bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost Burden of Raising A Child with Fetal Alcohol Spectrum Disorder
Authors: Stade B , Cheema S , Watson W , Bonifacio J , Campbell D , Becker B , Sgro M
Published: September 2022

BACKGROUND: In Canada the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. FASD is the leading cause of developmental and cognitive disabilities in Canada. No study has examined the cost to parents/caregivers of raising a child with FASD in Canada.

OBJECTIVES: To calculate an estimate of direct and indirect costs associated with raising a child with FASD at the patient level.

DESIGN/METHODS: Cross-sectional study design was used. Two-hundred and thirty (230) participants completed the study tool. Participants included caregivers of children from day of birth to 18 years of age, living in urban and rural communities throughout Canada. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total average costs per individual with FASD were calculated by summing the costs in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs of raising a child with FASD.

RESULTS: Total adjusted annual costs associated with FASD at the individual level was $31, 640 (95% CI $25,342; $38,642). Severity of the child’s condition, age, and relationship of the individual to the caregiver (biological, adoptive, kinship) were significant determinants of costs (p < 0.001). Thirty-two (32) percent of the total costs were paid by families caring for the children: The total annual cost to parent(s)/caregiver(s) of a child with FASD was $10,124.80. These costs were beyond the costs of raising a healthy child and only associated with costs of FASD.

CONCLUSION: Study results demonstrated thecost burden of FASD in Canada to parents/caregivers. Implications to practice, policy, and research are discussed.
Severe Alcohol Intoxication in Canadian Adolescents: 2 Year Surveillance Data
Authors: Acker A , Dow K , Norris M , Allain D , Thomas K
Published: September 2022

BACKGROUND: Alcohol is the most commonly used drug by Canadian adolescents, and can lead to a host of negative short and long-term outcomes. Understanding more about youth drinking can help develop more effective strategies for treatment and prevention. This study, gathering data through the Canadian Pediatric Surveillance Program (CPSP), was completed to fill in knowledge gaps and provide epidemiologic data about severe alcohol intoxication among Canadian adolescents.

OBJECTIVES: The objectives of the surveillance study included: 1) To obtain national epidemiological data outlining the incidence of severe alcohol intoxication among adolescents. 2) To describe the demographics, presentation to hospital, co-ingestions, co-morbidities, management and short-term outcomes. 3) To use the data to increase awareness and education. 4) To facilitate harm reduction strategies.

DESIGN/METHODS: Through the established methodology of the CPSP, paediatric physicians have been actively surveyed on a monthly basis for identified cases of severe alcohol intoxication. A detailed questionnaire was then completed for each new case. The case definition includes any adolescent meeting the following criteria: 1) Between 11-15 years of age 2) Blood alcohol level > 0 g/L (if drawn) 3) Presenting with severe intoxication with impaired consciousness requiring prolonged ER observation (≥ 6 hours) or hospital admission.

RESULTS: In the two years of surveillance, 40 cases were confirmed, including 21 male and 19 female adolescents, with a median age of 14. The youngest case reported was 11 years old. There were no significant differences between sex and blood alcohol level or age at presentation and blood alcohol level. Additional descriptive data of the confirmed cases will be reported and discussed.

CONCLUSION: After two years of surveillance, 40 cases of severe intoxication in adolescents have been identified. This is likely only the ‘tip of the iceberg’ and represents the more severe cases that required prolonged ER observation or hospital admission. The young age of presentation (youngest 11 years of age) and severity of intoxication requiring observation/admission are concerning. These data regarding Canadian adolescents presenting to the ED with severe intoxication will help inform strategies for education, prevention and harm reduction. It is noteworthy that the majority of adolescents with severe intoxication consumed spirits, suggesting that more education for adolescents around the higher potency of spirits relative to other alcoholic beverages and the dangers of consumption even in small amounts could reduce the incidence of severe alcohol intoxication in children and adolescents. Consideration of more stringent controls on spirits to help decrease adolescents’ access would assist with harm reduction.
Embodied Motherhood: An Exploration of Body Image in Pregnant and Parenting Youth
Authors: Harrison M , Obeid N , Rohde K , McLean N , Haslett K , Simpson C , Barriault D , Clarkin C
Published: September 2022

BACKGROUND: Pregnancy is associated with changes in body shape that influence body image satisfaction. Body dissatisfaction during pregnancy is a concern because of the potential association with negative behaviours, such as unhealthy dieting, which have been linked to poor pregnancy and neonatal outcomes. This is of particular concern for pregnant youth as they are already at increased risk for medical complications. Body image dissatisfaction in pregnancy is also an important determinant of depressive symptoms in pregnancy and postpartum. Given that pregnant and parenting youth (PPY) have poorer mental health outcomes, including a high rate of both antenatal and postpartum depression, examining the relationship between body image and depression during pregnancy is particularly important.

OBJECTIVES: The objectives of this study were to 1) examine psychological profiles of PPY regarding body image and related issues, 2) explore differences between younger and older PPY, and 3) compare psychological profiles of those who are pregnant versus not pregnant.

DESIGN/METHODS: Data was collected from 75 PPY from 2 urban social service agencies via electronic questionnaires. Demographic data and scores from several validated self-report measures related to self-esteem, body esteem, eating disorder behaviours and depression were collected. Research ethics board approval was obtained prior to the onset of the study.

