bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatic cyst infection complicated by a hepatobronchial fistula diagnosed with unique features
Authors: Isogai Hatsuo , Inoue Masashi , Miura Masanao 
Published: October 2021

ABSTRACT
A hepatobronchial fistula (HBF) is a rare condition, defined as an abnormal connection of the respiratory system with the liver parenchyma. Although imaging may be helpful for diagnosis, fistulae are often difficult to identify. An 81-year-old woman presented with mild fever and right upper quadrant abdominal pain. Computed tomography (CT) showed bilateral pneumonia and hepatic cyst infection with air-fluid levels. After mechanical ventilation, abdominal CT showed increased air in the hepatic cyst. The drainage bag for the hepatic cyst infection was also inflated by positive pressure ventilation, suggesting a possible HBF. The ventilator was adjusted to minimize pressure on the fistula and prevent retrograde infection. The fistula eventually closed spontaneously. Appropriate antibiotic treatment and continuous drainage resulted in improvement of the hepatic cyst infection; however, the patient died due to respiratory complications. HBF should be suspected when positive pressure ventilation results in increased air at the hepatic infection site.
6 Neurodevelopmental Outcomes of Extremely Preterm Infants with Late-Onset Bacterial Sepsis According to Type of Bacteria
Authors: Roychoudhury Smita , Lodha Abhay , Synnes Anne , Ting Joseph , Augustine Sajit , Afifi Jehier , Bizgu Victoria , Shah Prakesh , Soraisham Amuchou 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Late-onset sepsis (LOS) is associated with adverse neonatal outcome. There is limited data on the long-term neurodevelopmental (ND) outcomes of infants based on type of bacteria causing LOS. We hypothesize that the type of bacterial pathogen causing late-onset sepsis influences the developmental outcome in extremely preterm infants.

Objectives
To compare the neurodevelopmental (ND) outcomes at 18-24 months corrected age (CA) of infants born &lt; 29 weeks who had late-onset sepsis (LOS) caused by: (1) gram-positive bacteria; (2) gram-negative bacteria; (3) mixed (both gram-positive and gram-negative bacteria); and (4) those with no sepsis (that is, no sepsis or culture-negative sepsis).

Design/Methods
In this retrospective multicentre cohort study, we studied infants born at &lt;29 weeks’ gestational age (GA) between January 2010 and December 2017 and evaluated for neurodevelopmental assessment at 18–24 months’ CA at nine Canadian Neonatal Follow-up Network centers. Infants with early-onset sepsis, major congenital anomalies, those who received palliative care at birth, those who died before 2 days of age, those with non-bacterial infections, and those lost to follow up were excluded. Exposure is late-onset sepsis (LOS) which is defined as the presence of a pathogenic organism in the blood or cerebrospinal fluid culture obtained from a neonate suspected of having sepsis after 2 days of age. The primary outcome was a composite of death or ND impairment (NDI) defined as the presence of any one of the following: cerebral palsy, Bayley-III score of &lt;85 on any one of the components (Cognitive, Language, Motor composite score), hearing loss, and visual impairment. Demographic factors and ND outcomes were compared among the four groups using univariate and multivariate analysis.

Results
Of the 3640 infants included, 823 (22.6%) had late-onset sepsis (LOS). Of the 823 infants with LOS, 569 (69.1%) infants had gram-positive sepsis, 172 (20.9%) had gram-negative sepsis, and 82 (10%) had mixed sepsis. Maternal and neonatal characteristics and outcome are reported in Table 1. Outcome data after adjustment for gestational age (GA), sex, antenatal steroids, SNAP-II score, small for gestational age (SGA), maternal age, and caesarian delivery are presented in Table 2.

