bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative HRTEM and its application in the study of oxide materials*
Authors: Jia Chun-Lin , Mi Shao-Bo , Jin Lei
Published: May 2018

On the basis of a state-of-the-art aberration-corrected transmission electron microscope, the spherical aberration coefficient C
S of the objective lens can be tuned to either a positive or a negative value. The use of a negative value of C
S combined with an overfocus setting of the objective lens leads to the development of the negative C
S imaging (NCSI) technique. Images obtained using the NCSI technique show superior contrast and signal intensity at atomic column positions than the corresponding positive C
S images, especially for weakly scattering oxygen columns that are in close proximity to strongly scattering cation columns in oxides. Based on the images obtained under the NCSI condition, quantification of the image contrast allows measurements of the atom positions with a precision of a few picometers and the local chemistry on atomic scale. In the present review, we discuss firstly the benefits of the NCSI technique in studies of oxide materials, and then show a procedure for quantitative analysis of the image based on the absolute value of contrast. In the last part, examples are given for the application of the quantitative high-resolution transmission electron microscopy (HRTEM) to the study of electric dipoles of oxide ferroelectrics and atomic-scale chemistry of interfaces.
QUELLE SPÉCIFICITÉ POUR LES BESOINS DE SANTÉ DES RÉFUGIÉS MINEURS NON ACCOMPAGNÉS? EXPÉRIENCE D’UNE CONSULTATION AMBULATOIRE DE MÉDECINE DE L’ADOLESCENT EN SUISSE
Authors: Narring Françoise , Patseadou Magdalini , Weber Catherine Chamay
Published: May 2018

BACKGROUND

Environ 3% des demandeurs d’asile sur le sol européen arrivent en Suisse et leur nombre a été multiplié par 10 entre 2000 et 2015. Les jeunes mineurs non accompagnés (MNA), parmi eux représentent un groupe particulièrement vulnérable.

OBJECTIVES

Le but de cette étude est d’identifier les problèmes les plus fréquents repérés et d’évaluer leur parcours de soin dans le pays d’accueil.

DESIGN/METHODS

Une étude rétrospective des dossiers médicaux informatisés de tous les adolescents MNA de 12 à 18 ans ayant consulté l’unité ambulatoire de l’Hôpital universitaires de Genève pour la première fois en 2015 et 2016 a analysé les données concernant les consultations de premier recours, les consultations avec des spécialistes et les admissions aux urgences. Les diagnostics codés à l’aide de la CIM-10 ont été classés en 5 catégories: 1) maladies transmissibles; 2) maladies non transmissibles; 3) carence nutritionnelle; 4) problèmes de santé mentale; 5) plaintes floues.

Un total de 226 jeunes MNA ont été inclus (89.4% de sexe masculin; âge moyen 16,4 ans).

RESULTS

La majorité (90,2%) ont au moins un problème de santé: 44% maladie transmissible, parasitoses principalement; 38% maladie non transmissible, acné et maladie chronique majoritairement; 43% carence nutritionnelle; 35% de problème de santé mentale, principalement troubles émotionnels et stress post traumatique; 31% de plaintes floues.

Un quart des jeunes MNA ont eu plus de 6 consultations avec le médecin durant les 12 premiers mois, deux tiers ont été référés à un spécialiste (dermatologie ou cardiologie pour les plus nombreux), 43% d’entre eux ont consulté au moins une fois le service des urgences pour un problème somatique aigu ou une détresse psychologique.

CONCLUSION

Les besoins de santé des jeunes MNA sont importants et devraient être une priorité dans les pays d’accueil de ces jeunes.
A GROUP FOR PARENTS OF YOUTH WITH CHRONIC PAIN: RATIONALE, STRUCTURE, CONTENT, AND PRELIMINARY OUTCOME DATA
Authors: Edwards Kim , McMurtry C Meghan , Lee Soeun , Jackson Elena
Published: May 2018

BACKGROUND

Parenting a youth with chronic pain can be challenging and have a significant impact relationally, emotionally and financially on caregivers (Palermo, 2000; Lewandowski et al., 2010). There is a growing literature indicating that parent emotions (e.g., anxiety, depression), cognitions (e.g., coping, pain catastrophizing), and behaviours (e.g., attending to pain symptoms) can moderate a child’s adjustment to chronic pain (Logan & Scharff, 2005; Palermo et al., 2014; Palermo & Eccleston, 2008). Therefore, intervening with parents of youth with chronic pain is believed to foster better outcomes regarding children’s functioning (e.g., school attendance; Coakley & Wihak, 2017).

OBJECTIVES

No study has evaluated a stand-alone intervention targeted at parents of youth with chronic pain. Consequently, this poster presents a five week parenting group that we developed and ran on four occasions. Preliminary results pertaining to group feasability, satisfaction, and effectiveness will also be presented.

DESIGN/METHODS

The group is designed to augment the treatment of youth in our program and includes the following topics: chronic pain 101 (psychoeducation), impact of pain on the family, self-care, tools for managing a child’s pain, identifying and overcoming barriers, school partnerships, and celebrating successes. Each session involves homework review, a mindfulness activity, new material (inclusive of a didactic activity), goal-setting, and assigned readings.

To date, 41 parents of youth with chronic pain have participated in the four group cycles. Outcomes were measured using the Adult Responses to Children’s Symptoms (ARCS) Questionnaire (Noel et al., 2015; Van Slyke & Walker, 2006) which parents completed at the start and end of the group. Feedback and parent satisfaction were also obtained on a feedback form designed by authors and given on the last session of group.

