bluuebunny/crossref_metadata_2025 huggingface dataset:
41 Evaluating Immunization Status and Barriers to Immunization for Patients Admitted to the Stollery Children's Hospital
Authors: Lissinna Brittany , Gilbert Chelsea , Isaac Calla , Mian Qaasim , Forbes Karen
Published: September 2023

Introduction/Background

Routine immunization is an effective public health intervention. Despite this, immunization coverage in Alberta remains below national targets. While vaccine hesitancy is a frequently cited barrier, underimmunization is likely multifactorial. Previous research has shown that hospitalization presents an opportunity to “catch-up” children who are underimmunized. Unfortunately, this is not readily available at the Stollery Children’s Hospital (SCH), a paediatric tertiary care facility serving a large catchment area.

Objectives

The primary objective of this study was to assess the immunization status of children admitted to paediatric clinical teaching units (CTUs) at SCH. Our secondary objective was to assess potential barriers caregivers face while attempting to immunize their children.

Design/Methods

Between July 2021 and October 2022, we prospectively gathered the immunization status of children aged 2 months to 18 years admitted to paediatric clinical teaching units (CTUs) at SCH. Two hundred and fifty children and their caregivers were enrolled in the research study. Demographic data and immunization records were documented, and immunization status of each participant was classified as up-to-date or not-up-to-date based on the Alberta Routine Childhood Immunization Schedule. Caregivers completed a standardized survey, Searching for Hardships and Obstacles to Shots (SHOTS), to assess potential barriers they face while attempting to immunize their children, including three subscales (access to shots, concerns about shots and importance of shots).

Results

Of the 250 children enrolled, immunization data was available for 240 children. Of these, 142 (59%) were up-to-date on their immunizations. Assessment of demographic data revealed no difference in immunization status between urban and rural addresses. When evaluating barriers that families face when approaching immunization, concerns about immunization were most commonly cited as barriers for all patients. However, caregivers whose children were not up-to-date on immunizations scored higher on all subscales compared to those whose children were up-to-date.

Conclusion

The immunization status of children admitted to paediatric CTUs at SCH falls far below national targets. Due to logistical issues, it is challenging to access routine immunizations during hospitalization. Caregivers of children who are underimmunized also identify a higher rate of barriers to immunization. These underimmunized patients represent a missed opportunity, and improving access to routine immunization while in hospital could improve the overall immunization rates for both hospitalized children and the broader community.
44 Ceftriaxone Prescribing Patterns in an Outpatient Hospital Setting: A Quality Improvement Study
Authors: Wong Kimberly , Papenburg Jesse , Evangeliou Helena
Published: September 2023

Background

Ceftriaxone is a commonly administered antibiotic in paediatric medical day hospitals (MDH) for certain conditions where it may be considered first-line. Its long half-life permits once-daily dosing, thus potentially avoiding inpatient admission. However, administration of ceftriaxone requires intravenous line insertion, daily follow-up, and time spent by the family. There is a perception among healthcare providers in our tertiary hospital that ceftriaxone use is frequently inappropriate in the outpatient setting, and that more narrow-spectrum oral agents could be prescribed instead.

Objectives

Our primary objective was to evaluate the appropriateness of ceftriaxone use according to centre-specific first-line indications, in children between the ages of 3 months and 18 years in the MDH.

Design/Methods

Data were collected retrospectively for one winter season (Nov 2, 2019 to Jan 11, 2020) and one summer season (June 2, 2020 to Sept 25, 2020). All patients initially referred by the emergency department (ED) to the MDH were reviewed. Inclusion criteria included children (age 3 months to 18 years) who received ceftriaxone in the MDH or the ED. Patients with pre-existing immunodeficiency were excluded. Appropriateness was assessed according to the empiric antimicrobial guide available at our centre. In cases where ceftriaxone appropriateness was unclear, a detailed chart review was conducted by two parties including a resident and a staff trained in paediatric infectious diseases.

Results

Among eligible patients referred to the MDH from the ED (n=196), ceftriaxone was inappropriate in 113 cases (57.7%). Inappropriateness was more prevalent in the summer than the winter (76% vs 41.3%, p<0.0001). The most frequent inappropriate indications for ceftriaxone were: cellulitis with a skin portal of entry, including pre-septal cellulitis (54.0%); non-severe pneumonia (11.5%); and acute lymphadenitis (11.5%). Cellulitis was more prevalent in the summer (38.7% vs 16.3%), whereas pneumonia was more prevalent in the winter (20.2% vs 2.2%). Ceftriaxone was almost always initially prescribed in the ED (95.4%), and was continued in 164/187 (87.7%) of first MDH visits. An average of 2.9 doses of ceftriaxone was given per patient. Only one patient was documented to be initially unwell looking in the ED, and 50% were afebrile.