RESULTS: Youth participants had a mean age of 19.6 years (SD=2.68); 29.3% (n=22) were pregnant at the time of the survey and 82.7 % (n=62) had at least 1 child. Youth reported a past history of depression (76.9%), anxiety (70.5%), drug/alcohol abuse (46.2%), and eating disorder (28.2%). Descriptive analyses revealed that PPY reported depression scores that were in the borderline clinical range (Edinburgh postnatal depression scale: mean 11.57, SD 6.26), whereas they scored within the relative normal range for all other psychological measures. There were no significant differences in any of the survey scores when comparing younger to (n=39, mean age 17.5 yrs) older participants (n=36, mean age 22 yrs); although when comparing pregnant (n=22) participants and non-pregnant (n=53) participants significant differences were found among scores of body esteem (t=-2.173, p=0.034) and eating disorder behaviours (t=2.713, p=0.008).

CONCLUSION: This study adds to the very limited research regarding adolescents' experience with body image during motherhood and the postpartum years, and can inform future program development for pregnant teens and young mothers struggling with poor body image. Future research is needed to continue exploring how adolescent body image during pregnancy and postpartum may differ and how this affects maternal and child outcomes.
Oral Food Challenges: A Retrospective Review of A Canadian Paediatric Allergy Clinic
Authors: Dhar A , Liao L , Liem J , Sidhu A , Kassum S
Published: September 2022

BACKGROUND: Food allergies in children can be life threatening and require prompt treatment with epinephrine. The gold standard for food allergy diagnosis is an Oral Food Challenge (OFC).

OBJECTIVES: To demonstrate the safety of OFCs for diagnosing and monitoring food allergies in a Canadian community paediatric population.

DESIGN/METHODS: Retrospective review of 500 paediatric patients that underwent 684 OFCs to a variety of foods from November 2006 to December 2013. Data collected from the patients includes demographics; the food challenged; reasons for the OFC; reactions experienced during the OFC; medical intervention performed; and whether the patient should continue eating the food challenged (OFC success). Anaphylaxis was defined using the World Allergy Organization criteria – i.e. dermatologic and cardiovascular or respiratory involvement after food ingestion; or two of dermatologic, cardiovascular, respiratory or gastrointestinal involvement after a likely allergen; or cardiovascular involvement after a known allergen. Mild reactions involved only 1 non-cardiovascular system; and moderate reactions involved more than 1 non-cardiovascular system, but did not qualify as anaphylaxis. Systems observed included the dermatologic, upper and lower respiratory, gastrointestinal, cardiovascular, and behavioural systems.

RESULTS: Of the 684 OFCs performed, there were 584 OFCs (85.4%) where the patients were successful at eating the food. Reactions occurred in 274 of 684 OFCs (40.1%), including 161 mild reactions (58.8% of reactions), 56 moderate reactions (20.4% of reactions), and 57 anaphylactic reactions (20.8% of reactions). Medical intervention was required in 74 OFCs (27.0% of reactions). All OFCs with no reaction were successful and all OFCs with anaphylaxis were not successful. OFCs with mild and moderate reactions had equivalent odds of being successful (OR [95% CI] = 0.01 [0.0003, 0.08] and 0.006 [0.0001, 0.04], respectively). Most reactions occurred within six hours of exposure to the food (267 of 274 reactions; 97.4%). The most common foods challenged were peanuts, eggs, and cow’s milk. The reasons for the OFCs were to diagnose an allergy (49.7%), monitor outgrowth of a diagnosed allergy (43.7%), or due to a family member having an allergy (6.6%).

CONCLUSION: In this community practice setting, patients undergoing an OFC were able to eat the food afterwards in 85.4% of the cases. Reactions occurred in 40.1% of OFCs. Anaphylaxis occurred in 8.3% of OFCs (57 of 684 OFCs). Most patients reacted within six hours of exposure. The majority of patients undergoing OFCs did not require treatment. OFCs provide a safe environment to diagnose and monitor food allergies in children.
Self-Blame and Avoidance Coping as Predictors of Post-Traumatic Stress Symptoms Among Sexually Abused Children
Authors: Bernard-Bonnin AC , Gauthier-Duchesne A , Allard-Dansereau C , Hébert M
Published: September 2022

BACKGROUND: Child sexual abuse is clearly associated with posttrau-matic stress symptoms (PTSS). Prior studies have identified self-blame and coping as important predictors of PTSS among adult survivors of sexual assault. However, few studies have explored the potential impact of self-blame and avoidance coping in influencing PTSS in children who have disclosed sexual abuse.

OBJECTIVES: This study attempted to test the contribution of self-blame and avoidance coping to the prediction of PTSS among sexually abused children. The severity of the abuse and child’s gender were also examined.

DESIGN/METHODS: The sample consisted of 477 sexually abused children (319 girls and 128 boys), aged 6 to 12. Self-blame and PTSS were evaluated by the Children’s Impact of Traumatic Events Scale II. A brief version of the Self-Report Coping Scale was used to assess children’s coping avoidance. These questionnaires were child self-report measures. The severity of the abuse was categorized as (1) less severe (physical contact over clothing), (2) severe (physical contact under clothing without penetration or force) and (3) more severe (physical contact with penetration or attempted penetration). Linear regression analysis was used to test the contribution of self-blame and avoidance coping to the prediction of PTSS. First, the child’s gender and the severity of the abuse were entered, and secondly, self-blame and avoidance coping.

