bluuebunny/crossref_metadata_2025_split huggingface dataset:
27 Determinants of referral to developmental resources among neonatal follow-up patients discharged from tertiary neonatal unit from 2005 UNTIL 2014
Authors: Saleem Maad , Hayawi Lamia , Barrowman Nick , BenFadel Nadya , Feberova Jana , Daboval Thierry 
Published: August 2020

Abstract

Background
Lower gestational age or birth weight and higher rate of neurodevelopmental impairment have been commonly linked to higher need for developmental resources in premature infants. Existing evidence on need for developmental support in premature infants is limited in description of the needs, timing and method of assessment.

Objectives
To identify predictors for the needs for developmental resources among high-risk groups of infants born less than 29 weeks or with a birth weight (BW) less than 1250 grams. Secondarily, to compare the need of referrals to developmental resources and the rate of neurodevelopmental impairment defined as cerebral palsy, global developmental delay, blindness and deafness for this high risk population.

Design/Methods
We conducted a retrospective chart review of premature infants &lt; 29+0 weeks GA or BW &lt; 1250 grams born between January 2005 and December 31st 2014, who had at least one visit at the neonatal follow up clinic. Univariate and multivariate logistic regression analyses were conducted to examine potential predictors for referral to developmental resources.

Results
The study included 687 infants. Within this high risk population, 579 (85.0%) of infants were referred, of these 153 (26.4%) had one referral, 132 (22.8%) had 2 and 294 (50.8%) had 3 or more referral/s to developmental resources. Most frequent referrals were for speech therapy (339, 50.0%) physiotherapy (319, 46.8%) occupational therapy (262, 38.3%) and infant development program (232, 34.1%). The rates of referral to developmental resources decrease with increasing gestational age. Multivariate logistic regressions showed that gestational age (OR: 1.19, 95% CI: 1.05 - 1.35), birth weight (OR: 0.87, 95% CI: 0.77 - 0.99), female gender (OR: 0.70, 95% CI: 0.49 - 0.99), intraventricular hemorrhage grades III-IV (OR: 3.02, 95% CI: 1.28 - 7.16), and days on mechanical ventilator (OR:1.03, 95% CI: 1.01 - 1.05) were predictors for 2 or more referrals to developmental resources. Cerebral palsy was present in 4.4 % of the study population, deafness in 4% and blindness in 0.6%. The rate of referral to developmental resources was 54 (98.2%) among infants with neurodevelopmental impairment (NDI) compared to 522 (83.9%) in infants without NDI (p value= 0.01).

Conclusion
There is substantial need for developmental support among high-risk premature infants. Infants without neurodevelopmental impairments still need significant developmental resources to achieve their outcome.
28 Association of serum sodium concentration, fluid balance and weight loss with bronchopulmonary dysplasia in very preterm infants
Authors: Soullane Safiya , Patel Sharina , Sant’Anna Guilherme , Claveau Martine , Wazneh Laila , Beltempo Marc 
Published: August 2020

Abstract

Background
Bronchopulmonary dysplasia (BPD) affects 20% of very preterm infants born &lt;33 weeks gestational age (GA). In this subgroup of neonates, postnatal fluid adaptation may be inefficient due to kidney immaturity, resulting in increased pulmonary interstitial fluid content, lung damage and impaired air-gas exchange. Early postnatal fluid status might contribute to the risk of developing BPD and requires further investigation.

Objectives
To investigate the association of three indicators of early postnatal fluid status (median serum sodium concentration, cumulative fluid balance and maximum percentage weight loss) measured over the first 10 days after delivery with death and/or BPD in infants born &lt;33 weeks.

Design/Methods
This retrospective cohort study included infants born 23-32 weeks GA, admitted to the Montreal Children’s Hospital’s NICU from 2015-2018. Neonates moribund on admission, with any major congenital malformation and/or admitted to the NICU &gt;1 day after birth were excluded. Data was collected from the Canadian Neonatal Network database and individual chart review. BPD was defined as oxygen therapy or respiratory support at 36 weeks’ corrected GA. Unadjusted comparisons were made using the Wilcoxon test. Associations between exposures (median serum sodium concentration, cumulative fluid balance and maximum percentage weight loss in the first 10 days after delivery) and outcomes (death and/or BPD) were assessed using multivariable logistic regression analyses adjusting for sex, steroid use, GA, small-for-gestational-age status, Apgar at 5 min&lt;7, surfactant use and mode of delivery.