Conclusion

Ceftriaxone is overused in the MDH at our institution, largely due to skin and soft tissue infections and non-severe pneumonia. Targeted antimicrobial stewardship interventions to reduce ceftriaxone use in both the ED and MDH could improve the patient experience (less broad-spectrum antibiotics, less invasive procedures) and the efficient use of the MDH.
45 Variation in the Management of Hospitalized Children with Orbital Cellulitis over Ten Years
Authors: Nguyen Emily , Mahant Sanjay , Cichon Jessica , Drouin Olivier , Pound Catherine , Quet Julie , Wahi Gita , Bayliss Ann , Vomiero Gemma , Foulds Jessica L , Kanani Ronik , Sakran Mahmoud , Sehgal Anupam , Borkhoff Cornelia M , Pullenayegum Eleanor , Widjaja Elysa , Reginald Arun , Wolter Nikolaus E , Oni Semipe , Anwar Rashid , Louriachi Hossam , Ge Yipeng , Kirolos Nardin , Patel Ashaka , Jasani Hardika , Kornelsen Emily , Chugh Ashton , Gouda Sandra , Akbaroghli Susan , McKerlie Morgyn , Parkin Patricia C , Gill Peter J , Hersi Leo
Published: September 2023

Background

Management of children with periorbital and orbital infections is multifaceted and interdisciplinary. However, no clinical practice guidelines exist to guide the evaluation and management of orbital cellulitis, leading to highly variable care.

Objectives

Identifying differences in management and outcomes at the hospital level can identify areas to improve care, standardize practice, reduce unnecessary testing, and rationalize pharmacotherapy. We aimed to describe variation and trends over time in diagnostic testing and imaging, adjunctive agents, empiric antibiotics, and surgical intervention in children hospitalized with orbital cellulitis.

Design/Methods

Multicentre cohort study of children aged 2 months to 18 years with orbital cellulitis infections admitted to ten hospitals from 2009 to 2018. We assessed hospital level variation using X2 tests. Trends over time were analyzed descriptively and with linear regression.

Results

Of 1579 patients, 1308 (82.8%) were admitted to a children’s hospital. There were significant differences between children’s hospitals in usage of C-reactive protein tests (P<0.001), computed tomography scans (P=0.004), magnetic resonance imaging scans (P=0.003), intranasal decongestants (P<0.001), intranasal corticosteroids (P<0.001), intranasal saline spray (P<0.001), and systemic corticosteroids (P<0.001). Among children’s hospitals between 2009 and 2018, C-reactive protein test usage increased from 28.8% to 73.5% (P<0.001), erythrocyte sedimentation rate decreased from 31.5% to 14.1% (P<0.001), and magnetic resonance imaging scans doubled 4.1% to 8.8% (P=0.02). Use of intranasal corticosteroids (P=0.003) and saline sprays (P=0.02) increased over time, while intranasal decongestants, corticosteroids, antibiotics, surgery rates, and length of hospital stay were similar.

Conclusion

There is significant variation in usage of diagnostic tests and treatments in children hospitalized with orbital cellulitis. There were increases in test usage and interventions over time despite minimal changes in surgery rates and length of stay. These findings highlight the need to develop evidence-based clinical practice guidelines.
48 Congenital Syphilis in Canada: Findings of a Canadian Paediatric Surveillance Program Study
Authors: Bullard Jared , Krueger Carsten , Gravel Geneviève , Guedes João , Sandhu Jaskiran , Tomas Kristina , Brophy Jason
Published: September 2023

Background

Since 2015, the incidence of congenital syphilis (CS) in Canada has increased significantly. Vertical transmission of syphilis can be prevented through timely treatment of infected pregnant persons; however, difficulty engaging in prenatal care can preclude diagnosis, and consequently treatment. Canadian data on sociobehavioural risk factors associated with poor engagement in prenatal care is limited, yet needed to inform prevention efforts.

Objectives

Our primary objective is to identify sociobehavioural risk factors of mothers with infants affected by syphilis, as well as describe the screening and treatment they receive. Our secondary objective is to describe the presentation and management of affected infants in Canada.

Design/Methods

Cases of confirmed and probable CS were elicited from paediatricians through the Canadian Paediatric Surveillance Program between June 2021 and October 2022. Survey responses were analyzed using descriptive statistics.

Results

In total, 143 cases were reported: 78% originated from the prairies (Alberta n=39, Saskatchewan n=50, Manitoba n=23) and 34% resided rurally. The median age was 27 years (range 17-39). Among the 143 women, 94 (66%) reported substance use, 42 (29%) child protection involvement with a previous child, and 25 (17%) housing insecurity; however, “unknown” responses were frequent for many variables. Of those reporting substance use, methamphetamines (n=46/94, 49%) and opioids (n=34/94, 36%), were the most common. Most women (n=73/143, 51%) had no known sexually transmitted co-infection, but among those who did, chlamydia was the most common (n=38/70, 54%). Only 22% (n=32/143) reported at least one prenatal visit per trimester. Of the 85/143 mothers known to have a positive syphilis screen, 22% (n=19/85) did not receive treatment. Of the 28 cases where specific barriers to accessing prenatal care were reported, 8 reported substance use, 6 reported housing insecurity, and 6 reported attitudinal barriers.

Most affected infants had no physical exam findings of CS (n=83/143, 58%), but among those who did, rash and hepatomegaly were the most common findings (n=17/143, 12% and n=15/143, 11% respectively). Of the 136 with long bone x-rays completed, 70% (n=95) were normal. Most cases (138/143, 96%) were identified within the first month of life, and 89% (n=127/143) began antibiotic treatment within a week of life.

