bluuebunny/crossref_metadata_2025_split huggingface dataset:
52 Cultivating Learner-centeredness in a Time of Rupture: Lessons from the Shift to Virtual Pediatric Academic Half Day during the COVID-19 Pandemic
Authors: Remington Mia , Schrewe Brett , Carwana Matt , Kadoura Basil 
Published: October 2021

Abstract

Primary Subject area
Medical Education

Background
The COVID-19 pandemic has significantly disrupted the postgraduate learning environment. In light of public health recommendations and the need to offer safe learning environments, many programs have drawn upon virtual technologies to continue delivery of formal academic curricula. Despite widespread use, however, little is currently known as to how trainees view these changes.

Objectives
The authors sought to explore resident perceptions on the COVID-19-influenced shift from in-person to virtual academic half day (AHD) delivery.

Design/Methods
A cross-sectional survey was created and distributed to 51 pediatric residents who participated in virtual AHD at a university-affiliated Canadian program distributed across three sites, from March to June 2020. Survey responses were obtained confidentially through a secure, online platform (REDCap). Descriptive statistics and inductive thematic analysis were used to analyze responses to close-ended questions and narrative comments, respectively.

Results
Response rate was 60.8%. Residents reported statistically significant improvement in their attitudes towards virtual AHD across all metrics collected. Areas most strongly rated included increased trainee engagement and overall satisfaction with virtual delivery, in part due to increased relevance of content. Factors enabling participation included educationally safe interactions and a more comfortable and flexible learning environment.

Conclusion
These results suggest that the transition to virtual AHD was generally well received. During an uncertain time, when trainee vulnerability is heightened, the need to explicitly attend to educational issues of relevance, engagement, safety, and comfort are crucial. Further, given the rapid and reactive pivots to new curricular strategies in the wake of COVID-19, it is incumbent upon programs to incorporate resident feedback to ensure a learner-centred environment is maintained.
64 Association of 24-hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants
Authors: Debay Anthony , Shah Prakesh , Lodha Abhay , Shivananda Sandesh , Redpath Stephanie , Seshia Molly , Dorling Jon , Lapointe Anie , Canning Rody , Strueby Lannae , Beltempo Marc 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Medical team composition at the delivery of high-risk neonates may contribute to better outcomes. The presence of 24-hour (h) in-house staff neonatologist (NN) may improve delivery room (DR) care practices and outcomes.

Objectives
To assess if 24-h in-house NN coverage is associated with better care practices and outcomes among inborn infants born &lt; 29 weeks GA.

Design/Methods
Cross-sectional cohort study of 2476 inborn infants born at 23-28 weeks gestation, admitted in 2014-2015 to Canadian Neonatal Network level 3 NICUs with a maternity unit that participated in a 2015 survey on NICU coverage. Exposures were classified using survey responses based on the most senior provider offering 24-h in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders with generalized estimating equations to account for clustering within each site.

Results
Among the 28 participating NICUs, most senior providers ensuring 24-h in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). Infants’ characteristics are shown in Table 1. No NN/fellow coverage and 24-h fellow coverage were associated with higher odds of infants receiving DR chest compressions or epinephrine compared to 24-h NN coverage (adjusted odds ratio [AOR] 4.72, 95% CI 2.12-10.6 and AOR 3.33, 95% CI 1.44-7.70, respectively) (Table 2). 24-h fellow coverage was associated with higher odds of normothermia (36.5°C-37.2°C) on admission (AOR 2.26, 95% CI 1.51-3.37) compared to 24-h NN coverage (Table 2). Rates of mortality or major morbidity did not differ significantly among the three groups: NN, 63% (249/395); fellow, 64% (1092/1700); no NN/fellow, 70% (266/381). Compared to 24-h NN coverage, 24-h fellow coverage was associated with lower odds of mortality (AOR 0.62, 95% CI, 0.43-0.88) (Table 2).