Results
Among 439 eligible infants, 125 died and/or developed BPD (29%). Median serum sodium concentration was 139 mmol/L (IQR 136-141) among BPD-free survivors and 136 mmol/L (IQR 134-139) among infants with death and/or BPD (p&lt;0.001). Cumulative fluid balance was 4.09 dL/kg (IQR 2.98-4.78) among BPD-free survivors and 4.88 dL/kg (IQR 3.96-5.95) among infants with death and/or BPD (p&lt;0.001). Maximum percentage weight loss was 8.5% (IQR 5.4-11.6) among BPD-free survivors and 9.2% (IQR 4.9-12.9) among infants with death and/or BPD (p=0.41). Adjusted odds ratios (95% confidence interval) are presented in Table 1.

Conclusion
Among very preterm infants, higher cumulative fluid balance in the first 10 days after delivery is associated with higher odds of death and/or BPD. Thus, targeting lower cumulative fluid balance may improve BPD-free survival.
33 NeoCHIRP: A Collaborative Care Model for Intestinal Rehabilitation in the NICU
Authors: Dhaliwal Keerat , Albersheim Susan , Casey Linda 
Published: August 2020

Abstract

Background
Many children with intestinal failure (IF) start their course in the NICU with medical or surgical conditions limiting enteral feeding. Multidisciplinary intestinal rehabilitation teams have improved outcomes in pediatric IF patients, but this is not well described in neonates.

Objectives
NeoCHIRP represents a unique IR Team; this study describes its roles in collaborating neonatal and IR care.

Design/Methods
Retrospective descriptive chart review of neonates at risk for IF in one NICU, of patients admitted between April 1, 2013 and March 31, 2019. All neonates at risk for IF were evaluated weekly by a multidisciplinary Neonatal Children’s IR program in the NICU (NeoCHIRP) that is composed of surgeons, dieticians, neonatologists, IR paediatrician, nurses and patient families, to evaluate nutritional status, and provide recommendations. Data collected included weight, patient characteristics, number of NeoCHIRP visits, type of recommendations, cholestasis interventions, successful oral tolerance, and survival.

Results
There were 163 patients, 105 males, 58 females with 1-27 weekly visits (mean= 9.1) and gestational age between 23-43 4/7 weeks (median= 35). There were 153 survivors discharged from the NICU and 10 deaths (3 from IF related complications.) Enteral autonomy was achieved by 139/163 patients (85.3%.) Common recommendations made were enteral feeds (96.3%), parenteral nutrition (95%) or sodium management (93.9%.) Recommendations for oral stimulation were made in 79.1%, of which 40.5% (66/163) were exclusively orally fed and 20.2% partially orally fed by discharge. Cholestasis interventions were made in 66.9% and conjugated bilirubin (CB) &lt;15 at discharge in 93 patients (range 0-123, mean 12.9 median 2) with only 23/163 patients with CB &gt;30 at final visit. Evaluation of patient weights showed increased z-scores in only 23/153 (15%) from birth to discharge versus increased z-scores in 51/141 (36.2%) from NeoCHIRP consult to discharge.

Conclusion
A Multidisciplinary Neonatal Intestinal Failure Team is a useful collaborative model to support NICU medical management, by minimizing poor weight gain, cholestasis and oral aversion. Recommendations made for all NeoCHIRP patients in enteral, parenteral and sodium management resulted in improved weight gain of patients.
37 Growth and neurodevelopment in early childhood of preterm infants with complex congenital heart defects following open cardiac surgery
Authors: Cheung Po-Yin , Hajihosseini Morteza , Dinu Irina , Switzer Heather , Robertson Charlene M T 
Published: August 2020

Abstract

Background
Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks of gestational age and received neonatal open cardiac surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. Specific details related to the neurodevelopmental outcome of these infants remain unpublished.

Objectives
To describe the growth, disability, functional, and neurodevelopmental outcome in early childhood of preterm infants (born at &lt;37+0 weeks gestation) with CCHD and neonatal OHS.

Design/Methods
We studied all infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. In the Western Canadian Complex Pediatric Therapies Follow-up Program, comprehensive neurodevelopmental assessments at a corrected age of 18-24 months were done by multidisciplinary teams at the original referral sites. In addition to demographic and clinical data, standardized age-appropriate outcome measures included physical growth with calculated Z-scores, disabilities including cerebral palsy, visual impairment, sensorineural hearing loss; adaptive function (Adaptive Behavioural Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III).