Conclusion
Late-onset bacterial sepsis, especially gram-negative sepsis and mixed infections, were associated with increased risk of composite outcome of death or neurodevelopmental impairment (NDI), or NDI alone, at 18-24 months corrected age (CA) in infants &lt;29 weeks’ gestational age (GA).
10 High spontaneous ductal closure even at the extreme of prematurity
Authors: de Carvalho Nunes Gabriela , Wutthigate Punnanee , Simoneau Jessica , Beltempo Marc , Sant'Anna Guilherme , Altit Gabriel 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Extremely preterm newborns are at risk of prolonged patency of the ductus arteriosus (PDA). Current literature has failed to indicate improvement in outcomes after exposure to strategies promoting ductal closure. As such, our center abandoned these practices in 2013.

Objectives
Describe the spontaneous PDA closure in premature infants, including those infants born at the extreme of gestational age (&lt; 26 weeks).

Design/Methods
Retrospective study of newborns &lt; 29 weeks, admitted within 24 hours after birth between 2015 and 2019 and without genetic or congenital anomalies. Newborns who were last known to be alive, with an available echocardiography, and who were not exposed to any intervention to accelerate PDA closure were included. Images were reviewed by experts blinded to the outcomes.

Results
296 infants were analyzed. 37 (12%) did not survive their hospitalization, and 16 were exposed to interventions to accelerate ductal closure at some point during their lifetime (4 ligations, 4 catheter-closure, 5 ibuprofen and 3 acetaminophen). Out of the 243 remaining newborns, 214 had at least one echocardiography to ascertain ductal patency or closure (100% of those &lt;26 weeks). The average gestational age was 26.3±1.5 weeks, with 84 (39%) being &lt;26 weeks. PDA closed spontaneously in 194 (91%), with 60 having closure ascertainment after discharge (average age at closure ascertainment of 36.4 [IQR: 34.4 – 40.1] weeks). Of the 84 &lt;26 weeks, 76 (90%) had confirmation of ductal closure. The 20 infants with an open PDA at the last evaluation were followed in an outpatient setting and considered small/restrictive. In our cohort, 92/243 (38%) were exposed to post-natal steroids. In the &lt;26 weeks group, 74% were exposed to steroids, at a cumulative dose of 1.64 [0.89 – 2.44] mg/kg. BPD was found in 57% of the overall cohort and in 79% of &lt;26 weeks.

Conclusion
The majority of newborns &lt; 29 weeks, and even those at the extreme of gestational age (&lt; 26 weeks) spontaneously closed their PDA before term-corrected age. While BPD rate was similar to previous cohorts, post-natal steroids use was high.
13 Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy
Authors: Bhattacharya Soume , Read Brooke , Miller Michael , daSilva Orlando 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Surfactant delivery via a thin endotracheal catheter during spontaneous breathing, a technique called minimally invasive surfactant therapy (MIST), is an alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multi-access catheters, vascular catheters and, recently, custom-designed catheters for this purpose. The impact of choice of catheter on procedural success and adverse effects has not been reported.

Objectives
The objective of the present study was to compare the procedural success and adverse effects of MIST, using a semi-rigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multi-access catheter (MAC).

Design/Methods
This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics, data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath were compared using a Chi Square test or Fisher’s test, as appropriate. A P value of less than 0.05 was considered significant.

Results
A total of 139 neonates received surfactant via MIST method during the study period. 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two groups were similar (Table 1). A higher proportion of neonates in the Angiocath group received atropine (100% vs. 76%, P =.002] and fentanyl (98% vs. 36%; p&lt;0.001) than the MAC group.
The procedural success was 91% in the Angiocath group and 89% in the MAC group (p &gt;.99). Multiple attempts were needed in 24% of neonates in the Angiocath group, and 37% in the MAC group (p=0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%) (P=0.012). Other rates of common adverse effects were similar between the two groups (Table 2).