Conclusion

Substance use during pregnancy is common in mothers of children with CS; however, the presence of other sociobehavioural risk factors is often not known by reporting paediatricians. Most affected infants are asymptomatic but are diagnosed and treated early. Findings will inform public health strategies for preventing CS and combatting the current epidemic.
49 Systematic Review and Meta-analysis of SARS-CoV-2 Vaccine Acceptance in Parents of Children Aged 5-11
Authors: Hui Caitlyn , Piche-Renaud Pierre-Philippe , Peresin Joelle , Shahrbabak Elahe Karimi , O'Kelly Ciobha , Macikunas Andrea , Yan Tingting , Chiara Costanza Di , Tailor Lauren , Farrar Daniel S , Morris Shaun K
Published: September 2023

Background

Despite the well-studied benefits and safety of SARS-CoV-2 vaccines, many caregivers of children aged 5 to 11 years old remain hesitant to have their child vaccinated. Reasons for vaccine non-acceptance and barriers specific to children aged 5-11 and caregivers are poorly understood.

Objectives

Our study aims to: 1) Assess proportion of parents who are acceptant of vaccines in different populations/settings; 2) Identify parent and children characteristics associated with vaccine acceptance; and 3) Identify reasons for vaccine non-acceptance.

Design/Methods

Medline, Embase, Cochrane and CINAHL were searched using predefined search terms to identify relevant studies published between October 29, 2021 and September 12, 2022. Studies were assessed for inclusion/exclusion by two authors, and discrepancies were resolved by discussion with a senior author. Random-effects meta-analysis was performed to estimate the pooled proportion of parents who are acceptant of SARS-CoV-2 vaccines.

Results

A total of 1571 articles were identified for full text review, of which 30 were included. Twenty-four studies were conducted in high income countries, three in upper middle-income countries and three in low- to middle-income countries. The pooled effects size for vaccine acceptance in caregivers of children aged 5-11 years was calculated as 54% (95% confidence interval 47–60%), with considerable between-study heterogeneity (I2 of 99.04%). Characteristics associated with vaccine acceptance included caregivers being vaccinated against SARS-CoV-2 themselves, and higher parental education. Common reasons for vaccine non-acceptance consisted of vaccine safety/efficacy concerns and perception children being less susceptible to SARS-CoV-2 infection compared with adults.

Conclusion

The overall proportion of caregivers being acceptant of SARS-CoV-2 vaccine for their child aged 5-11 was found to be low, with the main barriers relating to vaccine safety concerns and health education. Further studies exploring these barriers and potential solutions to increase vaccine confidence and uptake in this age group are needed.
54 Preterm Parents Identified Meaningful Outcomes: Involving Parents in Implementing Change
Authors: Janvier Annie , Synnes Anne , Lam Mei Mei , Bacchini Fabiana , Jones Melissa , Bong Karen , Richter Lindsay , Luu Thuy Mai
Published: September 2023

Background

The Canadian Neonatal Follow-Up Network (CNFUN) reports on neurodevelopmental impairments (NDI) in the very preterm population but has never asked parents which outcomes and definitions are meaningful to them. The Parent Voices group conducted four studies which showed differences between parents and CNFUN perspectives on definitions, severity, composite outcomes, which outcomes, and the need to report positive as well as adverse outcomes. Disseminating and implementing change based on these results is the next essential step.

Objectives

To create consensus statements to guide evidence-based change.

Design/Methods

Using a modified Delphi method, Parent Voices results were reviewed and discussed with parents, clinicians and researchers in a virtual workshop in Oct 2021. The discussion was analyzed qualitatively to create statements, circulated for feedback, and 80% consensus statements identified by electronic polling. Priority items requiring further work were identified, working groups created, and results presented at a Sept 2022 workshop.

Results

In the 2021 workshop, 17 consensus statements were identified (7 from the Parent Voices results, 5 from the discussion, and 5 were out of scope). Actionable statements (n=11, Table 1) and items needing further work (n=6, Table 2) were identified and progress was made (Tables 1 and 2). To identify how to measure 7 outcomes which parents and stakeholders identified as important (child well-being, quality of life, socioemotional and behavioural, respiratory, feeding, sleeping, and caregiver well-being), working groups reviewed literature and made recommendations for minimal dataset and funded research at a virtual presentation with parent, clinicians, and researchers in Sept 2022.

In the summer of 2022, the Canadian Premature Babies Foundation (CPBF), Parent-EPIQ team members and summer students disseminated the Parent Voices results to lay stakeholder groups via CPBF blogs and webinars. They also pursued a project identified in the 2021 workshop to educate parents about the role of Neonatal Follow-Up Programs using infographics and information sheets.

Conclusion

We have successfully collaborated with parent partners to implement the actionable results from our Parent Voices Project, and have a process to implement change when further work is required. Involving parents in research, knowledge dissemination and implementation can lead to changes that accurately represent the priorities of families.
56 Survival and Long-term Outcomes of Children who Survived after End-of-Life Decisions in the NICU
Authors: Janvier Annie , Boutillier Béatrice , Biran Valérie , Barrington Keith , Caeymaex Laurence
Published: September 2023

Background

The majority of deaths in neonatal intensive care units (NICU) follow end-of-life decision-making. Most discussions regarding the withdrawal or withholding of life-sustaining interventions (WWLST) occur when infants are dependent on life-sustaining technology (LST) to stay alive. These children are often expected to die within a relatively short time if LST is withheld or withdrawn. The objective of this study was to investigate long-term outcomes of babies who survive despite WWLST decision-making.