Results
From 1996 to 2016, 115 preterm infants (34±2 weeks gestation, 2339±637g, 64% males) with CCHD had OHS with 11(10%) deaths before first discharge and 21 (18%) by 2 years. Prior to the first surgery, 7 (6%) neonates had cerebral injuries. Overall, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. All 94 surviving infants received comprehensive evaluation at 2 years corrected age; Eighteen (19%) had congenital syndromes who had worse functional and neurodevelopmental outcomes compared to those (n=76) without syndromal abnormalities (SA) (Table).

Conclusion
For preterm neonates with CCHD and early OHS, the mortality was significant, but the short-term neonatal morbidity was not increased. Compared with published preterm outcomes, the early outcome suggests more cerebral palsy but not sensorineural hearing loss, and greater neurodevelopmental delay. This information is important for management care of the infants, parental counselling and the decision-making process.
39 Early Higher Parenteral Lipid Intake Decreases Extra-Uterine Growth Restriction in Very Low Birth weight Infants: A Randomized Controlled Trial
Authors: Alburaki Wissam , Alshaikh Belal , Yusuf Kamran 
Published: August 2020

Abstract

Background
Approximately 43-65% of very low birth weight (VLBW) infants develop extra-uterine growth restriction (EUGR).
EUGR is associated with a significant increase in the risk of neurodevelopmental impairment.
Inadequate early postnatal nutrition results in excessive weight loss that cannot be explained by the physiologic contraction of body water alone.
EUGR and postnatal growth failure are usually associated with negative early energy and nitrogen balance in the first week of life.
Growth trajectories after initial weight loss have similar slopes regardless of gestational age, which indicates that the early excessive weight loss is a lead cause for EUGR.

Objectives
To study whether an early and higher parenteral lipid intake in the first week after birth would decrease the percentage of weight loss and subsequently the incidence of EUGR.

Design/Methods
This was a randomized, open-label, control trial of appropriate-for-gestational age VLBW infants admitted to our level III NICU.
Lipid intake in the control group started at 0.5-1 g/kg/day and was increased daily by 0.5-1 g/kg/day until 3 g/kg/day was reached.
The intervention group was started on 2 g/kg/day then increased to 3 g/kg/day the following day.
Triglyceride levels were measured the day after the start and after each increase in lipid intake.

Results
Among the 176 infants assessed for eligibility, eighty-three were included in the trial.
There were no significant differences between the control and the intervention group in mean gestational age (27.3 ± 2.4 vs. 27.1 ± 2.3 weeks respectively) or birth weight (1011 ± 250 vs. 1019 ± 271 g respectively).
Infants in the intervention group were started on lipid earlier (13.8±7.8 vs. 17.5±7.8 h; p=0.03) and had higher cumulative lipid intake in the first 7 days of age (13.5±4.2 vs. 10.9±3.5 g/kg; p=0.004) that led to a protein to energy ratio; closer to the recommended values.
Total fluid intake was similar between the two groups.
Infants in the intervention group had a lower percentage of weight loss (10.4±3.6 vs. 12.7±4.6; p=0.02).
The mean triglyceride level was higher in the intervention group (1.91± 0.79 vs. 1.49±0.54 mmol/L; p= 0.01), however, hypertriglyceridemia was similar between the two groups at 2 and 3 g/kg/day of lipid intake. Enteral energy and protein intake calculated weekly between the time of parenteral nutrition discontinuation and 36 weeks corrected gestational age (CGA) were similar between the 2 groups.
EUGR at 36 weeks CGA was significantly lower in the intervention group (38.6% vs. 67.6%; p=0.01).

Conclusion
In VLBW infants, the provision of an early and higher dose of parenteral lipid in the first week of life results in less weight loss and lower incidence of EUGR.
42 The Impact of Home Respiratory Support on Developmental Outcomes in Very Preterm Infants
Authors: McRae Lindsay , Kieran Emily , Luu Thuy Mai , Shivananda Sandesh , Synnes Anne 
Published: August 2020

Abstract

Introduction/Background
Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity and may require prolonged home respiratory support. BPD is associated with worse neurodevelopmental outcomes but the impact of home respiratory support on neurodevelopmental outcomes, rehospitalization rates and association with caregiver sociodemographics is less well studied.