RESULTS: A total of 10.7% of the sample reported less severe sexual abuse, 27.7% reported severe sexual abuse and 61.6% reported more severe abuse. The model which only included child’s gender and severity of the abuse explained 3.8% of the variance (F=9.04, p<0.001) in PTSS. Adding self-blame and avoidance coping, the proportion of explained variance increased to 35.1% (F=56.62%, p<0.001). Being a girl (beta=0.15, p<0.001), reporting high levels of self-blame (beta=0.26, p<0.001) and using avoidance coping (beta=0.43, p<0.001) were predictors of PTSS. The severity of the abuse was significant into the first model (beta=0.14, p=0.004), but not into the final one (beta=0.08, p=0.057).

CONCLUSION: Results suggest that sense of self-blame and using avoidance coping are important targets for clinical intervention with sexually abused children, because these factors contribute to the prediction of PTSS among this vulnerable population.
Two Decades of Measuring Ins and Outs: 20 Years of Paediatric Intensive Care Unit Admissions and DISCHARGES At A Small, Tertiary Care Paediatric Hospital with A Large Geographic Catchment Area
Authors: Krmpotic K , Young M
Published: September 2022

BACKGROUND: Over the past three decades, pediatric critical care has become recognized as its own subspecialty, with well documented benefits for critically ill children cared for by a pediatric intensivist, in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. Previous studies describing the demographic of critically ill children have been conducted in large hospitals that provide tertiary and quaternary care, or nation-wide studies including several PICUs.

OBJECTIVES: The primary objective of this study was to describe the volume and type of patients admitted to the PICU of a small, tertiary care pediatric hospital with a large geographic catchment area over a period of 20 years.

DESIGN/METHODS: We audited a prospectively maintained, administrative database to determine the age, primary diagnosis, length of stay, and outcome for all children, newborn to 18 years of age, who were admitted to the PICU at the Janeway Children’s Health and Rehabilitation Centre in St. John’s, Newfoundland between January 1, 1995 and December 31, 2015.

RESULTS: Data were available for 3800 admissions. Children requiring admission to PICU were a median age of 7.1 years (IQR 1.5 - 13.6 years). Medical patients accounted for 60% of admissions with most common diagnoses being respiratory insufficiency (32%), metabolic conditions (15%), neurological conditions (15%), trauma (14%), and cardiac insufficiency (6%). The remainder of admissions were for surgical patients from general surgery (50%), orthopedics (29%), and neurosurgery (21%). Median length of stay for admitted children was 2 days (IQR 1 – 5 days). Overall mortality rates were 2.8%.

CONCLUSION: Despite the benefits associated with regionalization of pediatric critical care for acutely ill children, positive outcomes and low mortality rates are observed in a small, tertiary care hospital with a large catchment area that is geographically isolated from other parts of the country. We were able to identify common admission diagnoses for our patient population, comparable to those reported at larger institutions.
A Retrospective Review of Service Documentation by Physicians Following Families of Children Diagnosed with Autism Spectrum Disorder: Identifying Gaps in Communication
Authors: Dunlap H , Ler S , Jegathesan T , Minhas R , Huber J , Young E
Published: September 2022

BACKGROUND: Currently very little is reported on the best way for family physicians and pediatricians to manage children diagnosed with autism spectrum disorder (ASD). There is no standard way to monitor whether families manage to access services, how long they wait for services, and what they do if services are deferred/denied. Consequently, families are often left with limited guidance and support when accessing developmental services.

OBJECTIVES: To evaluate the documentation patterns in medical charts of children diagnosed with ASD between 0-6-years old, whose care is shared between general and developmental pediatricians working in an inner-city setting. In particular, to study how physicians document the timeline and access to medical investigations and community services recommended by physicians.

DESIGN/METHODS: A retrospective chart review of a random sample of approximately 40 patients diagnosed between 0-6-years old with ASD followed by general and developmental pediatricians is currently being conducted at St. Michael’s Hospital. A systematic review of referral pathway to diagnosis, medical investigations, procurement of financial support and access to community services will be performed. Details obtained for review include date of recommendation, parent contact date, date on wait list, start date, and end date.

RESULTS: Preliminary data from 30 patient medical records revealed inconsistencies in how services were documented by physicians. 80% of charts noted that Intensive Behavior Intervention (IBI), Applied Behaviour Analysis (ABA) and speech and language therapy (SLP) were recommended and/or accessed by families. However, the recorded timeline of access varied extensively, with start and end dates recorded in ≤ 20% of charts for ABA, ≤ 50% of charts for SLP and ≤ 70-80% of charts for IBI. ABA therapy appeared to be the most difficult to access, with uptake occurring in only 50% of recommendations. Medical investigation results were often present, however the dates for hearing and vision tests were inconsistently recorded by the pediatrician in the medical charts. Parent education and attendance to drop-in centres were not recommended or accessed in 50% and 25% of patient charts respectively.

