bluuebunny/crossref_metadata_2025_split huggingface dataset:
9 Corticosteroid use in periorbital and orbital cellulitis: A Cochrane systematic review
Authors: Kornelsen Emily , Mahant Sanjay , Parkin Patricia C , Reginald Arun , Shah Samir S , Gill Peter J 
Published: August 2020

Abstract

Background
There is significant variation in the use of corticosteroids for the treatment of periorbital and orbital cellulitis. Corticosteroids may act to reduce inflammation and edema but there are concerns that corticosteroids may lead to immune suppression and worsening infection. Evidence-based recommendations regarding the use of corticosteroids for periorbital and orbital cellulitis are lacking.

Objectives
To assess the effectiveness and safety of corticosteroids in the treatment of periorbital and orbital cellulitis.

Design/Methods
We conducted a detailed search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Plus, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform for randomized controlled trials (RCTs) of children and adults with periorbital and orbital cellulitis treated with systemic or intranasal corticosteroids. There were no exclusions based on language or publication status. Studies were excluded if they focused exclusively on participants undergoing elective surgery, on post-operative infections, or infections secondary to trauma. Two reviewers independently assessed studies for inclusion, and extracted data in duplicate. Risk of bias was assessed using the Cochrane Collaboration’s domain-based evaluation tool. Data were analyzed according to standard Cochrane methodology.

Results
Of the 7,476 unique results identified, 7,465 records were excluded based on title and abstract screening, and a further 10 records were excluded based on full text review. We identified one small RCT conducted in India with an unclear risk of bias. No other eligible ongoing or completed trials were identified. The small trial of 21 participants 10 years and older compared the use of corticosteroids and antibiotics (n=14), to the use of antibiotics alone for the treatment of orbital cellulitis (n=7). Participants receiving corticosteroids had a shorter length of hospital stay (14.1 ±3.7 vs. 18.4 ±5.9 days, p=0.02) and required antibiotics for a shorter duration (8.6 ±1.3 vs. 11.6 ±4.6 days, p=0.013) compared with the control group. Earlier improvements in fever, pain, periorbital edema, extra ocular motility, conjunctival chemosis, and visual acuity were seen in the corticosteroid group. No major complications of orbital cellulitis or adverse effects of corticosteroids were reported.

Conclusion
There is insufficient evidence to draw conclusions about the use of corticosteroids in the treatment of periorbital and orbital cellulitis. Currently, there is significant variation in how corticosteroids are used in clinical practice and additional high-quality evidence is needed to inform decision making.
10 Mechanical Complications Associated with Central Venous Catheters at a Canadian Tertiary Care Centre
Authors: Moore Kieran , Kulkarni Ketan , Greencorn David , Kuhle Stefan , Langley Joanne 
Published: August 2020

Abstract

Background
The administration of life-saving treatment through central venous catheters (CVC) has significantly improved the quality of life and outcomes for patients, especially for those requiring long-term care. While CVC-associated bacteremia is a standard patient outcome measure, little is known about the incidence of mechanical complications in children. Although common, large data on mechanical complications are scarce and generally limited to specific paediatric populations from modest single center series.

Objectives
To determine the incidence of mechanical complications among paediatric patients with CVCs.

Design/Methods
In this retrospective study we analyzed data from all paediatric patients (0-19 years) who required a CVC between 2001 and 2016 at our health care center, which services patients from regional hospitals in a shared care model. Details on CVC insertions and daily records of catheter function while in hospital have been collected prospectively and stored in a dedicated database. Patient demographics, catheter characteristics, and complications were abstracted from the database. Complications were defined through clinician documentation of CVC mechanical failures such as disconnect, leakage, fracture, and blockage. Complication rates were expressed per 1,000 line days.

Results
A total of 8,747 CVCs were placed in 5,743 patients during the study period for a total of 780,448 line days. Neonatal patients required the most CVC insertions and made up 41% of the cohort studied. Total mechanical complication rates were the highest over the 15-year period in 2001 (12 per 1,000 line days) and lowest in 2013 (3.8 per 1,000 line days). Peripherally inserted central catheters were used in the majority of patients (56%), while port-a-caths made up the vast majority of line days (78%). Mechanical complications occurred more frequently in non-tunneled catheters and were least likely to occur in port-a-caths (43 and 3.1 per 1,000 line days, respectively). Tunneled catheters failed mechanically at a rate of 8.0 per 1,000 line days and the peripherally inserted central catheter complication rate was 17 per 1,000 line days.

Conclusion
We provide a novel description of the incidence of mechanical complications in the setting of commonly used CVCs in a large paediatric cohort. Our findings help convey the true frequency of mechanical failures and create a benchmark for mechanical CVC complications in children. Recognizing the mechanical limitations of indwelling catheters will assist clinicians in optimizing catheter choice. Future study is planned to identify risk factors associated with CVC complications.
16 Variability in lumbar punctures and neuroimaging in infants less than 90 days with acute bacterial meningitis at a provincial children’s hospital in Canada
Authors: Bourne Stephanie , Findlay Briar , McLaughlin Thomas , Remington Mia 
Published: August 2020

Abstract

Background
Bacterial meningitis remains a significant cause of morbidity and mortality in infants, necessitating appropriate and timely investigations and treatment. Despite this, there are no current Canadian practice guidelines outlining the recommended management of infants with bacterial meningitis beyond empiric antimicrobial choice. As bacterial meningitis remains one of the most severe infectious diseases managed by general pediatricians, it warrants an attempt at practice standardization.

Objectives
The purpose of this study is to review and identify variation in the timing and frequency of lumbar punctures (LPs) and the use of neuroimaging for the management of bacterial meningitis for infants less than 90 days of age at BC Children’s & Women’s Hospital (BCCWH).