Conclusion
24-h in-house NN coverage was associated with lower rates of DR chest compressions or epinephrine use; however, it was not associated with death and/or major morbidity. These results are from a survey linked cohort, and data on the actual presence of individuals in NICU/resuscitation is unknown. Future prospective research on care providers present in the NICU, and its impact on outcomes, is needed.
65 Complication rate of cuffed versus uncuffed PICC lines placed by interventional radiology in pediatric patients
Authors: Al Bandari Maria , Donnellan John , Tavares Filomena 
Published: October 2021

Abstract

Primary Subject area
Paediatric Radiology

Background
Peripherally inserted central catheters are commonly used in pediatrics to offer stable access for administering prolonged courses of antibiotics, chemotherapy, parenteral nutrition, or other intravenous fluids.

Objectives
To assess the complication rates of cuffed versus uncuffed PICCs in a pediatric tertiary referral centre.

Design/Methods
Research ethics board approval was sought and granted. A dual arm study design was employed with a retrospective chart review of PICCs inserted between June 2017 - June 2018, and a prospective chart review of PICCS inserted between January 2019 - June 2019 at a large tertiary pediatric referral center. Data collected from the electronic record included age, weight, and diagnosis. Line type, size, location, insertion and removal dates, and indications were recorded. Primary outcome was removal of PICC after completion of therapy or premature removal due to the following complications: infection, thrombosis, or mechanical failure (defined as catheter breakage, blockage, or dislodgement).

Results
The study included 266 patients. Across all patients weighing &lt; 10 kg, 90.5% of those with cuffed PICCs and 65% of those with uncuffed catheters completed therapy. The predominant complication resulting in premature removal was mechanical failure, but this was only observed in patients with uncuffed catheters (25%). Infection was also observed only in uncuffed catheters (10%), and thrombosis (4.8%) was only in the cuffed lines. For patients weighing ≥ 10 kg, 86% of those with cuffed PICCs and 77.2% with uncuffed catheters completed therapy. More complications were observed in uncuffed catheters (infection 7.7%, mechanical failure 6.6%, thrombosis 5%). Infection resulting in premature removal occurred in 7% of cuffed catheters. There was no reported mechanical failure or thrombosis in the cuffed group. The distribution of diagnoses was relatively homogenous between the groups for most diagnoses. However, there was a higher percentage of oncology patients in the uncuffed group (23%) than the cuffed group (7%) due to the need for power-injectable lines, which were not available in a cuffed variant during this study.

Conclusion
All-cause pediatric PICC-associated complications rate in the neonate group for patients &lt; 10kg in the uncuffed group is 35% and in the cuffed group is 4.8%. Whereas in the pediatric group ≥ 10kg, all-cause pediatric PICC-associated complications rate in the uncuffed group is 19.3% and in the cuffed group is 7%. There were no mechanical complications in the cuffed group and the vast majority of lines made it to completion of therapy. This work supports utilization of cuffed PICC lines in selected pediatric patients.
66 Long-term survival and neurodevelopmental outcomes of very-preterm infants born in Canada between 2009 and 2016
Authors: Ricci M Florencia , Shah Prakesh , Moddemann Diane , Alvaro Ruben , Ng Eugene , Lee Shoo K , Synnes Anne 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Quality improvement programs across Canadian Neonatal Network (CNN) sites have led to increased neonatal survival without major neonatal morbidity among infants born extremely preterm. The next step is to determine if such activities impact longer-term survival and neurodevelopmental outcomes.

Objectives
This cohort study aimed to compare death or significant neurodevelopmental impairment (sNDI) (Bayley-III scores &lt; 70, severe cerebral palsy, blind, or hearing aided) at 18-24 months corrected age among infants born &lt; 29 weeks’ gestation admitted to CNN sites, between 2 Epochs: 1 (2009-2012) and 2 (2013-2016). Secondary objectives included death or neurodevelopmental impairment (NDI) (Bayley-III &lt; 85, any cerebral palsy, visual or hearing impairment), death, sNDI, NDI, and components of neurodevelopmental impairment.