Objectives

The goals of this study were to: 1) examine the prevalence of WWLST discussions with parents in a level 3 NICU; 2) investigate decisions associated with WWLST discussions; and 3) examine survival and long-term outcomes of children when life-saving interventions (LSI) are withheld or withdrawn.

Design/Methods

In 2020 and 2021, the charts of all 6 years of level 3 unit NICU admissions were reviewed for presence of WWLST discussions or decisions, as well as the functional long-term outcome at 2 years for all children who survived. The decisions taken at the time of the WWLST discussions were categorized into 4 groups, using a modification of the Verhagen classification.

Results

WWLST discussions occurred for 266 of 5251 infants admitted to the NICU: 151 were term and 115 were preterm infants. In more than two-thirds of these discussions, themes related to concerns about the future and were mainly based on severe neurological prognosis. Among all discussions, 164 led to a WWLST decision, 130 of which were followed by the infant’s death. Of 34 children who survived to discharge despite WWLST, 20 were preterms and 14 were males. Among these, 10 died before 2 years of age and 11 require frequent medical follow-up. Major functional limitations were common among survivors, but eight were classified as functionally normal or as having mild to moderate functional limitations.

Conclusion

Many discussions about WWLST do not result in a decision to withhold or withdraw life-saving interventions. When a WWLST decision is taken, survival may occur, which is usually associated with poor long-term outcomes, but this trajectory is not universal. Discussions about WWLST should recognize all possibilities.
60 NICU Manager’s Perception of High Unit Activity and Its Association with Patient Care in the Neonatal Intensive Care Unit
Authors: Herman Carla
Published: September 2023

Background

Each year, 15,000 critically ill neonates require specialized care that is offered in only 32 tertiary neonatal intensive care units (NICUs) in Canada. Previous studies have shown associations between nurse-to-patient ratios and higher bed occupancy with patient outcomes.

Objective

To explore neonatal managers’ perceptions of organizational factors in Canadian NICUs.

Methods

This was a web-based cross-sectional survey, consisting of 20 questions pertaining to the determinants of resource allocation, the ascertainment of high occupancy state, as well as the different challenges and mitigation strategies implemented during periods of high unit strain. The survey was designed following the CHERRIES guidelines and was critically reviewed through a two-round validation process prior to deployment. It was sent by e-mail to the unit managers of all Canadian Level-3 NICUs between August and November 2022. They were invited to respond based on their unit’s practices in 2021. The analysis was conducted using descriptive statistics, where units were dichotomized by size (small unit ˂36 beds, large unit ≥36 beds).

Results

A total of 24 unit managers (75%) completed the survey. Most respondents relied exclusively on clinical judgment to estimate the total number of nurses required per shift (33%) and the individual nurse-to-patient ratios (67%) as opposed to nursing workload assessment tools (8% and 21%, respectively). The response for the proportion of nursing shifts perceived as adequately staffed was: 0% for 100% adequately staffed, 37% for ˃80% adequately staffed, and 27% for 60%-80% adequately staffed. The response for the proportion of nursing shifts perceived as understaffed to the point of being unsafe for patient care was: 17% for no understaffed, 52% for ˂20% understaffed, and 9% for 20%-40% understaffed. The most common organizational challenges were personnel recruitment and unit occupancy (each reported as being a major issue by 38% of respondents). Although most (75%) respondents believed that high occupancy, especially when exceeding 90%, likely increases the risk of adverse patient outcomes, they revealed implementing mitigation strategies to reduce occupancy only when it exceeded 95%. At that point, the most common strategies implemented were to call for additional voluntary nurses, implement voluntary nursing overtime, and accelerate patient transfer.

Conclusion

Although Canadian NICUs form a very heterogeneous group, managers shared similar perspectives in terms of staffing and occupancy challenges. This emphasizes the need for collaborative NICU person-power resource management practices to improve neonatal intensive care service organization.
62 Neurodevelopmental Outcomes Following Preterm Prelabour Rupture of Membranes Versus Spontaneous Preterm Birth among Infants Born at <29 Weeks of Gestation
Authors: Ricci M Florencia , Moddemann Diane , Zwicker Jill , Richter Lindsay , Pylypjuk Christy , Shah Prakeshkumar
Published: September 2023

Background

Few studies examine differences in neurodevelopmental outcomes between spontaneous preterm birth (sPTB) and those additionally complicated by preterm prelabour rupture of membranes (PPROM).

Objectives

This prospective cohort study from the Canadian Neonatal Follow-Up Network compared mortality and neurodevelopmental outcomes (Bayley-III scores <70 and <85, hearing/vision loss and cerebral palsy) at 18-24 months corrected age following PPROM versus sPTB among infants <29 weeks of gestation born between 2010-2018. Secondarily, this study compared neurodevelopmental outcomes between those with PPROM lasting 1-7 days, >7days, and sPTB.

Design/Methods

Differences in maternal-infant characteristics and neonatal morbidities were assessed by Chi-square and Student t-tests. Raw and adjusted odds ratios (OR) with 95% CIs were calculated to compare outcomes.