Design/Methods
A retrospective chart review at BCCWH identified confirmed, presumed or possible bacterial meningitis in infants less than 90 days of age over a five-year period (2013-2018). Anonymized data was collected from medical charts, de-identified and stored in REDCap.

Results
Eighty-one patients were included. Fifty-three percent of all patients had a delay in receiving an initial LP. The most common reasons for delays were that the patient was too unstable (42%) or that the first LP attempt was unsuccessful (26%). Forty-six percent of all patients had only one LP while 36% had at least one repeat LP. Most repeat LPs were done within 7 days of diagnosis. Twenty-nine percent of patients had an end of treatment LPs. Of all patients, 80% had neuroimaging. Head ultrasound (US) was the most commonly used imaging modality for both first image (68%) and subsequent images (64%). Seventeen percent of patients received a CT scan and 15% an MRI as their first image. In most cases, there was no clear clinical indication for imaging noted other than a diagnosis of meningitis (44%).

Conclusion
This retrospective study confirms that there is variability in the management of bacterial meningitis with respect to lumbar punctures and neuroimaging in young infants. The findings demonstrate LPs are commonly delayed, and suggest a need to develop clearly defined criteria for evaluating instability before an initial LP. Furthermore, the findings raise concern regarding the common practice of ordering head ultrasound for meningitis, given lower sensitivity in detecting disease complications and therefore disputed clinical utility.
17 Lyme Disease in Eastern Ontario - A Paediatric Centre’s Experience from 2009-2018
Authors: Zahradnik Stephanie , Barrowman Nick , Tsampalieros Anne , Harrison Mary-Ann , Bowes Jennifer , Brophy Jason 
Published: August 2020

Abstract

Background
Lyme disease (LD) is caused by the tick-borne bacterium Borrelia burgdorferi. Over the past ten years, robust local public health data indicates that the incidence of LD has increased significantly in the eastern region of Ontario due to the spread of its vector, the blacklegged tick. As a result, we have seen an increase in the number of cases of LD in children at our tertiary paediatric centre, at all stages of infection. Familiarity with Lyme disease is important as incidence increases. We sought to characterize the cases at our centre.

Objectives
To describe the epidemiology of LD in children at our centre from 2009-2018, as well as the variety of clinical presentations of paediatric LD.

Design/Methods
We completed a retrospective chart review from 2009-2018 of all cases admitted or seen in the Infectious Disease (ID) clinic or the Emergency Department (ED) with a diagnosis of LD. Demographic, clinical and laboratory data were collected, including geographic location where infection occurred and resource utilization. We used descriptive statistics to describe cases and comparative statistics to determine changes in number of cases over time.

Results
There were 171 LD cases managed at our centre during this period. Mean age was 7.4 (SD 4.5) years, 89 (52.0%) were male. The annual number of cases from 2009 - 2018 increased from 1 to 44 and peaked in 2017 (47 cases). The highest number of cases occurred among children &lt;6, the lowest in children ≥11. Most cases occurred in summer (60%), with the fewest in winter months (4%). Stage of LD was not documented in 1 case. Of the remainder, 98 (57.6%) cases were early localized, 41 (25.7%) early disseminated and 31 (19.7%) late disseminated LD.
Early and late disseminated cases occurred more commonly in the summer and accounted for the majority of admissions. These included neurologic Lyme (lymphocytic meningitis [2, 1.2%], polyneuropathy [1, 0.6%], cranial nerve palsy [13, 7.6%]), Lyme carditis (5, 2.9%), and Lyme arthritis (29, 17.0%). There were 133 (77.8%) patients managed in ED, 66 (38.6%) in the ID clinic and 17 (9.9%) in the inpatient ward; median length of stay was 6 (IQR 5, 9) days, with a range of 1 to 30 days. The most common geographic locations of infection acquisition were Ottawa (120 cases, 71.0%) and Kingston (26, 15.4%).

Conclusion
Cases of LD managed at our paediatric centre have increased in keeping with population trends, with all LD stages experienced. Severe cases of meningitis, carditis, and arthritis resulted in hospitalization, with increasing numbers over the study period.
19 Treatment of Neonatal Hyperbilirubinemia – Ontario Cohort 2014-2018
Authors: Rasiah Saisujani , Jegathesan Thivia , Campbell Douglas , Sgro Michael 
Published: August 2020

Abstract

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

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

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

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

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

Abstract

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

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

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

Results
The survey response rate was 57. The majority of respondents were neonatologists (50%), with many having more than 5 years of experience. Provision of palliative care was common with 20/57 respondents being involved in 5 or more cases in the past year.
Only 40% of respondents reported that neonatologists and neonatal NPs received palliative care training at their center. When education did exist, lectures (31%) and workshops (26%) were most common. 97% said their centre would benefit from more education.
53% of respondents said their center had an established guideline around neonatal PC, 20% did not know and 27% answered no. Only 8% of respondents who work at centres with a guideline found that it was consistently followed.
Respondents were asked to identify barriers to implementation at their place of practice. Common responses noted challenges in NICU collaborations with maternal-fetal medicine and palliative care teams, as well as lack of education and providers’ personal beliefs.
Lastly, respondents provided details of their guidelines or common practices in PC which has been collated and summarized.

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Conclusion
When they come to neonatal follow-up, parents generally perceive the health of their extremely preterm children in a positive way. While some parents have no wishes for improvement in their children, many are concerned by their children’s NDI. On the other hand, several parent-important outcomes, such as lung health and overall medical fragility, are insufficiently investigated during follow-up at the present time.