Design/Methods
Only sites with ≥ 70% follow-up rates were included. Differences in maternal-infant characteristics and neonatal morbidities were assessed by Pearson Chi-square and Student t-test testing. Adjusted odds ratios with 95% CIs were calculated for outcome change between the 2 Epochs, accounting for patient characteristic differences in the model.

Results
Study population included 4426 children; Epoch 1: 1895 (43%) and Epoch 2: 2531 (57%). In Epoch 2, more mothers received MgSO4 (56.3% vs. 28.4%; p&lt;0.01), antibiotics (69%vs.65.3%; p 0.01) and delayed cord clamping (37.1% vs. 31.3%; p 0.02), and fewer infants had SNAP-2 (illness severity score) &gt;20 (30.7% vs. 35.2%; p&lt;0.01) or late-onset sepsis (23.3% vs. 26.9%; p 0.01). See Table 1.

Conclusion
Significant reductions in rate of death or sNDI, and in visual and hearing impairment, were identified between Epoch 2 to Epoch 1. An increase in poor cognitive outcome rates requires further study.
68 COVID-19 in children: A case series
Authors: Kukreti Vinay , Sakran Mahmoud , Tsimelkas Sarah , MacDonald Jessie , Wadhwa Anupma 
Published: October 2021

Abstract

Primary Subject area
Community Paediatrics

Background
The COVID-19 pandemic has had an overwhelming impact worldwide. Studies on pediatric populations remain limited, as the burden of disease in pediatric patients appears to be low at this time.

Objectives
To further describe clinical characteristics and severity of disease of confirmed pediatric COVID-19 patients seen and evaluated in a community-based hospital.

Design/Methods
A retrospective chart review of positive COVID-19 patients ≤ 18 years seen in COVID clinic or in the Emergency Department (ED) between April and December 2020 was performed. The results of nasopharyngeal swabs were confirmed using real-time reverse-transcription-polymerase chain reaction (RT-PCR) assays. A descriptive analysis of illness severity, performed via Excel 2019, was based on clinical presentation, laboratory data, and chest x-ray imaging. The categories of illness severity were: asymptomatic, mild, moderate, severe or critical.

Results
A total of 53 positive COVID-19 patients were enrolled in this study, which consisted of 24 (45.3%) males and 29 (54.7%) females. The median age was 7.5 years (2.4-12.8). The majority of patients presented with mild symptoms (64.2%), with fever and cough being the main symptoms in 20 (37.7%) and 16 (30.2%) cases, respectively. Other symptoms included sore throat (15.1%), diarrhea (13.2%), headache (9.4%), runny nose (7.5%) and abdominal pain (7.5%). The remaining patients (35.8%) were asymptomatic. Of note, one patient (1.9%) presented with COVID toes requiring referral to a tertiary centre, and one (1.9%) was diagnosed with acute appendicitis. A history of contact with a confirmed COVID-19-positive family member was present in 43 (81.1%) patients, and 6 (11.3%) reported a history of recent travel. Laboratory tests were performed in 7 (13.2%) patients, and chest x-rays were performed in 9 (17%). There were no abnormalities detected in either, other than an elevated CRP seen in one patient with appendicitis. Two (3.8%) patients were admitted, including the patient with appendicitis who developed a perforation and was later transferred to a tertiary care centre to undergo an appendectomy. The majority of patients (96.2%) were discharged home.

Conclusion
All patients either presented with mild symptoms or were asymptomatic. Fever and cough were the most common presenting symptoms. Due to this, the vast majority of patients were discharged home. The infection in the majority of patients could be traced to a positive family contact. Our findings are consistent with what has been observed previously in our centre as well as worldwide.
72 Identifying Perinatal and Neonatal Factors Associated with Autism Spectrum Disorder among Preterm Infants Born &lt; 29 Weeks’ Gestation
Authors: Busque Andrée-Anne , Jabbour Elias , Patel Sharina , Couture Élise , Garfinkle Jarred , Khairy May , Claveau Martine , Beltempo Marc 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Preterm infants born &lt;29 weeks’ gestational age (GA) are at risk for autism spectrum disorder (ASD), typically diagnosed at age &gt;2 years. Perinatal and neonatal factors, including interventions and morbidities during neonatal intensive care unit admission, may contribute to the risk of ASD among these infants.