RESULTS

Overall, the group demonstrated adequate feasibility, was well-received by parents, and high satisfaction was reported. Preliminary data suggest that the group was helpful in reducing some parental responses associated with maladaptive child outcomes. More specifically, statistically significant decreases in protectiveness, monitoring, and minimizing (subscales of the ARCS) were found after the 5 week intervention.

CONCLUSION

“Anecdotally, many parents expressed uncertainty about how to respond when adolescents complained of pain and refused to go to school, and parents appeared eager for…strategies to help them negotiate the situation” (Logan & Simons, 2010, p. 833).

Our results are consistent with previous literature (Logan & Simons, 2010; Saunders et al., 1994) and suggest that intervening with parents may help improve outcomes for youth with chronic pain.
ARE SEXUALLY ABUSED CHILDREN AT RISK FOR VICTIMIZATION BY PEERS?
Authors: Bernard-Bonnin Anne-Claude , Tremblay-Perreault Amélie , Hébert Martine , Allard-Dansereau Claire
Published: May 2018

BACKGROUND

A few studies suggest that children who suffered maltreatment are more at risk for victimization by peers. However, there is little knowledge about factors that may influence the risk of re-victimization by peers for sexually abused (SA) children.

OBJECTIVES

Identify if self-blame and post-traumatic stress symptoms (PTSS) are risk factors for SA children victimization by peers.

DESIGN/METHODS

376 children (248 girls and 128 boys) between 5 to 14 years of age were recruited within five centers for child and youth SA evaluation. Victimization by peers was measured with the Report Victimization Scale answered by the child, his parent and his teacher. PTSS were measured with the subscale of the Children’s Impact of Traumatic Events Scale (CITES II) and self-blame was measured with three items from the subscale guilt/blame of ​CITES II. Characteristics of the abuse were abstracted from the medical chart. Description of SA was done according to Russell’s classification: less severe (physical contact over clothing), severe (physical contact without penetration, and without using of force), very severe (attempted or actual penetration). Statistical analysis was done through logistic regression.

RESULTS

Abuse was very severe in 61% of cases and chronic in 37.4% of cases. Aggressors were family members in 53.3% of cases. Clinical level of peer victimization was reported for 19.2% of children by their own score, 9.2% by parental score and 3.6% by teacher’s score. PTSS were at the clinical level for 53.3% of children Around 60% of the sample reported feelings of blame, as indicated by at least one score of “somewhat true”on one of the three items. The dichotomized analysis (clinical vs subclinical score of victimization by peers) showed that PTSS were positively associated with the child’s peer victimization score (Exp (B) = 1.05, p<.02), and self-blame was positively associated with the parent’s peer victimization score (Exp(B)=1.23, p<.05). Results of a Sobel test revealed that PTSS completely mediated the positive relationship between self-blame and peer victimization (Standard Beta = .37, p<.01). In the final model, self-blame was positively associated with PTSS (Standard Beta = .54, p<.01), while the latter were positively associated with victimization by peers (Standard Beta = .44, p<.01). The final model explained 26.7% of the variance of victimization by peers.

CONCLUSION

These results suggest that PTSS and self-blame are key targets for intervention in order to diminish the risk of victimization by peers in SA children.
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) IN SCHOOL-AGED CHILDREN AT TWO SCHOOL BASED HEALTH CENTERS (SBHCS): A DESCRIPTIVE STUDY
Authors: Ghosh Nayantara , Aiyadurai Ramanan , Freeman Sloane
Published: May 2018

BACKGROUND

The number of school-aged children diagnosed with ADHD in Canada has been on the rise over the past three decades. Evidence suggests that children with ADHD dealing with risk factors, such as poverty and prolonged wait-times are more likely to have poorer outcomes due to challenges in accessing healthcare services. Schools are ideal for the early identification of children with ADHD, as they are often the setting in which attention and behavioural issues come to light. School-Based Health Centres (SBHCs) are embedded within the school system and are an ideal entry point for children with ADHD into the healthcare system.

OBJECTIVES

To examine the prevalence of ADHD and as well as demographic characteristics and time to assessment of children at two inner-city SBHCs in Toronto.

DESIGN/METHODS

A retrospective chart review was performed on 869 children from November 2010- March 2016 from two SBHCs. Frequency measures were used to determine the proportion of children that received a new diagnosis of ADHD. Within this population, the patient’s age, gender, ethnicity, parental income, home arrangement, parental education and newcomer status were described. Diagnostic wait-times within the SBHC were calculated using two specific data points – a child’s first clinic visit data and the clinic date they saw a general paediatrician, who would provide the ADHD diagnosis.

RESULTS

Of the 869 children, 9.6% of children received a new diagnosis of ADHD. The mean age of diagnosis was 7.6 years and 80% of the children were male. 74.6% of children’s families identified them as an ethnicity other than white. 60.2% of the patients’ household income was <$30,000/year. 44.5% of the families were composed of single-parent households. 52.8% of the patients’ mothers and 47.6% of fathers had completed a high school level of education or less. 34% of the children were not born in Canada, and of those, 57% had been in the country for only 0–3 years. The average wait time for a child to see a general paediatrician for a developmental assessment from initial visit date was 62.3 days.