CONCLUSION: Preliminary results demonstrate inconsistent patterns of documentation by pediatricians following children with ASD when monitoring medical and community services, especially when recording timelines. Advocating for timely involvement in appropriate services requires an awareness of patients’ past and current involvement in services. Thus, further research may be warranted to determine why certain services are less frequently documented, and how these gaps in communication can be improved to ensure optimal management.
Prevalence of Autism in Children Prenatally Exposed to Alcohol: A Pilot Study
Authors: Young E , Stade B , Falsetti A , Fulford E , Jegathesan T
Published: September 2022

BACKGROUND: The prevalence of autism among Canadian children is 1.1 in 100.1 The possibilty of an association between prenatal alcohol exposure and autism was based on early case reports describing autistic behaviour in children with Fetal Alcohol Syndrome.2

OBJECTIVES: The objective of this study was to identify the prevalence of autism in children prenatally exposed to alcohol.

DESIGN/METHODS: A chart review was conducted of 220 children, aged 4 to 16 years, admitted to a Fetal Alcohol Spectrum Disorder(FASD) Clinic, and prenatally exposed to alcohol. Descriptive statistics were used to determine prevalence of the autism diagnosis,number of children diagnosed with FASD, and relevant demographic data.

RESULTS: Nine (9) of the total 220 children, or 4.1 %,had been diagnosed with autism using standarized tests. Mean age was 7.6 years with a range of 4.3 to 14.2 years. Five (5) of the children were boys, and 4 were girls. Six (6) additional children had autistic behaviours: autism was ruled out in 2 of the 6 children, and 4 had not been assessed. Eight (8) of the 9 children diagnosed with autism were also diagnosed with FASD, and in 1 child the diagnosis was deferred.

CONCLUSION: The prevalence of autism among children prenatally exposed to alcohol was significantly higher than the overall Canadian population (4.1 % vs. 1.1 %). Implications for practice and research are described.
Prevalence of overweight And Obesity in Canadian Children: A Decade of Progress in the Canadian Community Health and Health Measure Surveys
Authors: Rodd C , Sharma A
Published: September 2022

BACKGROUND: Previous studies using the Canadian Community Health Survey (CCHS) demonstrated an increase in the prevalence of overweight or obesity in Canadian children from 23.3% to 34.7% (1978– 2004) using the new 2010 WHO for Canada Growth Charts.

OBJECTIVES: To better define temporal trends in overweight and obesity status, this study examines additional data from the Canadian Health Measures Survey (CHMS, 2009-2013) by applying current Canadian definitions based on WHO body mass index (BMI) thresholds and recently validated waist-circumference norms from NHANES III (1988-1994). Associations with variables such as family income, parent education and number of parents were also explored over this time frame.

DESIGN/METHODS: Directly measured heights and weights were available for 14,014 children aged 3-19y from the decade 2004 to2013 in CCHS (n=8976)CHMS cycle 2 (n=2578) and CHMS cycle 3 (n= 2460). Z-scores for BMI, height, and weight were based on the 2014 WHO Growth Charts for Canada, including their new extension of weight-for-age beyond 10y. For waist circumference and waist-height ratios, we used new charts from the NHANES III reference population. Inverse probability survey weights were used to account for non-response and under-coverage.

RESULTS: The sex distribution was similar in each survey cycle and ~ 80% were of white race/ethnicity. Using current WHO definitions based on BMI, we observed a decline in the proportion ‘overweight or obese’ from 30.7% (95%CI=29.4–32.0) to 27.0% (25.7–28.3, p<0.001) and a stabilizations in obesity rates at ~13%. Rates of overweight and obesity were higher in boys, non-whites, and older children. These trends persisted after regression adjustment for age, gender, and race-ethnicity. Although declining, median Z-scores for BMI, weight, and height were positive compared to the WHO reference population. Waist-circumference and waist-height ratio Z-scores were negative, with less central adiposity than American children in historic or contemporary NHANES cohorts. Temporal trends in overweight/obesity appear to vary with family income, educational achievement, and immigrant status.

CONCLUSION: After a period of dramatic growth, both BMI-Z-scores and the prevalence of overweight or obesity appear to be declining in in Canadian children, attesting to progress against this important public health challenge.
How Well Does the Nipissing District Developmental Screen (NDDS) Identify Communication Problems in Infants?
Authors: Heuvel M Van den , Borkhoff C , Koroshegyi C , Zabih W , Maguire J , Birken C , Parkin P
Published: September 2022

BACKGROUND: Communication problems are often the first presenting problem in infants with developmental disabilities. With early detection, intervention can start. The 18-month Nipissing District Developmental Screen (NDDS) was created as a developmental checklist for use in primary care. The Infant Toddler Checklist (ITC) is a validated questionnaire for detecting communication problems. Our objective was to examine how well the 18-month NDDS identifies communication problems. We therefore assessed the convergent validity of the 18-month NDDS with the ITC as a gold standard.

OBJECTIVES: To examine how well the 18-month NDDS identifies communication problems. To compare parents’ answers to a similar question, “How many different words does your child use?”, on both checklists.

DESIGN/METHODS: Healthy children (n = 348, 55% male, mean age 18.6 months, SD 0.7) were recruited during scheduled health supervision visits. Parents completed both the 18-months NDDS and ITC. We assessed the convergent validity of the 18-month NDDS with the ITC as a gold standard. Correlation (Spearman) and the level of agreement (Cohen’s kappa, sensitivity, specificity) were calculated. For our secondary outcome, we compared the percentage of agreement between the answers to the same question on both instruments.