Results

Study population included 4271 children, 1503 (35%) PPROM, 2768 (65%) sPTB. The sPTB group had younger mothers, and a higher proportion of maternal nulliparity, maternal hypertension, and outborn infants. In the neonatal period, PPROM neonates had lower rates of ROP and severe neurologic injury. Raw OR comparing PPROM vs. sPTB showed decreased mortality (OR: 0.75[0.65, 0.87]), and decreased total cerebral palsy rates (OR: 0.57 [0.41, 0.80]) (Table 1).

Conclusion

Among Canadian infants born at <29 weeks of gestation, PPROM lasting 1-7 days associated with decreased mortality and decreased rates of non-ambulatory cerebral palsy at 18-24 months corrected age when compared to sPTB. Such findings may be explained by heightened maternal/fetal care in PPROM cases.

RESULTS

Table1 Comparisons of the neurodevelopmental outcomes between exposure groups.
77 Qualitative Needs Assessment of Child and Caregiver Perspectives to Inform Design of an Artificial Intelligence-enhanced Social Robot to Improve Paediatric Emergency Care
Authors: Hudson Summer , Nishat Fareha , Ali Samina , Litwin Sasha , Wiles Brittany , Foster Mary Ellen , Stinson Jennifer
Published: September 2023

Background

Children routinely experience under-treated pain and distress related to medical procedures, such as intravenous insertions (IVI), which can have negative consequences in both the short-term (e.g., fear, inability to complete procedure) and long-term (e.g., needle phobia, healthcare avoidance). Socially assistive robots (SARs) are a promising tool to manage pain and distress in paediatric healthcare settings. As we work towards building a more developmentally adaptive and interactive SAR, we must first understand how children and families perceive SAR to create a safe and ethical tool.

Objectives

The aim of this study was to understand children’s and caregivers’ perceptions of interacting with an artificial intelligence (AI)-enhanced SAR as a distraction tool in the paediatric emergency department (ED) to improve their IVI experience.

Design/Methods

We conducted semi-structured interviews and focus groups with children and their caregivers from two Canadian paediatric EDs between April 2021 to January 2022, with interview transcription and analysis conducted concurrently until thematic saturation was achieved. Qualitative content analysis was performed independently by two team members, who met regularly to discuss the coding scheme and key themes, and facilitate iterative adjustments to the interview script based on emerging themes.

Results

Nineteen children (mean age 8.42 years [SD 2.21]) and twelve caregivers were included. Three main themes were identified: (1) Overall ED experience, (2) General acceptance of a SAR, and (3) Suggested SAR features to support child engagement. Most participants were comfortable in the ED but identified long wait times and lack of technological supports (e.g., iPads) as an impediment to positive experience. Most participants expressed excitement and comfort surrounding robot technology. However, concerns were raised about photo/video capture by the SAR and the possibility of technical failure resulting in child disappointment or disengagement. Suggestions for potential robot features were unique to the phase of IVI: before IVI (developmentally appropriate procedure explanation, creation of a shared distraction plan); during IVI (variety and choice of distractions, SAR capability to stop or alter course); and after IVI (debriefing and positive reinforcement).

Conclusion

Overall, AI-enhanced SARs were perceived by children and caregivers as a promising tool to distract children. Insights collected will be used to inform the ethical and emotionally safe design of an AI-enhanced SAR. Next steps include development and usability testing of the SAR, subsequent evaluation in the paediatric ED via a randomized controlled trial, and clinical implementation.
80 Family Caregiver Emotional and Communication Needs in Canadian Paediatric Emergency Departments
Authors: Maki Claudia , Rahimi Asa , Ma Keon , Yaskina Maryna , Wong Helen , Stang Antonia , Principi Tania , Poonai Naveen , Gouin Serge , Froese Sylvia , Clerc Paul , Carciumaru Redjana , Alqurashi Waleed , Rajagopal Manasi , Kammerer Elise , Leung Julie , Wright Bruce , Scott Shannon , Ali Samina
Published: September 2023

Background

Paediatric emergency departments (EDs) have been identified as inherently stressful for families, making it challenging to understand and meet families’ global needs, beyond urgent medical care. There is a paucity of research describing how effectively the emotional and communication needs of family caregivers are met during ED visits.

Objectives

To describe the extent to which family caregivers’ emotional and communication needs were met during paediatric ED visits and relate these findings to visit and demographic characteristics.

Design/Methods

Electronic surveys with medical record review were deployed at ten Canadian paediatric EDs from October 2018 – March 2020. A convenience sample of families with children <18 years presenting to a paediatric ED were enrolled, for one week every three months, for one year per site. Caregivers completed one survey in the ED and a follow-up survey, up to seven days post-visit.