Objectives
This study examines the impact of home respiratory support on neurodevelopmental outcomes in very preterm infants at 18-24 months corrected gestational age.

Design/Methods
This linked Canadian Neonatal Network and Canadian Neonatal Follow-Up Network (CNFUN) multicenter cohort study of infants born April 1, 2009-December 31, 2016 at &lt;29 weeks’ gestational age assessed at 18-24 months corrected age at a CNFUN site compared significant neurodevelopmental impairment rates, rehospitalization rates and sociodemographics in children with and without home respiratory support using Chi-square and student t-tests.

Results
Of the 3918 infants, 622 (15.9%) received home respiratory support. As expected, infants on home respiratory support had a lower gestational age (mean 25.5 vs 26.5 weeks, p &lt; 0.01), lower birth weight (mean 781 vs 955 grams, p &lt; 0.01), longer NICU stay (mean 118 vs 76 days, p &lt; 0.01) and more comorbidities: late onset sepsis (35.1% vs 22.9%, p &lt; 0.01), NEC ≥ stage 2 (8.9% vs 5.9%, p = 0.01), grade 3-4 IVH or PVL (12.7% vs 8.4%, p &lt; 0.01) and ROP ≥ grade 3 (28% vs 10.8%, p &lt; 0.01). Infants on home respiratory support had higher significant neurodevelopmental impairment rates defined as Bayley-III motor, cognitive, language scores &lt;70, nonambulatory cerebral palsy (GMFCS ≥ 3), hearing and/or visual impairment rates (Table 1), rehospitalization rates (63.3% vs 29.2%, p &lt; 0.01) and &gt;3 rehospitalizations (19.8% vs 5.0%, p &lt; 0.01). With home respiratory support, fewer families had paid employment and more were on social welfare.

Conclusion
Children born preterm who are discharged home on respiratory support, compared to those without home support, are more likely to experience neurodevelopmental impairment and rehospitalization, and may have an adverse impact on family income. This is important for discharge planning and follow-up care of these high risk children.
44 Management of Neonatal Hypoglycemia using Dextrose 40% Oral Gel in Term and Late Preterm Neonates
Authors: Zhou Kim , Pang Adrienne , Huang Tianhua 
Published: August 2020

Abstract

Introduction/Background
Oral dextrose gel has been shown to be an effective first-line treatment for neonatal hypoglycemia (NH) in full term and late preterm neonates in New Zealand (Harris et al., 2013). The use of dextrose gel in NH has not been evaluated in a Canadian setting. Dextrose gel preparations in Canada are not designed for neonates, and significant variations in dextrose concentration have been reported (Solimano et al., 2019). In October 2018, we instituted a new clinical guideline for the use of dextrose gel to treat NH.

Objectives
Primary Objective: To determine if the use of dextrose gel is effective in treating infants with NH, and if it leads to higher rates of breastfeeding and lower rates of formula supplementation at discharge.
Secondary Objective: To determine if the use of dextrose gel leads to a decrease in NICU admissions due to NH.

Design/Methods
We performed a retrospective cohort study of all neonates treated for hypoglycemia during a six month period before and after implementation of a clinical guideline involving dextrose gel (January 1 – June 30, 2018 and 2019). Equivalent timeframes were used with a two month washout period during guideline implementation.

Results
A total of 269 neonates were treated for hypoglycemia - 109 in the formula group and 160 in the dextrose group. The two study cohorts shared similar baseline characteristics. The timing and severity of the first episode of hypoglycemia were similar in both groups, but the median blood glucose following treatment was higher in the formula group (median 3.3 mmol/L, p&lt;0.05). The proportion of neonates who experienced a second episode of hypoglycemia and the rate of NICU admission for IV dextrose appeared to be higher in the dextrose group, although the differences were not statistically significant. There was no statistical difference in the average volume of formula used per feed at discharge, the rates of exclusive breastfeeding at discharge, or the average quality of breastfeeding as measured by the LATCH score.