RESULTS: On the NDDS, 138 (39.7%) children had “one or more flags” (+1 NDDS) and 54 (15.8%) children had “two or more flags” (+2 NDDS). 13 (3.7%) infants had a concern on the total ITC score, 31 (8.9%) a speech-, 9 (2.6%) a social -, and 14 (4.0%) a symbolic concern.The +2 NDDS had a medium correlation (Spearman’s rho 0.42) and a fair agreement (Cohen’s kappa 0.32) with the ITC. Sensitivity and specificity of the NDDS using the +1 and + 2 flag cut-offs in detecting concerns compared with the ITC are shown in the table.The similar question about number of words spoken by 18-month old infants revealed agreement between the NDDS and ITC; 24.4% versus 30.8% of the 18-month old infants did not speak 20 words or more respectively.

CONCLUSION: Infants with a severe overall communication delay were identified with the 18-months NDDS. The low sensitivity of the 2+ NDDS flag in detecting speech and social concerns suggests that infants who could benefit from early interventions may not be identified.The low specificity of the 1+ NDDS flag may cause unnecessary concerns for parents.For the early identification of all levels of communicationdelays, we recommend using a standardized questionnaire like the ITC.
Reduction of the 28-Day Readmission Rate for Children with Sickle Cell Disease
Authors: Beck C , Kirby-Allen M , Cheong M , Langrish K , Clarke A , Nishimura C , Palmer M , Gervais A , Moloney J , Mack L
Published: September 2022

BACKGROUND: Failure to provide coordinated care may lead to inefficiencies and negatively impact the quality of patient care provided. For children with sickle cell disease (SCD) at our tertiary care children’s hospital, traditionally hematology has provided ambulatory and consultative care, and general paediatrics has provided inpatient management. We fostered collaboration and used quality improvement (QI) methods to improve patient care, using hospital readmission rates as our primary QI measure.

OBJECTIVES: To reduce the 28-day readmission rate for pediatric patients with SCD from current levels (18.5%) to 14% over a 12-month period.

DESIGN/METHODS: An interdisciplinary team diagnosed and developed strategies to address gaps in care coordination. A chart audit was conducted and a process map of the hospital journey was created to identify opportunities for improvement. Based on impact and effort, the following strategies were prioritized and implemented: standardization of pain management, support for patients at highest risk of readmission, streamlining the discharge process, and increased use of hydroxyurea. Quarterly data were abstracted via Health Records from the Discharge Abstract Database (DAD). The measure of interest was the percentage of patients (0-18 years of age) with SCD and crisis readmitted with the same or related diagnosis within 28 days. Patients were identified using the ICD10 code D57.0; “crisis” includes vaso-occlusive crisis, acute chest syndrome, and splenic sequestration. Individual process measures reflecting our multiple improvement strategies were also collected.

RESULTS: From fiscal year 2013-14 to 2014-15, the total number of patient admissions for SCD decreased from 173 to 166. The readmission rate, as defined above, decreased from 18.5% to 10.8%. Other measures specifically reflecting our improvement strategies continue to be followed with ongoing process improvement.

CONCLUSION: A multi-modal strategy approach aimed at coordinating care has led to a decrease in rate of readmission for children with SCD below the established target. Ongoing monitoring will be required to ensure sustainability of this result. Further opportunities for standardization of care for this patient population include updating relevant clinical practice guidelines and order sets; implementing “pain plans” for transition home; and optimizing outpatient follow-up.
Evaluation of a Child Safety Program Based on the Safe Community Model in Canada
Authors: Beaulieu E , Cyr C , Santschi M
Published: September 2022

BACKGROUND: Despite national safety programs, unintentional injuries remain an important health problem in children and adolescents. Cycling, pedestrian and young drivers injuries are particularly influenced by specific community and city aspects. The World Health Organization (WHO) developed community based programs that have been effectively implemented as complements to national safety programs to prevent injuries.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of a local program based on a WHO Safe Community model to reduce cycling, pedestrian and young drivers injuries.

DESIGN/METHODS: A population based quasi-experimental design was used. Pre-implementation and post-implementation data of cycling and pedestrian injury rates (0-15 years) and young drivers injury rates (16-24 years) were collected in the intervention area (Sherbrooke) and in two control communities (Trois-Rivières and Gatineau) in Québec, Canada. RESULTS: Sherbrooke, Gatineau and Trois-Rivières had respectively 69, 82 and 119 cycling and pedestrian injury rate per 100000 children-year in the pre implementation period. Despite its already lower pre-implementation rate, Sherbrooke showed a statistically significant reduction in the post-implementation injury rate compared to Trois-Rivières (Sherbrooke: 49:100000 children-year (OR comparing pre-post rates 0.70 ; 95%CI : 0.45-1.08) and Trois-Rivières 80:100000 children-year (OR comparing pre-post rates 0.68; 95%CI: 0.46-1.0). Gatineau showed a cycling and pedestrian post-implementation injury rate of 63:100000 (OR 0.77; 95%CI: 0.58-1.02). Sherbrooke had the largest young drivers injury reduction with rates of 2912:100000 young driver-year (pre) to 2121: 100000 young driver-year (post) (OR 0.73; 95%CI: 0.66-0.8). Gatineau and Trois-Rivieres showed respectively young drivers injury rate lowering from 2383: 100000 to 2099: 100000 young driver-year (OR 0.88; 95%CI: 0.81-0.95) and from 3447: 100000 to 3295: 100000 young driver-year (OR 0.96; 95%CI 0.87-1.05).