Objectives
We aimed to assess the incidence of and risk factors for, ASD among preterm infants born &lt; 29 weeks’ GA.

Design/Methods
&lt;29 weeks’ GA admitted 2009-2017 to two tertiary NICUs and followed ≥18 months at the Neonatal Follow-Up Clinic. Primary outcome was ASD defined as a confirmed diagnosis using standardized testing or suspected diagnosis at &gt;18 months of corrected age. Patient data and 18-month developmental outcomes were obtained from the local Canadian Neonatal Follow Up Network database and from chart review. Stepwise logistic regression was used to identify significant perinatal, neonatal, and socio-economic factors associated with ASD.

Results
Among 300 eligible infants, 47 (15.7%) developed ASD (Figure 1, Table 1). Mean follow-up duration was 3.9 ± 1.4 years and mean age at diagnosis was 3.7 ± 1.5 years. Male sex (adjusted odds ratio [aOR] 4.63, 95% CI 2.12, 10.10), small for gestational age status (aOR 3.03, 95% CI 1.02, 9.01), maternal age ≥ 35 years at delivery (aOR 2.22, 95% CI 1.08, 4.57), and tobacco use in utero (aOR 5.67, 95% CI 1.86, 17.29) were significantly associated with ASD. Major neonatal morbidities (retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, late-onset sepsis, severe neurological injury) were not associated with ASD. Among infants with a complete 18-month corrected age developmental assessment and later diagnosed with ASD, 46% (19/41) did not have significant neurodevelopment impairment (Bayley-III &lt; 70, deafness, blindness, or cerebral palsy).

Conclusion
ASD is a significant morbidity among infants born &lt; 29 weeks’ GA. ASD was associated with infant and prenatal risk factors but not with neonatal morbidities or socio-economic factors. These findings emphasize the need for ASD evaluation among preterm infants &lt; 29 weeks and for reporting developmental outcomes beyond 18-months corrected age.
73 Off-label use and safety of drug use in vascular anomalies
Authors: Gariépy-Assal Laurence , Marcoux Simon , Coulombe Jerome , Powell Julie , Essouri Sandrine , McCuaig Catherine , Dubois Josée , Kleiber Niina 
Published: October 2021

Abstract

Primary Subject area
Clinical Pharmacology and Toxicology

Background
Vascular anomalies (VA) represent a heterogeneous group of disorders associated with an abnormal development and proliferation of blood and/or lymphatic vessels displaying variable clinical presentations and severity. Infantile hemangiomas, venous, and lymphatic malformations, for example, are commonly encountered in children. Other, less frequent diagnostics include Klippel-Trenaunay syndrome and PIK-3CA-related overgrowth spectrum (PROS). Severe phenotypes can alter organ function and/or lead to pain and chronic functional impairment, and are associated with significant morbidity and mortality. Management includes surgical, interventional radiology, and pharmacologic modalities. Drugs are administered by systemic (e.g., oral, intravenous) or local (topical, intralesional) routes, or by sclerotherapy (endovascular or percutaneous venous, lymphatic, or arterial injection). Off-label drug use is common in pediatrics and in rare diseases, two characteristics applying to vascular anomalies (VA). Off-label use is associated with an increased risk of adverse drug reactions.

Objectives
To quantify off-label drug use in VA and assess its safety.

Design/Methods
A guidelines search was conducted to extract a list of drugs used in VA management. The labelling status and safety of each drug was assessed based on the product monograph, Micromedex, and the FDA data. A drug was considered to have significant safety concerns if a black box warning (the FDA’s most stringent warning dedicated to serious or life-threatening risks) or if a serious adverse drug reaction was reported in at least 1% of the patients (leading to hospitalization, congenital malformation, persistent or significant disability or incapacity, life-threatening condition, or death).