CONCLUSION

The prevalence of ADHD at 2 SBHCs was higher than that reported in the general population. A number of barriers to health care access were identified in this cohort of children including low income, single parent homes and newcomer status. SBHCs serve as an accessible health care model that can provide timely diagnosis and management to vulnerable children with ADHD which may improve outcomes.
UTILIZATION OF COMPUTED TOMOGRAPHY FOR PEDIATRIC HEAD TRAUMA FROM 2007–2014 IN THE UNITED STATES: BEFORE AND AFTER PECARN CLINICAL DECISION RULES
Authors: Burstein Brett , Upton Julia , Fuzaro Terra Heloisa , Neuman Mark I
Published: May 2018

BACKGROUND

The Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules identify children at low risk of clinically important traumatic brain injury in whom computed tomography (CT) neuro-imaging can safely be avoided. Since publication in 2009, these rules have been externally validated and are widely used in the Emergency Department (ED) assessment of children with acute head trauma.

OBJECTIVES

This study sought to determine if the proportion of children receiving CT-imaging in US EDs following head trauma has decreased following the development of PECARN rules.

DESIGN/METHODS

This study was a cross-sectional study using the National Hospital Ambulatory Care Survey (NHAMCS) database from 2007–2014. NHAMCS collects data on approximately 30,000 nationally representative visits annually to 300 randomly selected U.S EDs. We included all children <18 years old presenting with a chief complaint or discharge diagnosis of head injury. We collected data on patient demographics, reason for ED visit, discharge diagnosis, patient disposition, and use of head CT. Multivariable logistic regression was used to identify characteristics of CT use, with appropriate weighting to account for the survey methodology. The primary outcome was proportion of children receiving a head CT before and after 2009.

RESULTS

There were 55,253 paediatric visits during the 8-year study period. Among these, 2,783 (5.3% 95%CI 5.0%-5.6%) met inclusion criteria, representing 12,417,725 paediatric head trauma visits. Median patient age was 6 years (IQR 2–13 years), 62% were male, and a majority were evaluated in non-teaching and non-paediatric hospitals (88% and 90%, respectively). Overall, 32% (95%CI 29%-35%) underwent CT neuroimaging. There was no significant difference in CT use after 2009 (31% after vs. 33% before, p=0.41). Multivariate analysis similarly demonstrated no difference after adjustment for patient age, gender, race, insurance provider, paediatric or teaching hospital, admission status and triage acuity (AOR 1.02 after vs. before, 95%CI 0.79–1.32, p=0.85). Factors associated with increased CT use were age ≥2 years (AOR 1.4, 95%CI 1.1–1.9, p=0.02), admission (AOR 5.3, 95%CI 2.2–12.4, p<0.001), highest triage acuity (AOR 7.3, 95%CI 3.5–15.3, p<0.001) and presentation to a non-teaching (AOR 1.5, 95%CI 1.1–2.2, p=0.02) or non-paediatric (AOR 1.5, 95%CI 1.3–2.8, p<0.01) hospital.

CONCLUSION

The use of CT neuro-imaging did not decrease in the 5-year period following derivation of PECARN rules. Findings suggest an important need for quality improvement initiatives to ensure appropriate CT utilization among head injured children.
ACCELERATED GROWTH IN EARLY CHILDHOOD IS ASSOCIATED WITH INCREASED SYSTOLIC AND DIASTOLIC BLOOD PRESSURE
Authors: Eny Karen , Maguire Jonathon , Dai David , Lebovic Gerald , Adeli Khosrow , Hamilton Jill , Hanley Anthony , Mamdani Muhammad , McCrindle Brian , Tremblay Mark , Parkin Patricia , Birken Catherine
Published: May 2018

BACKGROUND

Maternal obesity, low birthweight, and accelerated growth have been shown to be associated with elevated blood pressure in children. However, it is unknown which growth periods are associated with blood pressure, and whether birthweight or maternal obesity modify the relationship between growth and blood pressure in early childhood.

OBJECTIVES

We examined the relationship between age- and sex-standardized body mass index (zBMI) growth trajectories with longitudinal measures of systolic (SBP) and diastolic (DBP) blood pressure in early childhood.

DESIGN/METHODS

We collected repeated measures of zBMI and blood pressure in 2502 children participating in the TARGet Kids! cohort. In stage 1 we used linear spline multilevel models to estimate each child’s zBMI at birth and zBMI growth trajectories in early infancy (0–3 m), late infancy (3–18 m) and toddler years (18–36 m). In stage 2 we used generalized estimating equations to examine the relationship between zBMI at birth and zBMI growth with repeated measures of SBP and DBP from 3 to 6 years of age. We tested for effect modification by birthweight and maternal obesity status by inclusion of interaction terms in each growth period.

RESULTS

After adjusting for confounders and prior growth, a 1 standard deviation unit increase in zBMI growth per month in early infancy (β=0.59; 95% CI 0.32,0.87) and late infancy (β=0.73; 95% CI 0.44,1.01), were associated with higher SBP. Growth in the toddler years was not significantly associated with SBP (p=0.08). Similar but smaller associations were observed for zBMI growth and DBP in early (β=0.29; 95% CI 0.04, 0.53) and late infancy (β=0.42; 95% CI 0.18, 0.66). Birthweight status modified (p=0.004) the relationship between zBMI growth and SBP during late infancy, with the strongest positive association observed in the low birthweight group. During toddler years, birthweight status modified the relationship between zBMI growth with SBP (p=0.03) and DBP (p=0.04), with the strongest positive association observed in the low birthweight group, followed by the high birthweight group. Maternal obesity status modified (p= 0.03) the relationship between zBMI growth with DBP in late infancy, with a stronger association observed among children of mothers with obesity.