CONCLUSION: Safe Community program established in Sherbrooke was associated with favorable results in injury prevention. Despite its lower pedestrian and cycling injury rate before the intervention, post-implementation injury rate in Sherbrooke was significantly lower compared to Trois-Rivieres. Concerning young drivers injury rates, Sherbrooke showed the biggest reduction, compared to Trois-Riviere and Gatineau. In addition to national injury prevention programs, communities should be encouraged to adopt WHO safe community programs to reduce to a minimum unintentional injury rates in children and adolescents.
The Emotional Intelligence of Paediatric Residents – A Descriptive Cross-Sectional Study
Authors: McLeod S , Sonnenberg L
Published: September 2022

BACKGROUND: Emotional Intelligence (EI) is a type of social intelligence with high scores achieved through factors including being empa-thetic in interpersonal relationships, displaying flexibility in adapting to change, and managing stressful situations. There has been an explosion of research into EI in medicine since many of the social competencies described may have a direct impact on patient care.

OBJECTIVES: The objective of this study was to describe EI of pediatric residents and to identify if there are EI skills that should be selected for targeted intervention in this population.

DESIGN/METHODS: This was a cross-sectional study administering the EQi-2.0© psychometric instrument to all pediatric residents at a Canadian residency program. Scores were analyzed by year of training, gender, and age.

RESULTS: Thirty-five residents completed the EQi-2.0© (100% response rate). Their overall EI score was not significantly different than a normative group of college educated professionals. There was no correlation between overall EI and year of training, gender, or age. Residents had relative strengths in the subcategories Emotional expression, Interpersonal Relationships, Empathy, and Impulse Control (all p<0.05). Areas of relative weakness were in the subcategories Stress Tolerance, Assertiveness, Independence and Problem Solving (all p<0.05). There were significantly higher scores in the subcategories Independence, and Problem Solving for residents over thirty years old when compared to younger residents (both p<0.05).

CONCLUSION: The EI of pediatric residents is consistent with that of other professionals. Educational interventions may be useful in the areas of weakness, however, individual score reports vary so emphasizing the individual learning needs of each resident based on their weaknesses may be the best educational intervention to enhance the physician-patient relationship.
The Impact of Continuous Digital Video Electroencephalogram (CEEG) Introduction on the Use of Anti-Epileptic Drugs (AEDS) in Neonates with Hypoxic Ischemic Encephalopathy (HIE)
Authors: Bashir RA , Espinoza L , Vayalthrikkovil S , Buchhalter J , Bello-Espinosa L , Mohammad K
Published: September 2022

BACKGROUND: Use of AEDs in neonates may disrupt neuronal development by synaptic re-organization and altering brain plasticity. Introduction of cEEG as part of neonatal neurocritical care long term monitoring (LTM) aims to improve seizure detection and control in neo-nates with HIE.

OBJECTIVES: To assess the impact of cEEG on seizure detection and the use of AEDs in neonates with HIE

DESIGN/METHODS: A retrospective cohort study of neonates admitted with HIE to a level III NICU two years before and after introduction of LTM in August 2013. The cEEGs were read remotely by a pediatric epileptologist. Before LTM, a 60 minute routine EEG (rEEG) was the standard practice. Primary outcome was the number of AEDs used. Secondary outcomes were AEDs used as maintenance and on discharge, and AEDs burden (total mg/kg used during hospital stay). HIE staging was based on modified Sarnat scoring system. Drug burden for each AED was calculated. Categorical variables were analysed using Chi-square test and continuous variables using student's t test.

RESULTS: n=157 (total number of HIE patients); median gestation 40 weeks (IQR 38-40); 71 infants(45%) had LTM monitoring;103 infants(66%) were cooled. Baseline and clinical characteristics including disease severity and cooling were similar. In the pre LTM era, 12 of 52 (23%) infants with clinical seizures, only 12 had seizures by rEEG . Using cEEG, 17 out of 33 (52%) clinical seizures were confirmed by cEEG; 5/36(1%) had subclinical seizures compared to none before LTM. Detection of EEG seizures increased significantly with LTM (p 0.02). Discharge on any AEDs was less in the LTM group and the mean AEDs burden was reduced from 176 mg/kg in the pre LTM to 91 mg/kg in the post LTM group.

CONCLUSION: Introduction of cEEG improved seizure detection and control; but decreased the overall use and burden of AEDs.

p value <0.05 is denoted as *
Prevalence and Characteristics of Intracranial and Extracranial Hemorrhages in Neonates with Hypoxic Ischemic Encephalopathy (HIE)
Authors: Vayalthrikkovil S , Bashir R A , Espinoza L , Irvine L , Mohammad K
Published: September 2022

BACKGROUND: Intracranial hemorrhages (ICH) and extracranial hemorrhages(ECH) are not uncommon in neonates with HIE. The risk factors of hemorrhages and their association with HIE severity and other therapeutic interventions are unclear.