Results

This study recruited 2005 caregivers who were mostly identified as mothers (74.3%, 1462/1969); mean age was 37.8 years (SD 7.7). 71.7% (1081/1507) of caregivers felt their emotional needs were met. Staff physicians (35.6% [535/1502]), bedside nurses (24.2% [364/1502]), residents/medical students (13.8% [207/1502]) and triage nurses (12.4% [186/1502]) were identified as providing the best emotional support to caregivers. 86.4% (1293/1496) identified communication with the doctor as good/very good and 83.4% (1249/1498) with their child’s nurse. Caregiver involvement in their child’s care was reported as good/very good 85.6% (1271/1485) of the time. 81.8% (1074/1313) of caregivers felt comfortable in caring for their child at home at the time of discharge. Greater triage acuity, being the father (vs. mother), lower caregiver anxiety, respect for the child’s privacy, caregiver involvement in their child’s care, satisfactory updates, and having questions adequately addressed positively impacted caregiver emotional needs. Caregivers feeling less scared during an ED visit, lower caregiver anxiety, caregiver involvement in their child’s care, satisfactory updates, and having questions adequately addressed increased caregiver comfort in caring for their child’s illness at home.

Conclusion

Approximately 30% of caregivers presenting to paediatric EDs have unmet emotional needs, over 15% have unmet communication needs, and 15% felt inadequately involved in their child’s care, challenging healthcare providers to do better. Family caregiver involvement in care and good communication from ED staff are key elements in improving overall patient experience and satisfaction.
85 Incidence of Intravenous Immunoglobulins-related Adverse Events in Children
Authors: Chaloult-Lavoie Mathilde , Pelland-Marcotte Marie-Claude , Poulin Elisabeth , Hayes Laurence Amélie , Ouellet Pierre , Côté Jade
Published: September 2023

Background

Intravenous immunoglobulins (IVIG) therapy is increasingly used in the treatment of various paediatric diseases. Data about frequency and underlying mechanisms of IVIG-related adverse events (IVIG-AEs) in children are limited.

Objectives

Objectives of this study were to document the incidence of IVIG-AEs in paediatric hospitalized patients and identify risk factors for IVIG-AEs.

Design/Methods

In this retrospective cohort study, we included patients aged < 18 years old who received IVIG therapy, for any indication, as inpatients at a Canadian paediatric tertiary care centre between 2016-2020. Patients and IVIG-perfusion characteristics were collected, as well as any AEs occurring during the perfusion or up to 10 days after. AEs were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Bivariate and multivariate logistic regressions were used to explore the associations between patients’ characteristics and the incidence of IVIG-AEs.

Results

We included 228 children in this study (mean age: 4 years), receiving 478 IVIG infusions. Indications for IVIG infusions included inflammatory (120/228, 52.6%), replacement (27/228, 11.8%) and auto-immune (81/228, 35.5%) disorders. A total of 211 IVIG-AEs were reported in 89/228 (39%) of patients, and 125/478 (26.2%) of infusions. Fever (65/478, 13.6%) was the most frequent AE, followed by headache (32/478, 6.7%) and tachycardia (31/478, 6.5%). Most IVIG-AEs were of mild (121/211, 57%) or moderate (66/211, 31%) severity, but 12% (24/211) were severe reactions (serious AEs or grade 3-4), and no fatal reactions (grade 5) were encountered. The highest proportion of IVIG-AEs occurred when administered for inflammatory conditions. Older age, dehydration, first infusion, higher IVIG dosage and concurrent allergies were significantly associated with IVIG-AEs, while treatment with a steroid was significantly associated with a reduced risk of AEs.

Conclusion

IVIG-AEs are frequent in children. While most of them are self-limited, more serious complications may occur. Adequate hydration, low concentrations of IVIG products and the administration of glucocorticoid prior to the infusion could minimize these AEs. Further research is necessary to prevent IVIG-AEs in high-risk children.
87 Infant Malrotation with Midgut Volvulus Presenting in the Paediatric Emergency Department or the Neonatal Intensive Care Unit: A Retrospective Review for a Quality Improvement Initiative
Authors: Trottier Evelyne D , Filion Ludovik , Blondin Sarah Emmanuelle , Beaunoyer Mona , Miron Marie Claude , Assaad Michael
Published: September 2023

Background

In neonates, bilious vomiting is considered malrotation with midgut volvulus (MV) until proven otherwise, given its associated high morbidity and mortality. The diagnosis is time-critical, requiring prompt identification to avoid complications. Many of these patients are described as clinically well at time of presentation, possibly delaying definitive management.

Objectives

This study was a retrospective quality initiative aimed to evaluate the clinical presentation of infants and children with MV in a single paediatric tertiary care centre emergency department (ED) and neonatal intensive care unit (NICU). The study also aimed to identify delays in the management pathway.

Design/Methods

Patients with a final diagnosis of MV presenting to the ED/NICU were identified between January 2015 and May 2022. Patient demographics, signs and symptoms at presentation, initial laboratory studies, imaging, and surgical findings were recorded. The following time points were recorded: (1) first medical evaluation, (2) radiologic investigations (abdominal X-ray [AXR], ultrasound [US], upper gastrointestinal radiography [UGI]), (3) consultation with surgical team, and (4) time to surgery.