CONCLUSION

Accelerated growth in early and late infancy are associated with increased blood pressure in early childhood. Growth during late infancy and toddler years may impact blood pressure differently in children born with high and low birthweights and high maternal BMI, suggesting prospective windows and risk groups to target interventions.
Anticipating pediatric patient transfers from intermediate to intensive care
Authors: Cheng Daryl , Hui Caitlyn , Langrish Kate , Beck Carolyn
Published: May 2018

BACKGROUND

Paediatric intermediate care units (IC) function to provide a higher level of inpatient paediatric care such as frequent monitoring or nursing intervention compared to routine inpatient general paediatric care. A small subset of these patients in IC deteriorate further and require transfer to the paediatric intensive care unit (PICU). By identifying patient characteristics at the time of admission that predict secondary transfer, specific monitoring, resource allocation and early intervention may be implemented in order to improve quality of care. Appropriate and timely patient flow and length of stay (LOS) can also be optimized.

DESIGN/METHODS

The IC at our tertiary care institution admits predominantly general paediatric patients. Its admission criteria have been designed with input from stakeholders, and comprise a range of physiologic and resource based measures.

Data were collected on patients who were admitted to IC, including those subsequently transferred to PICU, between July 2016 - June 2017. Patients whose index IC admission was from the PICU were excluded. Data included demographic and physiologic characteristics (heart rate, respiratory rate, temperature, oxygen therapy) and the bedside paediatric early warning system (BPEWS) score, a validated score based on vital signs. Quantitative and qualitative data were analyzed using Fisher and Mann-Whitney tests respectively.

RESULTS

210 patient visits occurred in this time period, with 44 (20.95%) transferred to PICU (Table 1). Transferred patients showed no significant difference in age or sex. However, they had significantly higher median BPEWS, heart rate, respiratory rate and mean body temperature compared to non-transferred patients, as well as a significantly higher rate of respiratory support and shorter LOS on IC. There was a non-significant trend toward admission directly from the Emergency Department (ED) in transferred patients. Admission criteria and main organ systems affected were similar amongst both groups, with a predominance of respiratory conditions.

PICU transfer was predicted by most physiological characteristics, including BPEWS. This coupled with a significantly shorter length of stay is a likely reflection of higher disease acuity in this group of patients and higher risk of deterioration and subsequent transfer to PICU.

CONCLUSION

The need for close monitoring of physiologic parameters remains paramount in predicting the need for transfer from the IC to PICU.
DURATION OF SUSTAINED INFLATION DURING SUSTAINED INFLATION AND CHEST COMPRESSION IN A PORCINE MODEL OF ASPHYXIA
Authors: Mustofa Jannatul , Patel Sparsh , Cheung Po-Yin , Lee Tze-Fun , Pasquin Matteo , O’Reilly Megan , Schmolzer Georg
Published: May 2018

BACKGROUND

Current resuscitation guidelines recommend 3:1 C:V ratio, however the most effective C:V ratio in newborns remains controversial. We recently demonstrate that combining chest compressions (CC) with a sustained inflation (SI) (=CC+SI) significantly improves return of spontaneous circulation (ROSC) in asphyxiated newborn piglets compared to 3:1 C:V resuscitation. However, the optimal length of SI during CC+SI is unknown.

OBJECTIVES

To examine if a 60sec SI compared to a 20sec SI or 3:1 C:V will reduce will reduces ROSC during resuscitation in asphyxiated newborn piglets.

DESIGN/METHODS

Cardiac arrest with achieved was induced in newborn piglets and then randomized to receive either “3:1 C:V ratio, SI+CC-20sec” or “SS+CC-60sec”. Piglets randomized to “SI+CC+20sec” or “SI+CC+60sec” received 90/min CC during a SI of 20sec or 60sec. Piglets randomized to 3:1 C:V received 90/min CC and 30 inflations/min. The default settings for airway pressures were peak inflation pressure of 30 cm H2O and a positive end expiratory pressure of 6 cm H2O. The primary outcome was duration of CC to achieve ROSC.

RESULTS

Eight piglets were randomized to each group; the mean (SD) age and weight was similar between groups.

Median (IQR) ROSC was significantly shorter in the SI+CC-20sec and SI+CC-60sec group with 96 (68–168) sec and 78 (60–91) sec compared to the 3:1 C:V group with 235 (182–347)sec (p=0.002). 5/8 in the SI+CC-60sec group, 7/8 in the SI+CC-20sec and 8/8 in the 3:1 C:V group received epinephrine (p=0.82).

CONCLUSION

Lengths of SI during CC+SI does not affect ROSC, however CC+SI compared to 3:1 C:V does improve ROSC in newborn piglets.
DOES PRETERM INFANTS BORN OUTSIDE TERTIARY PERINATAL CENTRE HAVE AN IMPACT ON NEURODEVELOPMENTAL AND GROWTH OUTCOME AT 36 MONTHS CORRECTED AGE?
Authors: Soraisham Amuchou , Sheta Ayman , Ringtham Catherine , Tang Selphee , Creighton Diane , Hendson Leonora , Lodha Abhay
Published: May 2018

BACKGROUND

Infants born in tertiary perinatal centres (inborn) have higher survival and lower morbidity than outborn infants. However, there is limited information regarding the long term neurodevelopmental and growth outcomes among outborn preterm infants.

OBJECTIVES

To compare the neurodevelopmental and growth outcomes at 36 months corrected age (CA) between outborn and inborn infants born < 29 weeks.