OBJECTIVES: To examine the prevalence and risk factors associated with ICH and ECH in neonates with HIE.

DESIGN/METHODS: A retrospective cohort study of neonates admitted with HIE from September 2011 to October 2015 in a level III NICU. ICH[mainly subdural(SDH), intraventricular (IVH), intraparenchymal (IPH)] and ECH [mainly subgaleal(SGH) and cephalhematoma] were diagnosed by MRI.Perinatal and neonatal characteristics were examined, including mode of delivery, outborn status, HIE staging(using modified Sarnat scoring), therapeutic hypothermia(TH), clinical/EEG seizures, hypo/hypercarbia, inotrope use, thrombocytopenia-mild, moderate, severe(platelet count 100-150, 50-100, 1.8, activated partial thromboplas-tin time(aPTT)>45 sec, fibrinogen

RESULTS: Number of HIE patients,n=157; median gestation 40 weeks(IQR 38-40); outborn=104(66%);TH used=103(66%);MRI brain done=138. . Prevalence of SDH,IPH,IVH and SGH were 47,22,9,9 (34%,16%,6.5%,6.5%) respectively. There was no significant increase in hemorrhage with mode of delivery except instrumentation, seizures, hypo/ hypercarbia, severe thrombocytopenia or deranged coagulation. Instrumental delivery significantly increased the prevalence of IPH and SGH. All hemorrhages except cephalhematoma increased with severity of HIE staging, but not with MRI severity. In the logistic regression analysis, use of dopamine was associated with increased risk of IPH(OR 2.94; 95% CI 1.42, 12.08) and trended towards increased risk of IVH (OR 4.49; 95% CI 0.98, 20.6).

CONCLUSION: SDH followed by IPH are the common ICH. Despite being frequent, thrombocytopenia and deranged coagulation did not increase the risk of ICH or ECH in HIE; dopamine use associated with significant increase in the risk of IPH.
Neurodevelopmental Outcomes Following Extensive Cardiopulmonary Resuscitation in the Delivery Room for Infants Born <29 Weeks’ Gestational Age
Authors: Fischer N , Soraisham A , Lodha A , Ting J , Rabi J , Synnes A , Creighton D , Shah P , Singhal N , Dewey D , Metcalfe A , Ballantyne M , Cooper S
Published: September 2022

BACKGROUND: Neurodevelopmental outcomes of preterm infants who receive extensive CPR (ECPR), defined as chest compression with or without epinephrine in the delivery room, remain unclear.

OBJECTIVES: To compare the neurodevelopmental outcomes of preterm infants admitted to Canadian NICUs requiring ECPR versus those who did not require ECPR in the delivery room.

DESIGN/METHODS: Preterm infants born at <29 weeks GA between January 1, 2010 and September 30, 2011 and evaluated at CNFUN centers were retrospectively evaluated. The primary outcome was a composite of death or neurodevelopmental impairment (NDI) at 18-21 months CA defined as presence of any one or more of the following: definitive cerebral palsy or Bayley- III cognitive, language, motor scores <85 on any one of the components or hearing impairment or visual impairment. Demographic factors, neurodevelopmental status including Bayley III cognitive, language and motor scores and sensory impairments were compared between the ECPR and the no ECPR group using univariate and multivariate analyses. RESULTS: Of 2488 eligible infants, 197 (7.9%) received ECPR. 83% of surviving infants had follow-up data. Demographic and outcomes data are summarized below in Table 1 and 2 respectively.

CONCLUSION: In very preterm neonates, ECPR was associated with increased risk of death or neurodevelopmental impairment and lower motor scores at 18-21 months CA.
The Association between Hyperlactatemia and Adverse Long-Term Outcome in Infants With Moderate-To-Severe Hypoxic Ischemic Encephalopathy
Authors: Elboraee M
Published: September 2022

BACKGROUND: Hypoxic ischemic encephalopathy (HIE) remains one of the most devastating events in the newborn period. Lactate is invariably produced with hypoxia and poor tissue perfusion. Initial highest lactate in the first hour of life and serial measurements of blood lactate have been found to be important predictors of moderate to severe neonatal encepha-lopathy in cases of intrapartum asphyxia.

OBJECTIVES: To examine the association between initial lactate level and the long term adverse outcome in infants with moderate to severe HIE (HIE II/III). We hypothesized that the level and duration to normalize hyperlactatemia in HIE infants can predict long term adverse neurodevel-opmental outcome.

DESIGN/METHODS: A retrospective chart and database review for all infants ≥ 35 weeks gestational age treated in the Northern Alberta Neonatal Program with HIE II/III from January 2006 to December 2012 (excluding infants who were growth restricted or with major congenital anomalies). The primary outcome was composite of death or any disability (cerebral palsy, cognitive delay <2SD below the mean, hearing loss and blindness) at 18 months or 3 years of age. Univariate and multivariable regression analyses were used to compare the outcome.

RESULTS: Of 167 infants, 106 had initial lactate >5.0mmol/L (63%) and 48 had initial lactate 16mmol/L is significant (P0.0015) for detection of adverse outcome; sensitivity 29.3% and specificity 90.5%.