Conclusion
The overall procedural success of MIST was similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with Angiocath use, though this difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, possibly related to higher use of procedural sedation in this group.
21 Long-Term Ophthalmologic Outcome of Young Adults Born Extremely Preterm
Authors: Zhou Tianwei , Kassis Pierre-Olivier , Hamel Patrick , Qian Cynthia , Chemtob Sylvain , Nuyt Anne Monique , Luu Thuy 
Published: October 2021

Abstract

Primary Subject area
Ophthalmology

Background
Retinopathy of prematurity (ROP) remains the dominant cause of severe visual impairment in childhood in North America and Europe. With the salient improvement in neonatal care since the 1980s, more and more very/extremely premature infants survived and are now reaching adulthood. Premature birth interferes with the critical period of retinal maturation and foveal development. The development of ROP further damages the retina and its vasculature. So far, outcome studies on visual functions and ocular structure in adults born preterm remain scarce.

Objectives
The first aim of this study is to describe the visual function and retinal structure in a cohort of young adults who were born prematurely. With the recognition of the insidious nature of ROP, we also aimed to investigate if ROP could exert a “second hit” beyond prematurity.

Design/Methods
This cross-sectional observational study compared visual function of young adults (18-29 years old) born prematurely (&lt; 30 weeks of gestational age [GA]) versus full-term controls. Participants were categorized into three groups: preterm without ROP, preterm with ROP, and term. Comprehensive ophthalmologic examination was performed with blinding to preterm and ROP status. Best corrected visual acuity (BCVA) was assessed with a standardized linear Snellen chart and contrast sensitivity (CS) with the Vistech system. When analyzing BCVA, refractive errors, and contrast sensitivities, we further grouped data based on the strong eyes (better BCVA) and the weak eyes (worse BCVA). Area-under-the-curve (AUC) analysis was performed to gauge the overall CS. Group comparisons were done using ANOVA.

Results
In this study, 88 individuals born prematurely and 86 individuals born full-term were recruited. Among the strong eyes of the 3 groups, there was no significant difference for BCVA or refractive errors (see image). Among the weak eyes, the preterm with ROP group had the worst BCVA and refractive outcomes, compared to the preterm without ROP and term groups. In the strong eyes, the CS AUC of the preterm with ROP group (16.22 ± 2.69 p&lt;0.0001) was significantly lower than both the preterm without ROP (18.13 ± 2.01) and term (19.55 ± 2.48) groups. In the weak eyes, the AUC of the 3 groups showed a significant and progressive decline from the term group (18.9 ± 2.84) to the preterm without ROP group (18.29 ± 2.14), then to the preterm with ROP group (15.24 ± 2.21).

Conclusion
In our cohort of young adults born preterm, prematurity alone did not affect their BCVA and refractive errors. However, ROP was independently associated with a lower BCVA, higher refractive errors, and a reduced contrast sensitivity. Our data have shown that prematurity and ROP have independent effects on contrast sensitivity. This study highlights the necessity of long-term ophthalmologic follow-ups for adults who were born prematurely.
22 Housing Need Amongst Children with Medical Complexity: A Cross-Sectional Descriptive Study of Three Populations
Authors: Esser Kayla , Moore Clara , Hounsell Kara Grace , Davis Adrienne , Sunderji Alia , Shulman Rayzel , Cohen Eyal , Orkin Julia 
Published: October 2021

Abstract

Primary Subject area
Complex Care

Background
Children with medical complexity (CMC) have medical fragility, complex chronic disease necessitating specialized care, functional disability, and/or high technology dependence. Housing is an important social determinant of health, yet research on prevalence and types of housing need in CMC is limited. Housing need encompasses unstable (frequent moves), inaccessible (lack of ramps/lifts), inadequate (major repairs needed), unsuitable (not enough bedrooms), or unaffordable housing. Given the association between housing and health, housing need may be an important consideration when caring for CMC.

Objectives
The primary objective was to describe the prevalence of and factors related to housing need in CMC. The secondary objective was to compare housing need between CMC, children with one chronic condition (Type 1 diabetes; CT1D) and healthy children (HC) to understand the relationship between chronic conditions and housing need.

Design/Methods
This was a cross-sectional descriptive study. Housing affordability, adequacy, suitability, stability, and accessibility were evaluated through surveys administered to caregivers of CMC, CT1D, and HC at a tertiary-care paediatric hospital using convenience sampling. The association of binary outcomes of housing need between groups was analyzed using logistic regression models, adjusting for sociodemographic factors (income, education, employment, geography, immigration status).