DESIGN/METHODS

This is a retrospective cohort study. We included infants born <29 weeks admitted to Foothills Medical Centre, Calgary between January 2000 and December 2012, who had neurodevelopmental(ND) assessment up to 36 months CA. Infants with intrauterine infection, major congenital and chromosomal anomalies were excluded. Our primary outcome was composite of death or neurodevelopmental impairment (NDI). We compared ND and growth outcomes between inborn and the outborn infants using univariate and multivariate logistic regression analysis.

RESULTS

Of 1235 eligible infants, 175 (14%) were outborn. Outborn infants were lower in GA (25.8 ± 1.7 wk vs 26.2 ± 1.5 wk), had lower chorioamnionitis rate (15% vs 24%), received less antenatal steroid (55% vs 90%) and maternal antibiotics (51% vs 68%). Neonatal morbidities were similar between the two groups except that outborn infants had higher rates of severe brain injury (24% vs 12%) and mortality (22% vs 11%).

Of 1078 eligible survivors, 1048 (97%) were followed. There was no difference in ND outcomes (Table). Multivariate regression analysis controlling for potential confounders (GA, gender, chorioamnionitis, antenatal steroids and maternal age) showed outborn status was not associated with composite primary outcome of death or ND impairment (adjusted OR: 1.09, 95% CI, 0.69, 1.70). Growth outcomes were not significantly different between two groups.

CONCLUSION

In this cohort, neurodevelopmental and growth outcomes does not appear to be significantly different between outborn and infants at 36 months corrected age.
ARE CANADIAN NEONATOLOGISTS READY FOR A STEM CELL TRIAL FOR BRONCHOPULMONARY DYSPLASIA?
Authors: Guillot Mireille , Asad Sarah , Presseau Justin , Lalu Manoj M , Lemyre Brigitte , Thébaud Bernard
Published: May 2018

BACKGROUND

Pre-clinical studies support the role of stem cells in preventing bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurity. We are planning the first Canadian clinical trial of stem cell therapy for BPD.

OBJECTIVES

To ensure successful bench-to-bedside translation, the objective of our study was to identify the barriers and enablers that may influence neonatologists’ decision to identify extremely preterm infants at risk of BPD for participation in a stem cell trial for BPD.

DESIGN/METHODS

Semi-structured interviews were conducted with neonatologists across Canada. We used the Theoretical Domains Framework (TDF) to develop an interview topic guide covering 14 key domains that influence behavior (e.g. knowledge, intentions, goals, social influences). Two independent researchers used directed content analysis (using qualitative software NVIVO 11) to assign utterances to TDF thematic domains. We further identified sub-themes within domains to identify key barriers and enablers to neonatologists identifying infants for the planned trial.

RESULTS

Sixteen interviews were conducted with neonatologists across Canada (Western Canada n=7, Central Canada n=7, Eastern Canada n=2). Seven were practicing as a neonatologist for 10 years or less, 5 for 11–20 years and 4 for >20 years. Preliminary analyses demonstrated that neonatologists are eager to help identify patients for this study due to the importance they place on trying to treat BPD. Many participants had worries concerning the lack of evidence on long-term outcomes of stem cell therapy. Access to clear protocols, well defined eligibility criteria, and research assistants were brought up as key facilitators for screening patients. The most commonly reported barrier included the need for human resources (e.g. research assistants), funding, and institutional support to help screen patients.

CONCLUSION

Our interviews identified facilitators and barriers from a neonatologist perspective to a potential stem cells trial for BPD. Our findings will inform the design of a phase I/II clinical trial.
DOES THE TIMING OF INITIATION OF THERAPEUTIC HYPOTHERMIA INFLUENCE MRI FINDINGS AND OUTCOMES IN ENCEPHALOPATHIC BABIES?
Authors: Guillot Mireille , Philippe Marissa , Miller Elka , Davila Jorge , Borrowman Nick , Harrison Mary-Ann , Fadel Nadya Ben , Redpath Stephanie , Lemyre Brigitte
Published: May 2018

BACKGROUND

Therapeutic hypothermia (TH), initiated < 6h of life, is the standard treatment for infants with moderate to severe hypoxic ischemic encephalopathy (HIE). While preclinical studies show that TH is more effective when started early, little clinical data exists.

OBJECTIVES

The objectives of our study are to examine the effect of early vs. late TH on the severity and pattern of brain injury on MRI and on the neurodevelopmental outcomes.

DESIGN/METHODS

This retrospective cohort included infants with HIE treated with TH at a level three neonatal intensive care unit between 2009 and 2016. Babies were grouped into: early cooling (TH started ≤ 180 minutes of life) or late cooling (TH started > 180 minutes of life). Two radiologists evaluated the severity and pattern of brain injury on MRI using both NICHD and Barkovich scoring system. Neurodevelopmental outcomes were evaluated at 4, 10, 18 and 48 months.

RESULTS

Ninety-four patients (median gestational age 39 weeks; median birth weight 3.3 kg) were included in the study, 55 in the early cooling and 39 in the late cooling group. The early cooling group included more patients with severe HIE (32.7% vs 10.3%, p=0.01). No difference was observed between the 2 groups in regard to the pattern and severity of brain injury. In the late cooling group, there was a trend toward more severe watershed (WS) injury (WS score ≥3) (30.6% vs 17%, p=0.19) and more moderate to severe brain injury (33.3% vs 23.4%, p=0.33). There was no difference in the neurodevelopmental outcomes between the 2 groups.