CONCLUSION: Most term/near term infants with HIE II/III had initial lactate > 5mmol/L. Initial lactate >16 mmol/L and duration to normalization of lactate levels was associated with the adverse outcome.
Quantitative 3D and 2D Head Ultrasound to Determine Thresholds for Intervention In Preterm Neonates with Posthemorrhagic Ventricular Dilation
Authors: Kishimoto J , Lee D S.C. , Salehi F , Romano W , Fenster A , Ribaupierre S de
Published: September 2022

BACKGROUND: Preterm neonates with intraventricular hemorrhage (IVH) often acquire post hemorrhagic ventricle dilation (PHVD), which, when severe, can lead to neurological impairment. Cranial 2D ultrasound (US) images are used for the diagnosis and monitoring of PHVD; however, there is no consensus on the use of 2D US images to guide treatment. This can lead to delays in interventions, and the potential for brain injury. We have developed a 3D US system that has been shown to accurately detect changes ventricle volumes (VV).

OBJECTIVES: We investigate the utility of using 3D and 2D US measurements to determine thresholds for treatment of neonates with PHVD and to predict the need for further treatments.

DESIGN/METHODS: Neonates were imaged twice weekly in accordance to a protocol approved by the research ethics board. 3D US images were manually segmented to obtain VV. 2D measurements included ventricle index, anterior horn widths, third ventricle width, and largest thalamo-occipital distance. The rate of change for each measurement was calculated. Decisions to perform ventricular taps (VTs) to relieve intracranial pressure were made independently by neurosurgeons who were blinded to study images. Receiver operator curves (ROC) were generated using the sensitivity and specificity of the rates of change of sonographic parameters in predicting the need for V T. For each parameter optimal threshold for intervention was estimated by the area under ROC; and positive and negative predictive values (PPV, NPV) were calculated. Additionally, we investigated whether US measurements predicted the need for multiple interventions.

RESULTS: 23 neonates with PHVD were enrolled, 8 required interventions. The best predictor to determine initial intervention was the rate of change in VV when a threshold of >2.04 cm3/day was used within the first three weeks of life (NPV and PPV of 1) and, this measurement was able to determine if then a patient would require further interventions when a threshold of -0.04 cm3/day was used looking at imaging time points after the first intervention (NPV and PPV of 1). 2D measurements were less sensitive and/or less specific (sensitivity of 88-57%, specificity of 100-79%, PPV of 0.88-0.57 and NPV of 0.93-0.79).

CONCLUSION: 3D US VV can predict the requirement for interven-tional ventricular tap in neonates with IVH, and can identify patients that have resolving PHVD following initial intervention, with higher sensitivity and specificity than 2D US measurements. These findings show promise for early classification of neonates using 3D US for prediction of interven-tional therapy, potentiallyaiding in timely management of these patients.
Nrp Prompt: A Randomized Controlled Trial of a Mobile App for Neonatal Resuscitation Training
Authors: Chan N , Campbell D , Mistry N
Published: September 2022

BACKGROUND: There is poor adherence to the Neonatal Resuscitation Program (NRP) algorithm by all levels of providers in simulated and clinical settings. While audio- visual prompting improves adherence to cardiopulmonary resuscitation, visual prompting alone has not been effective in improving NRP compliance. For this study, an iOS mobile app, NRP Prompt, was designed to provide audio -visual prompts based on user responses at NRP decision points.

OBJECTIVES: To determine if NRP Prompt improves the adherence of novice NRP providers to the NRP algorithm compared to visual- only prompting in simulated neonatal resuscitation.

DESIGN/METHODS: First year residents attending NRP training were randomized into intervention and control groups. Resident pairs used standard visual aids with NRP Prompt (intervention) or visual aids only (control) in two low- fidelity neonatal resuscitation simulations, where each resident took turns as team leader. Pairs were then evaluated in a third simulated scenario that was video -recorded, where neither group used NRP Prompt nor visual aids. The primary outcome was comparing the median checklist score in NRP Prompt versus control. Tw o independent NRP providers evaluated the video recordings of each pair using a validated NRP checklist. Secondary outcomes were: time to positive pressure ventilation (PPV), time to chest compressions and time to intubation. Inter-observer variability was determined using a two- way mixed -effects intra -class correlation coefficient (ICC). Median NRP scores and time to interventions were compared between intervention and control using the Wilcoxon ranked- sum test.

RESULTs: 39 residents participated, 8 pairs in intervention and 7 pairs (and 1 group of 3) in control. The ICC was 0.69, indicating good inter-rater agreement. Median NRP scores did not differ in intervention 21 (interquartile range (IQR): 1.5) vs. control 21 (IQR: 1.5), p=0.89. Median time in seconds did not differ for time to PPV (60.5 (IQR: 19.5) vs. 48 (IQR: 13.5) p=0.12), chest compressions (202.5 (IQR: 54) vs. 216 (IQR: 71) p=0.69), and intubation (234 (IQR: 145) vs. 264 (IQR: 94.5) p=0.25).

CONCLUSION: Training using NRP Prompt did not improve performance in simulated neonatal resuscitation. Potential reasons include voice prompts being distracting and smaller than hypothesized effect size. Future development of prompting apps should have options for different degrees of prompting tailored to user preferences.