Conclusion
This is the first study evaluating dextrose gel in the management of NH in Canada, and it did not identify any significant advantage over formula-based treatment, with some parameters demonstrating an inferior response. With the latest Canadian Paediatric Society hypoglycemia guidelines recommending the routine use of dextrose gel, further studies are urgently needed to evaluate the efficacy of Canadian preparations, and advocacy is needed at a national level to create a paediatric-specific formulation.
47 Increase Clinic Attendance Among Adolescents and Young Adults: A novel cost-effective method
Authors: Jegathesan Thivia , Roth Megan , Florence Melissa , Mistry Niraj , Bonifacio Herbert J , Sgro Michael , Baker Jillian 
Published: August 2020

Abstract

Background
Transition clinics have been introduced to address the unique needs of adolescent and young adult (AYA) populations, however clinic attendance continues to be an issue. Although poor clinic attendance among the AYA population has been well known, solutions to address this has been limited. Some factors that have been associated with missed appointments include forgetfulness, negative previous clinic experiences and clinic schedules. With widespread use of digital technologies among AYA, the application of digital solutions to increase attendance at healthcare appointments has been explored, but little is known on its effectiveness.

Objectives
To determine the effect of text messaging appointment reminders on uninformed no show rates in an AYA transition clinic. Uninformed no show rate was defined as an absence from clinic (not related to a medical emergency) without communication with the clinic.

Design/Methods
A pilot prospective cohort study with a retrospective control group was conducted in an AYA general hematology transition clinic. In order to establish the current no show rate at the clinic, a retrospective review of AYA patients who attended the clinic between April 2013-August 2015 was conducted. Thereafter, all patients who had an appointment scheduled between February 2016 and December 2017 were included in the study and received a text message reminder of their appointment 48 hours prior to their appointment. Monthly uninformed no show rates were collected, and a student’s t-test was conducted to determine if there was a significant difference in uninformed no show rates before and after the introduction of text message reminders.

Results
Eighty-six participants consented to participate in the study and received a text message reminder of their appointment. From April 2013- August 2015 a total of 51 clinic days with 236 appointments occurred. During this time the mean uninformed no show rate was 39.9%. SMS appointment reminders were sent from February 2016 to December 2017 for 48 clinic days for a total of 206 clinic appointments. The mean uninformed no show rate after the introduction of text message appointment reminders was 22.6%. The introduction of text messaging appointment reminders significantly (p&lt;0.01) decreased uninformed no show rates by 17.3%.

Conclusion
Text message reminders are an effective low cost method in reminding AYA patients about their appointments. By using innovative, cost effective and practical strategies like text messaging reminders to increase clinic attendance, we not only improve the care of our patients but also reduce the financial and clerical burden to the system resulting from missed appointments.
48 Paediatric intubation in an adult-based community hospital emergency department (ED)
Authors: Kukreti Vinay , Nonoyama Mika , Papaconstantinou Efrosini , Heath Jane , Kozlowski Natascha , Tsimelkas Sarah , Leach Courtney 
Published: August 2020

Abstract

Background
Airway intubation is a high-risk procedure, especially in the paediatric population. Training ED healthcare providers is challenging because it is rare. Success and adverse events (AEs) could be due to patients’ illness, the health professional intubating, and hospital factors.

Objectives
Describe paediatric intubations in an adult community-based hospital, with primary outcomes being first-pass success and AEs. The secondary objective is to determine what factors are association with intubation success and related AEs.

Design/Methods
Retrospective chart review of patients &lt; 18 years intubated in the ED between Jan 1, 2006 and Mar 31, 2017 (demographics, intubation details, physiologic outcomes). Analysis: descriptive and comparative statistics (intubations with vs. without AEs), p&lt;0.05 significant.

Results
n=121 intubations occurred in the ED over the 10-year period. Mean (standard deviation) age 6.9 (6.8) years. First pass success occurred in n=76 (62.8%), and 33 (27.3%) second pass success. There was n=22 (18.2) minor AEs, n=3 (2.5) major AEs. There were no significant differences between profession intubating and first pass success (p=0.384), or AEs (p=0.472), Table 1. Indications for intubation included respiratory and/or oxygenation failure n=54 (44.6%), airway protection n=51 (42.2%), airway obstruction n=4 (3.3%), cardiopulmonary arrest n=2 (1.7%) [n=9 missing]. Use of specialized equipment was used in n=19 of the intubations, n=12 on first attempt, 8 second attempt, 4 third attempt. No accidental extubations occurred, but the ETT was repositioned in n=33 (27%) after first intubation.

Conclusion
Pediatric intubation in an adult community-based hospital is rare. Success rate of intubation on first attempt is low with minor AEs. There was no significant difference between the type of health professional intubating. These results will inform the development of tools and education for paediatric advanced airway management in adult community-based hospitals, and enhance patient outcomes in the ED.