CONCLUSION

TH initiated early (before 180 minutes of life) was neither associated with a difference in brain injury on MRI nor better neurodevelopmental outcomes. Despite having more infants with severe HIE in the early cooling group, there was a trend toward less significant brain injury in this group.
THE EFFECT OF EYEMASKS ON REDUCING DISTRESS ASSOCIATED WITH THE RETINOPATHY OF PREMATURITY EXAM
Authors: Speckert Matthew , Szigiato Andrei-Alexandru , zielonka Jeanne , Hollamby Kathleen , Ng Eugene , Altomare Filiberto , Sgro Michael , Nisenbaum Rosane
Published: May 2018

BACKGROUND

Retinopathy of prematurity (ROP) is a disorder of retinal development in the low birthweight preterm infant. Eye screening is routinely performed for infants at risk of developing this disorder. While these examinations help prevent blindness, they can be physiologically stressful for infants, with changes in oxygen saturation, blood pressure and heart rate occurring during the exam and increased apneic episodes reported the 24–48 hours period afterward. The cause of these increased apneic episodes is not currently known.

OBJECTIVES

To evaluate the effect of decreasing light simulation during mydriasis on the frequency of stressful episodes after ROP screening.

DESIGN/METHODS

Multi-centre randomized study. This study was approved by hospital ethics boards at all sites. After informed consent was obtained, infants with a birthweight <1500g or gestational age of ≤32 weeks and scheduled for their first ROP screening were randomized to receive either standard of care or a phototherapy mask during pupil dilation, in addition to routine care. Dilated retinal exams were performed by retinal surgeons and fellows. The primary outcome was the frequency of any desaturation, bradycardic event, or apneic event 12 hours following the examination, compared to a baseline rate 12 hours prior to the exam. Heart rate, respiratory rate and oxygen saturation were recorded for up to 48 hours following the examination and compared to baseline.

RESULTS

A total of 51 infants were enrolled; 28 randomized to the masked group and 23 to the control group. 10 and 13 infants were on ventilator support at the time of examination in each group, respectively. There was a 57.7% decrease in the total number of all stressful events in the masked group compared to controls in the 12 hour post exam period (Rate Ratio 0.42, 95% CI 0.2–0.9, P=0.024). There was a 61.3% decrease in the number of bradycardic events in the masked group compared to controls (RR 0.39, 95% CI 0.2–1.0, P=0.042). Heart rate was significantly higher in both groups after the exam (Effect by time P=0.04), with no difference in between groups (Effect by group P=0.31). There was no significant difference seen in either group in respiratory rate or oxygen saturation at 2 or 4 hours after the ROP examination compared to baseline. Risk factors that were associated with increased stress included: younger gestational age (RR=1.32 95%CI [1.2–1.5] per week), lower birthweight (RR=1.39 [1.2–1.5] per 100g), ventilator support around the time of exam (RR=2.67 [1.3–5.6]), diagnosis of intraventricular hemorrhage (RR=3.78 [1.9–7.3]), and hyponatremia (RR=3.42 [1.8–6.6]). No adverse events occurred while using eye masks.

CONCLUSION

The infants who wore a phototherapy mask during pupillary dilation had lower rates of stressful episodes following screening for retinopathy of prematurity, particularly lower episodes of bradycardia.
PERSPECTIVES ON NEONATAL RESUSCITATION TRAINING IN A CANADIAN PEDIATRIC RESIDENCY PROGRAM: COMMUNITY VERSUS TERTIARY CARE EXPERIENCES
Authors: Woodward Mary , Hunter Andrea , McConnell Meghan , Williams Connie
Published: May 2018

BACKGROUND

The competencies involved in neonatal resuscitation include a thorough knowledge of transitional neonatal physiology as well as technical expertise, the ability to lead a multidisciplinary team, and appropriate management of resources. In Canadian paediatric training programs, residents acquire neonatal resuscitation competency in both community and tertiary care settings. There is limited literature regarding experiences of training in variable settings and no literature with respect to the integration of neonatal competency acquisition across training environments.

OBJECTIVES

To explore residents’ and recent paediatric graduates’ perspectives on acquisition of competencies and neonatal resuscitation training in community and tertiary care centers.

DESIGN/METHODS

This project employed an interpretive design qualitative methodology, using an a priori educational theory incorporating the principles of social cognitive theory, deliberate practice, distributive practice, and ‘choke phenomenon’. Semi structured focus groups of residents and paediatricians were used for data collection. Interpretive analysis in the style of Crabtree and Miller was employed. Data validity was optimized through member checking and triangulation of themes across investigators. Validity criteria as described by Lincoln and Guba were applied. Institutional ethics board approval was obtained.

RESULTS

Overall, the participants described a large ‘disconnect’ (lack of communication and congruence of curriculum) between community and tertiary training environments for neonatal resuscitation. Inherent challenges in the community included the variable skill and experience of the interdisciplinary team, availability of resources, and a lack of confidence in their own leadership. In addition, gaps in preceptor knowledge and communication were identified. Strengths of the community setting included: more autonomy for the learner, a high volume of clinical cases with particular emphasis on the ‘normal’; and opportunity for observed feedback with preceptors. In comparison, tertiary center experiences were perceived to be ‘overwhelming’ with a demanding workload and limited opportunity for direct observation and feedback from faculty. Strengths of the tertiary center experience included: variety and high volume of acute clinical cases, facilitating technical skill expertise and self-confidence; and a strong academic focus on physiology and knowledge translation.