Results
453 caregivers participated (Table 1). Compared to caregivers of HC, caregivers of CMC had higher odds of reporting one or more moves in the last two years (1.3 times), having safety concerns (3 times), using a common area as a bedroom (5.2 times), and experiencing housing stress (3.2 times), after sociodemographic factors were adjusted for (Table 2). Families of CT1D also had elevated odds of some indicators of housing need compared to HC, although to a lesser extent than CMC. 62.2% of CMC indicated they had to reduce spending on basics in order to afford their rent/mortgage, compared to 35.9% of CT1D and 25.2% of HC. Nearly two-thirds of CMC (60.2%) reported a need for accessibility accommodations in their home. Of those who installed accommodations, 62.9% felt the installations were a financial burden (cost ranged from $800-$80,000).

Conclusion
Families of CMC had higher odds of reporting unstable, inadequate, unsuitable, and stressful housing compared to HC even after sociodemographic factors were accounted for, suggesting an association between complexity of child health conditions and housing need. Access to appropriate housing may improve the health of CMC. Health care providers can screen for housing need, become familiar with housing interventions, and advocate for improved resources to address housing need in CMC.
24 Reducing vibrations to improve infant patient safety during transportation
Authors: Renesme Laurent , Darwaish Fadwa , Greenwood Kim , Aubertin Cheryl , Green James , Chan Adrian , Langlois Robert , Redpath Stephanie 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Each year, thousands of newborns are transported by air or ground ambulance to receive specialized medical care. For neurologically immature and physiologically compromised infants, especially preterm infants, the noise and vibration exposure during transport are high despite preventative measures, and may be an important contributor to brain injury risk.

Objectives
To develop a new tool to investigate vibrations during neonatal transport and mitigation strategies.

Design/Methods
Proof of concept study including 3 steps: 1) Characterization of the vibrations during transport. Accelerometer sensors placed on different layers of the Neonatal Patient Transport System (NPTS) (neonate manikin, mattress, incubator, deck, stretcher, and vehicle floor) with a variety of ambulance on road tests performed to capture data. 2) Experimentation - A shaker table was used to develop a standardized test environment. Vibration testing was performed, with the entire NPTS mounted on the shaker table. 3) Mitigation - Shaker table tests were repeated using different configurations of mattress and harness types on manikins with different bodyweights.

Results
1) Characterization: Road transport exposed the manikin’s head to vibrations that exceeded adult standards. Examining the frequency spectra of the accelerometer signals across different layers of the NPTS suggests that two interfaces, stretcher/vehicle floor and incubator/deck, may be critical for intervention to mitigate the vibrations, as they both showed the highest gains in vibration power.
2) Experimentation: Comparison between the on-road and shaker table tests showed that the shaker table was able to reproduce on-road transportation with acceptable fidelity. The shaker table setup can serve as a standardized environment to explore the impact of several NPTS design variables on vibrations transmitted to the patient.
3) Mitigations: Different mattresses were shown to influence the vibrations experienced by the manikin. The head restraint harness type showed an amplitude reduction of the peak frequency component for all experiment types and for most mattress types compared to a standard 5-point harness.

Conclusion
Our study demonstrated that: i) vibrations during neonatal transport can exceed adult standards; ii) acceptable fidelity simulation of road conditions can be achieved using a shaker table system; and iii) the most effective approach for vibration mitigation should consider the whole NTPS, instead of focusing solely on the isolette.
27 ECG monitoring during NRP: A false sense of security?
Authors: Gariépy-Assal Laurence , Moussa Ahmed , Assaad Michael-Andrew 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
During neonatal resuscitation, use of an electrocardiogram (ECG) provides a more reliable measurement of heart rate than auscultation or pulse oximetry. Having an ECG monitor may, however, provide a false sense of security in the unlikely scenario of a newborn with pulseless rhythms. This could delay critical resuscitative steps during neonatal resuscitation.