Results

During the study period, 29 paediatric patients presented a diagnosis of MV (ED: 21, NICU: 8). The median age at presentation was 7 days (3-13.5), with 27/29 (93%) being less than 3 months. From them, 21 patients (72%) were male. Bilious green (17/26) and/or yellow (13/26) vomiting was the most frequent presentation in 26/26 (100%), the three other patients had missing data. Five patients (17%) had a pH < 7.30 (with base deficit < -5) and seven (24%) patients had a glucose value > 7 mmol/L. Abdominal radiograph was performed in 17/29 (59%) patients. All (100%) had ultrasound (US) which was diagnostic in 24/29 (83%) cases. Six upper gastrointestinal series (UGI) were performed, being diagnostic in all cases (100%). The Ladd’s procedure was the standard treatment for every patient (100%). Median time between arrival and US was 151 minutes (71 – 243), UGI was 347 min (246 – 800) and surgery was 299 minutes (204-371). In the NICU specifically, six cases were referrals, with the median time between the first documented bilious vomit and the call from the referral centre being 660 minutes (335-1104). Of the 29 cases, 27 (93%) survived and from them, one suffered a short bowel complication.

Conclusion

Bilious (green/yellow) vomiting is a reliable clinical sign of MV in infants, being always aware that yellow may be bile. Ultrasound is a rapid test with more than 80% diagnostic accuracy. Delay for definitive surgery was considered slightly high. This quality initiative will help develop a clinical practice guideline and algorithm to reduce delays for infants presenting with MV.
92 Trends in COVID-19 Vaccination Coverage among Children <5 Years of Age in Canada
Authors: Jeevakanthan Ahash , Mi Fane Brigitte Ho , Roubos Sophia
Published: September 2023

Introduction/Background

COVID-19 vaccinations for those aged 6 months to 5 years were announced in the summer of 2022. Specifically, Moderna Spikevax and Pfizer-BioNTech Comirnaty were authorized on July 14, 2022, and September 9, 2022, respectively. Given that this was the last age group to become eligible for vaccination against COVID-19, promoting and measuring vaccination coverage in this vulnerable population is of public health significance.

Objectives

This analysis describes and compares the trend in vaccination coverage (VC) over the initial weeks of eligibility in those 0-17 years old.

Design/Methods

Data were obtained from the Canadian COVID-19 Vaccination Coverage Surveillance System and were analyzed to describe and compare VC of those <5, 5-11, and 12-17-year-olds over the first 16 weeks of eligibility. VC is defined as the percent of the population that have received at least 1 dose of a COVID-19 vaccine.

Results

Sixteen weeks after those <5 years became eligible for vaccination, coverage was 10.9% in those aged 2-4 and 6.3% in those aged <2. Compared to other paediatric age groups, VC in those <5 is markedly lower, where, after 16 weeks of eligibility, coverage in those aged 5–11 was 54.4% and 81.5% in those 12-17. There was an immediate spike in coverage for both 5–11-year-olds and 12–17-year-olds over the first 4 weeks following eligibility, where VC was 40.1% and 63.3%, respectively. A similar increase was not observed 4 weeks following eligibility in those aged <5, where VC was 7.4% in those aged 2-4 and 4.0% in those <2. The weekly increase in VC decreased more rapidly as age groups decreased; weekly increase in VC slowed to less than 1% in 28 weeks, 20 weeks, and 16 weeks after eligibility in those aged 12-17, 5-11, and <5, respectively.

Conclusion

These data suggest that VC over time in the <5 population has been slow and has not followed the trajectory of other paediatric populations, when compared to the 5-11 and 12-17 age groups. Reasons for this may include but are not limited to parents and guardians’ knowledge, attitudes, and beliefs toward getting their infant children vaccinated, as well as pandemic fatigue, as eligibility for the infant population occurred after the other paediatric age groups.
95 Teaching Them to Fish: Developing and Implementing a MicroResearch Training Program for Elementary School Students
Authors: Filliter Jillian , Hunter Kelly , Newell Caitlin , Kielley Karen , MacDonald Noni , Taylor Michael , Oyesiji Oyedolapo Oyetola , Towns Zachary , Pinsent Penny , Ricciardelli Rosemary
Published: September 2023

Introduction/Background

The MicroResearch (MR) program was developed to build local research capacity by providing community-focused research training and mentorship to health professionals. MR supports trainees, who are community members themselves, in identifying health problems relevant to their communities and developing solutions tailored to local context, culture, and resources. The MR team has received numerous inquiries about adapting the program for delivery in schools to foster key critical thinking and reasoning skills through hands-on participation in research.

Objectives

The goals of the current project were to: 1) adapt the MR curriculum to the learning needs of Grade Six students while retaining the program’s core content, 2) implement MicroResearch in Schools (MRiS) for the first time in a classroom setting, and 3) examine the feasibility of MRiS from student and facilitator perspectives.

Design/Methods

Twenty-one Grade Six students, divided into four research teams, participated in the first MRiS offering. One graduate student coach was assigned to each team and a local researcher with MR experience was a coach mentor. The traditional 10-day workshop model was replaced with 13 sessions across three months. Content was delivered through presentations on research topics and teamwork with coaches and reinforced by the classroom teacher between sessions. Key curriculum adaptations included shorter lectures; simplified language and concepts; structured worksheets; engaging examples, games, and activities; and a field trip to tour a research institution and library. Each team identified a research question and, guided by their coach, developed a research proposal that they presented to a panel of judges. Feasibility was evaluated based on achievement of MR goals, questionnaires completed by students, and verbal and written feedback from facilitators (teacher, coaches, presenters).

Results

All four teams developed health-related research questions and proposals that were deemed relevant, feasible, important, and innovative by a panel of judges. Student and facilitator feedback indicated that MRiS has good potential as an effective and engaging way to teach research concepts and skills to senior elementary school students. Several opportunities to further tailor the program to the classroom setting were identified (e.g., ways to make the content even more engaging and ensure sufficient role clarity and support for coaches).