CONCLUSION

Participants described both valuable opportunities and challenges for training and competency acquisition in neonatal resuscitation in tertiary and community settings. Integration of curricula or competencies across settings and across residency level of experience was lacking. This work suggests areas for collaboration within and across training centres to align opportunities in neonatal resuscitation competency training.
USING CHEST COMPRESSIONS WITH ASYNCHRONOUS VENTILATION AT VARIOUS CHEST COMPRESSION RATES (90, 100, 120/MIN) – A RANDOMIZED CONTROLLED ANIMAL TRIAL
Authors: Patel Sparsh , Cheung Po-Yin , Lee Tze-Fun , Pasquin Matteo , O’Reilly Megan , Schmolzer Georg
Published: May 2018

BACKGROUND

The current Pediatric Advanced Life Support guidelines recommends that newborns who require cardiopulmonary resuscitation (CPR) in settings (e.g., prehospital, Emergency department, or paediatric intensive care unit, etc.) should receive continuous chest compressions with asynchronous ventilations (CCaV) if an advanced airway is in place. However, this has never been examined in a newborn model of neonatal asphyxia.

OBJECTIVES

To determine if CCaV at rates of 90/min or 120/min compared to current standard of 100/min will reduce the time to return of spontaneous circulation (ROSC) in a porcine model of neonatal resuscitation.

DESIGN/METHODS

Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Piglets were randomized into 3 CCaV groups: chest compression (CC) at a rate of 90/min (CCaV 90,n=7), of 100/min (CCaV 100,n=7), of 120/min (CCaV 120,n=7), or sham-operated group. A two-step randomization process with sequentially numbered, sealed brown envelope was used to reduce selection bias. After surgical instrumentation and stabilization an envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the group allocations was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.

RESULTS

The mean (±SD) duration of asphyxia was similar between the groups with 260 (±133)sec, 336 (±217)sec, and 231 (±174)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). The mean (SD) time to ROSC was also similar between groups 342 (±345)sec, 312 (±316)sec, and 309 (±287)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). Overall, 5/7 in the CCaV 90, 5/7 in CCaV 100, and 5/7 in the CCaV 120 survived.

CONCLUSION

There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.
MATERNAL VIRTUAL INFANT NUTRITION SUPPORT CLINIC FOR THE NEONATAL INTENSIVE CARE UNIT (MAVINS-NICU) - A QUALITATIVE STUDY
Authors: Rai Stientje
Published: May 2018

BACKGROUND

Canadian exclusive breastfeeding rates at 6 months of age are only 24.2%, and are even lower in mothers of infants requiring Neonatal Intensive Care Unit (NICU) admission. An interactive website was developed that provides professional (articles, videos) and peer (discussion forum for peers, access to a lactation consultant) breastfeeding support to mothers of infants requiring NICU admission.

OBJECTIVES

The objective of the study is to outline maternal perceptions of the breastfeeding support website (MAVINS-NICU) in a level-III NICU setting.

DESIGN/METHODS

This study represents the qualitative research component of the MAVINS-NICU project. Semi-structured interviews were conducted antenatally with women at risk of delivering an infant requiring NICU admission (n=6), and postnatally with mothers of infants admitted to the NICU (n=7), regarding their experiences with the MAVINS-NICU website. Interviews were audio-recorded and transcribed by a professional transcriptionist. Analysis occurred in an iterative fashion using open and axial coding strategies to identify majors themes.

RESULTS

Several themes were identified: 1) Women seemed comforted that a reliable hospital-provided resource would be available to them after birth, “…I’m very happy that I’m going to have lots of support”; 2) Women felt overwhelmed after birth, but often accessed the website on their phone or read newly posted comments on the discussion forum in response to automatically generated weekly emails from the website, “I’m just, overwhelmed… because I’m [in the NICU a lot], I only have my phone and it’s just easier to look at the emails… [they] just pop up”; 3) Mothers felt extremely comforted by the peer support component of the website, “to see what other moms are going through … similar emotions or issues … to see that I’m not the only one [helps]”; 4) Mothers enjoyed remote access and quick online lactation consultant response times, “ … [you can] get help even when there’s no one around”, “I was really surprised … by how quickly I got responses”; 5) Majority of mothers expressed a sense of empowerment to provide breast milk with the help of MAVINS support, “…being able to breastfeed eventually is a big deal for me… [it made me feel] like I was accomplishing something”.

CONCLUSION

Mothers of infants admitted to the NICU found the MAVINS-NICU website very helpful and considered it part of their success in providing breast milk for their babies.
PROFILE OF RESISTANCE TO IVIG TREATMENT IN PATIENT WITH KAWASAKI DISEASE AND CONCOMITANT INFECTION
Authors: Poupart Steffany , Dionne Audrey , Le Cathie-Kim , Meloche-Dumas Léamarie , Turgeon Jean , Autmizguine Julie , Dahdah Nagib
Published: May 2018

BACKGROUND

Kawasaki disease (KD) is a paediatric systemic vasculitis that can be associated with concomitant viral or bacterial infections. Patients with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications.

OBJECTIVES

However, it is unknown how concomitant infection influences the response to IVIG treatment. The aim of this study was to determine the impact of concurrent infection on the prevalence of IVIG resistance and coronary outcome.

DESIGN/METHODS

Retrospective study of 154 children (mean age at diagnosis: 3.4 ± 2.8 years) diagnosed with KD, between 2008–2016 in a tertiary paediatric university hospital, of which 59 (38%) had concomitant infection.