Objectives
The aim of this study is to evaluate whether the presence of ECG monitoring has an impact on the resuscitative steps of neonatal resuscitation providers.

Design/Methods
We conducted a prospective crossover randomized controlled trial, which took place at Sainte-Justine University Health Center in Montreal, Quebec, Canada. Residents, fellows, attending physicians, transport nurses, and respiratory therapists were recruited in teams of three. They participated in two simulation scenarios (pulseless electrical activity [PEA] with and without ECG monitoring). Teams were randomized to one of the scenarios and then crossed over. A debriefing session followed the two scenarios. All sessions were video-recorded. The primary outcome was the time to pulse check once the simulated mannequin was programmed to become pulseless. Secondary outcomes were the number of pulse checks, time to intubation, time to start of chest compressions, and time to administration of epinephrine.

Results
Preliminary results (n=5 groups, 10 scenarios) showed that the time to check the pulse once the mannequin was pulseless was longer when ECG electrodes were used (98.0 vs 55.6 sec, p = 0.07). There was a statistically significant decreased number of pulse checks with the ECG compared to without (2.4 vs 5.6, p = 0.004). Time to start of positive pressure ventilation (31.3 vs 27 sec), intubation (182.4 vs 179.2 sec), chest compressions (235.2 vs 227.6 sec), and epinephrine administration (340.8 vs 241.5 sec), were all increased in the presence ECG monitoring, but the difference between groups was not statistically significant.

Conclusion
ECG monitoring may alter the behaviour of individuals and delay recognition of a pulseless state, but preliminary data suggest that clinical endpoints are not affected.
30 Risk Factors for Stage III Necrotizing Enterocolitis in Very Low Birth Weight Neonates – A retrospective case-control study
Authors: Lalitha Renjini , Qureshi Mosarrat , Hicks Matthew , Kumaran Kumar 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Stage III necrotizing enterocolitis (NEC-III) is a serious intestinal inflammatory disease in neonates, with high case fatality rate and significant morbidities including need for surgical intervention. Research focusing on risk factors for the development of NEC-III are lacking.

Objectives
To determine the risk factors for NEC-III and its outcomes among neonates born under 33 weeks gestational age (GA).

Design/Methods
This was a single-centre retrospective case-control study of preterm neonates born under 33 weeks GA who were admitted to Stollery Children’s Hospital neonatal intensive care unit (NICU), Edmonton, Alberta, between January 2015 and December 2018. NEC-III cases were compared with Stage II NEC (NEC-II) and matched with 2-4 non-NEC controls by GA ± 1 week and date of birth within 3 months. Univariate and multivariate analysis compared the risk factors for NEC-III, adjusting for GA, birth weight, and sex.

Results
Out of 1360 babies born &lt;33weeks, 71(5.2%) had NEC-II and above during the study period (Figure 1). NEC-III constituted 46% of the total number of NEC cases. Average age of onset of NEC-III was 13.7 days versus 23.9 days for NEC-II (p=0.01). Neonates with NEC-III were of lower GA (25.4weeks) compared to NEC-II(27.3 weeks) and non-NEC (26 weeks), (p=0.0008), had higher severity of illness with Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE-II score) of 47.5 versus 28.4 for NEC-II and 37 for non-NEC ( p=0.003), spent more days on vasoactive agents (3.7 days versus 1.1 days and 1.8 days for NEC-II and non-NEC respectively; p=0.05).
There was a trend towards lower Apgar score &lt;7 at 10 mintues in NEC-III versus non-NEC (AOR 2.59, 95% CI [0.88-7.67]; p=0.085). Death or short bowel syndrome was higher for NEC III (AOR 12.4, 95% CI [1.16-132.28]; p=0.037).

Conclusion
In this case-control study of neonates born under 33 weeks GA, after adjustment for known confounders, duration of UAC and prolonged rupture of membranes were significantly associated with increased incidence of NEC-III. Composite outcome of mortality or short bowel syndrome were higher in NEC-III.