Published: September 2023

Rationale and Objectives

Strengthening confidence in COVID-19 vaccination in the paediatric population promotes more children getting vaccinated, leading to fewer COVID-19 illnesses, hospitalizations and deaths.

Paediatric providers play an important role in promoting dialogue on the risks and benefits of the COVID-19 vaccines for children. Caregivers who experience hesitancy toward the vaccines may lack access to quality medical information. Developed to close this gap, the SickKids COVID-19 Vaccine Consult Service (VCS) is a nurse-led, telephone consultation service for residents of Ontario with questions/concerns about COVID-19 vaccination for children. The VCS aims to address vaccine hesitancy and enhance vaccine uptake, and ensures that children and caregivers have equitable access to timely and reliable information regarding COVID-19 vaccines in a safe and judgement-free environment. The VCS has escalation pathways in place should further discussion with a physician be required. Appointments can be booked without a referral and discussions are held by telephone. The VCS supports families whose children require specialized accommodation for vaccination with appointments at SickKids and throughout Ontario.

Project Description

A retrospective review of telephone consults received by the VCS between October 1, 2021- April 1, 2022 was undertaken to evaluate the service utilizing descriptive methodology. Information was extracted from databases stored in RedCap/EPIC and was maintained by staff conducting the calls. Inductive Thematic Analysis was utilized to analyze qualitative data and codes were generated to inform themes. Feedback formation was collected via exit surveys and included details about who was calling, reasons for calling, if concerns had been addressed, and intention to vaccinate.

Outcomes

Parents were the majority of callers (96%) and 4% were patients themselves, grandparents or other. A total of 99% of the calls included general questions about the vaccine, 36% of calls were questions about children with underlying medical conditions (cardiac conditions being the most common), and 12% were allergy-related questions. 9% of calls required a consult with MD/NP. 83% of questions/concerns were resolved following the call. Further, the majority of those surveyed following the appointment expressed intent for vaccination. Safety and development, side effects, and doses/intervals were the most common reason callers described hesitancy with proceeding with vaccination.

Discussion/Future Directions

Providing caregivers with timely and reliable information regarding COVID-19 vaccines through the VCS has proven to be effective in reducing vaccine hesitancy and increasing vaccine uptake in the paediatric community. In the future, the VCS model can be utilized to provide education to caregivers on other routine childhood vaccines.
A novel chemokine biomarker to distinguish active tuberculosis from latent tuberculosis: a cohort study
Authors: Li H , Ren W , Liang Q , Zhang X , Li Q , Shang Y , Ma L , Li S , Pang Y
Published: September 2023

Background

Interferon-γ release assays (IGRAs), which are widely used to diagnose tuberculosis (TB), cannot effectively discriminate latent TB infection (LTBI) from active TB (ATB). This study aimed to identify potential antigen-specific biomarkers for differentiating LTBI cases from ATB cases.

Methods

Ongoing recruitment was conducted of individuals meeting study inclusion criteria at Beijing Chest Hospital from May 2020 to April 2022; 208 participants were enrolled and assigned to three groups: HC (60 healthy controls), LTBI (52 subjects with LTBI) and ATB (96 ATB patients). After participants were assigned to the discovery cohort (20 or 21 subjects/group), all others were assigned to the verification cohort. Discovery cohort blood levels of 40 chemokines were measured using Luminex assays to identify chemokines that could be used to discriminate LTBI cases from ATB cases; candidate biomarkers were verified using enzyme-linked immunosorbent assay-based testing of validation cohort samples.

Results

Luminex results revealed highest ATB group levels of numerous cytokines, growth factors and chemokines. Receiving operating characteristic curve-based analysis of 40 biomarkers revealed CCL8 (AUC = 0.890) and CXCL9 (AUC = 0.883) effectively discriminated between LTBI and TB cases; greatest diagnostic efficiency was obtained using both markers together (AUC = 0.929). Interpretation of CCL8 and CXCL9 levels for validation cohort IGRA-positive subjects (based on a 0.658-ng/ml cutoff) revealed ATB group CCL8-based sensitivity and specificity rates approaching 90.79% and 100.00%, respectively.

Conclusion

TB-specific chemokines hold promise as ATB diagnostic biomarkers. Additional laboratory confirmation is needed to establish whether CCL8-based assays can differentiate between ATB and LTBI cases, especially for bacteriologically unconfirmed TB cases.