RESULTS

Delay in diagnosis (>10 days of fever) was similar between patients with and without concomitant infection (7% vs 7%, p=0.89). Patients with concomitant infection were more likely to have fever 48 hours after initial treatment (36% vs 20%, p=0.05) and to be treated with a second dose of IVIG (33% vs 18%, p=0.04). Patients with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p=0.04), which persisted after IVIG administration (111 vs 59 mg/L at 48 hours, p=0.003). However, there was no statistically significant difference in the prevalence of coronary artery (CA) complications (coronary artery Z-score > 2.5) between patients with and without concomitant infection (36% vs 39%, p=0.68).

CONCLUSION

Children with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment requiring a second dose of IVIG. Nevertheless, this is not associated with an increased risk of CA complications. Larger scale studies are needed to help distinguish IVIG resistance from infection in children with persistent fever and guide management of this population.

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IMPROVING TRANSITIONS IN CARE FOR CHILDREN WITH COMPLEX CARE NEEDS IN NOVA SCOTIA
Authors: Curran Janet , Vine Jocelyn , Breneol Sydney
Published: May 2018

BACKGROUND

Children with complex care needs are a small yet resource intensive population in Canada. At present, there is wide variation in the way in which this population is characterized in the clinical and research literature. Transitions from hospital to home for these children can be complicated by variation in available services and resources in their home community; complex technological logistics; and a sharp disjuncture between discharge instructions provided to families and implementation in their home communities.

OBJECTIVES

Develop policy recommendations for inclusion in a Nova Scotia strategy to support transitions in care for these children with medical complexity.

DESIGN/METHODS

We used a mixed method design. During phase 1 we developed six cases representing children with different levels of complexity. Cases were informed by parent and provider interviews at 4 time points, chart audits and validated measures of caregiver distress. In phase 2, we conducted key stakeholder interviews across Nova Scotia to identify barriers and facilitators to successful transitions in care. A multi-sector consensus meeting was held during phase 3 to discuss study findings and refine key recommendations for inclusion in a Nova Scotia strategy.

RESULTS

Six cases included children aged 15 days to 9 years old who were followed by as many as seven services and lived 50–300 km from IWK Health Centre. Key stakeholder interviews were conducted with 4 nurses, 4 physicians, and 1 administrator from 5 communities across Nova Scotia. A range of inter-institutional communication challenges and limited educational resources were identified as a key barrier. Participants identified the need for a nurse-coordinator role to act as a resource for both families and health providers in the community. A half-day consensus meeting 20 stakeholders from different health and government sectors was held. Proposed policy recommendations included: (1) consistent, timely, and discharge planning, (2) a comprehensive repository of resources for health care providers and families, (3) educational outreach strategy to build capacity for providers and families, (4) a nurse-coordinator role in each health zone to act a liaison and resource for health care providers and families, (5) work with existing provincial programs and services to develop policies and tools that are unique to a paediatric population, (6) adopt an established definitional framework for Children with Medical Complexity.

CONCLUSION

Our collaborative patient-centred approach to understanding how children with complex care needs currently navigate transitions in care in Nova Scotia provided a foundation for developing recommendations for a provincial strategy.
AUTISM SPECTRUM DISORDER AND ALTERNATIVE DIETS
Authors: Lemay Jean-Francois , McLeod Scott , AlTokhais Rana , Gibbard Ben
Published: May 2018

BACKGROUND

Complementary and alternative therapies are a frequent topic of discussion in the treatment of Autism Spectrum Disorder (ASD). In particular, several diets have been proposed to target ASD symptoms. Prior evidence has suggested limited benefit from such therapies, although they are commonly used in the ASD paediatric population.

OBJECTIVES

To determine the proportion of children and adolescents with ASD using alternative diets in our area. Other objectives were to explore reasons, information sources, symptom changes, and barriers to use of diets.

DESIGN/METHODS

We conducted a cross-sectional, anonymous, validated questionnaire with parents of children with a diagnosis of ASD. Participants were recruited to a collection of organizations and support groups dedicated to the provision of care for individuals with ASD. The 15-minute survey utilized a combination of closed-ended and short answer questions. Parents not able to understand written English were excluded.

RESULTS

Overall, 67 parents (response rate of 34%) participated. The male/female ratio of children was 3.6/1. Use of alternative diets (for >3 months) was reported by 74% of respondents. Parents learned about these diets from the Internet (44%) and ASD support group (40%). The diets most commonly used were: gluten-free (77%), low carbohydrate (58%), casein-free (56%), foods free of additives and preservatives (54%) and lactose free (49%). The most successful diet (according to parent report) resulting in improvement of ASD behavioral symptoms was gluten free (19%). Twenty percent reported no improvements with any diets. The reasons most commonly cited for change in diets were to: reduce ASD symptoms (65%), improve general health (63%), and mental/well-being health (61%). Most noticeable improvements were: reduced anxiety (36%), improvement of mood (31%), sleep (28%) and social communication (28%). Fixations and restriction interests were rarely reported as improved (<3%). Cost and following daily diet plan were the major challenges encountered. Parents not using modified diet cited lack of scientific evidence and not believing in diet therapy. Physicians were informed by parents about diet changes 61% of the time.

CONCLUSION

Alternative diets are frequently used by children with ASD. Parents are not reporting any specific diet as a “miracle” although they have noticed some benefits in general health. Paediatricians need to be aware of the common alternative diets used in patients with ASD. More research is necessary to understand benefits, challenges and risks from alternative diet use in ASD.