Conclusion

Overall, our results suggest that MRiS is feasible and, with some further adaptations, could be a vital mechanism for fostering critical thinking and reasoning skills in students. We will follow the same students as they carry out their research projects and expect that this will further reinforce these invaluable skills.
99 Feasibility of a Co-designed Community Intervention for Families of Children with Developmental Diagnoses
Authors: Parmar Puneet , Suleman Shazeen , Kelly-Adams Deidre , Nwebube Chioma
Published: September 2023

Background

The COVID-19 pandemic has created considerable difficulties and barriers to accessing care for families of children with developmental disability (FCDD), particularly for families who are socially or economically marginalized. We have previously found that families have reported increased caregiver stress, difficulty navigating services and worsened social isolation. Building on these findings, a community-based intervention was co-created with community partners and families to improve social support, caregiver empowerment and access to services (see Figure 1, below), consisting of a ‘toolkit’ of resources with an accompanying workshop for caregivers and community service providers (CSPs), and a chat group community of support for caregivers.

Objectives

This study explored the feasibility of the co-designed intervention, examining the acceptability, implementation, and demand.

Design/Methods

This was a mixed-methods feasibility study, which incorporated quantitative and qualitative evaluation components, and received Research Ethics Board approval (SMH 20-127). Demand and implementation were assessed by measuring participant attendance in the workshops. Acceptability was assessed using post-workshop questionnaires to measure satisfaction and knowledge uptake, and further explored in semi-structured interviews, which were recorded, transcribed and analyzed using thematic analysis. Any caregiver, and CSPs who participated in any arm of the intervention, were invited to participate.

Results

Workshops were held 6 times (4 caregiver workshops, 2 staff workshops) in two community partner sites. A total of 55 participants (32 caregivers, 23 staff) participated. After receiving the toolkit and attending the workshop, both caregivers and CSPs reported that they felt more comfortable with navigating services, which was higher in CSPs (4.58/5, p<0.005). 100% of participants wanted additional iterations of the workshops with the toolkit. In the IDIs, both CSPs and caregivers reported that the toolkit was comprehensive and easy-to-use. Many caregivers reported using the toolkit immediately after the workshops to connect to new services. Among both CSPs and caregivers, it was found that the group chat was not commonly used but had the potential to be a helpful tool to share additional resources and discuss specific topics.

Conclusion

This community-based, co-created intervention was implemented successfully, with high acceptability and demand. Both CSPs and caregivers found the toolkit to be useful and have used it to successfully access services, while the group chat was less used. Our study demonstrates the critical importance of working alongside community to co-create interventions to best serve specific community needs.
C9 (Clinical Case) Monkeypox Virus Infection in a 2-Month-Old Infant
Authors: Payette Justine , Saleh Sima , Renaud Christian , Coulombe Jérôme , Quach Caroline , Charest Hugues
Published: September 2023

Introduction/Background

The 2022 Monkeypox virus outbreak shed attention on an illness that is rare in non-endemic countries. Children are at risk of severe disease based on case series from previous outbreaks. Tecovirimat may be considered as a therapy in young children. Its efficacy and safety profile, however, have never been formally studied. This case report presents the first laboratory-confirmed case of monkeypox virus infection in a Canadian infant and its management.

Case Description

A 2-month-old infant presented to an emergency department with a vesiculopustular skin rash. A week before, parents noticed an eruptive cluster of 3 fluid-filled vesicles on the infant’s forehead. In the next days, vesiculopustular lesions appeared on his body. One spike of temperature was reported with no other sign of illness. On physical examination, a dozen umbilicated well-circumscribed vesico-pustules were observed with minimal skin inflammation. They ranged from 2 to 5 mm in size and were scattered over the face, trunk and limbs including palms and soles. In addition, 3 confluent crusted umbilicated lesions were present on the forehead.

Discussion

Differential diagnosis included varicella zoster virus, herpes simplex virus, and enteroviral infections. Empiric intravenous acyclovir was initiated pending specimen analysis. Bacterial culture and viral PCRs were negative on CSF and skin specimens. Due to transmission of monkeypox in the local adult population, orthopoxvirus was tested by PCR. The result was positive on a skin specimen and was later confirmed by the National Microbiology Laboratory of Canada.

Because of the patient’s age and ongoing new lesions, tecovirimat was initiated. After 24 hours, new lesions stopped appearing and regression and crusting of active lesions were noted. Treatment was continued for 14 days without adverse events.

Although parents denied similar symptoms, an epidemiological link was postulated, given work exposure in a setting with high risk of transmission in one of them.

This case adds insight on the clinical features, the course of disease and management in infants. This 2-month-old infant did not develop any complication from the illness and was among the youngest patients with monkeypox to be treated with tecovirimat.

Conclusion

As monkeypox infection remains rare in children and may convey a higher risk for severe disease, a high degree of suspicion is warranted for clinicians caring for children. Monkeypox should be included in the differential diagnosis of an unexplained vesiculopustular rash. Finally, tecovirimat as a treatment for monkeypox infection in children was shown here to be safe and effective, even when started late in the evolution.