Results
Among 87 drugs, 13 were unlicensed and 73 off-label. Figure 1 describes the reason for considering the 73 drugs off-label. Among 74 licensed drugs, only the oral solution of propranolol hydrochloride (Hemangeol®) for the treatment of infantile hemangiomas (IH) is approved. 98.9% of the drugs are used off-label or unlicensed. Except infantile hemangioma, all other VA are exclusively treated with off-label drugs. Significant safety issues concerned 73% of the drugs and were more frequent among systemic than locally delivered drugs (Figure 2).

Conclusion
This first study determining the rate of off-label drug use in vascular anomalies shows that off-label drug use in VA is the rule and not the exception. Significant safety concerns are common. It is needed to carefully weigh risk and benefits for every patient when using systemic and local treatments carrying safety concerns. Patients and families should be openly informed and involved in the decision-making process.
75 Parental perspective about the health and development of their extremely preterm child
Authors: Milette Audrey-Anne , Richter Lindsay , Bourque Claude-Julie , Janvier Annie , Robson Kate , Church Paige Therrien , Synnes Anne , Luu Thuy 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Preterm birth outcome studies and clinical follow-up have traditionally focused on neurodevelopment. We previously showed in a selected sample of parents that they also valued other types of outcomes.

Objectives
This study aimed to validate these findings in a more diverse cohort by examining parental perspectives about the positive and negative aspects of their very preterm child’s health and development in relation to level of neurodevelopment impairment (NDI).

Design/Methods
Parents of children born &lt; 29 weeks gestational age in 2016-2018 and seen at two Canadian neonatal follow-up clinics were invited to complete an online survey about their level of agreement with statements about their child’s health, development, and well-being. Parental responses in relation to their child’s level of NDI were examined using Kruskal-Wallis and chi-square for trends tests.

Results
199 parental responses were obtained for 165 children (65% of eligible children). Of these children, 52%, 27% and 21% had, respectively, no, mild to moderate, and severe NDI. Development was the most common source of concerns (49%), followed by the child’s future (35%), and physical health (35%). Parents of children with severe NDI were more likely to express concerns than those with mild to moderate or no NDI. Parents rated their child’s health relatively high with a median score of 8/10 (range 3-10). Children with no NDI were given higher scores than those with NDI (p = 0.004). Regardless of level of NDI, almost all parents agreed with their child being happy (p = 1.000) and having a positive personality (p = 0.207). Figure 1 shows that parental concerns increased with level of NDI.

Conclusion
Parents of preterm children have a balanced perspective on their child’s outcome. Integrating their views when developing core sets of important outcomes for neonatal follow-up is critical.
78 Asking, listening, understanding: Establishing parent and youth priorities in child health research
Authors: Elliott Sarah , Hartling Lisa , Scott Shannon 
Published: October 2021

Abstract

Primary Subject area
Advocacy

Background
A growing body of literature supports the active involvement of stakeholders in the prioritization and dissemination of evidence-based health care information. However, in child health related research, the perspectives of parents and youth are rarely acknowledged.

Objectives
To engage parents and youth in identifying and developing priority lists of research topics that are most relevant and important to youth and their families.

Design/Methods
We engaged parents and youth across Alberta in a modified James Lind Alliance priority setting exercise. Two lists, containing 27 topics were developed and modified in consultation with local parent and youth advisory groups. The respective lists were sent to parents and youth via online surveys. The anonymous surveys asked parents and youth to rank the topics by rating the degree (5-point Likert scale) to which they agreed the topic was a priority for child health research. All topics rated “Agree” or “Strongly Agree” by ≥ 70% of respondents were retained for discussion. Online focus groups (utilizing deliberative dialogue) to discuss priority topics were held with parents and youth, separately. Focus group discussions were analyzed using thematic analysis; resultant themes and subthemes were used to produce representative research questions. These were then sent via a second online survey to all participating parents and youth, who were asked to rank their ‘top 10’ most important child health research topics. Ethics approval was received from our institutional ethics board, and all participants gave informed consent or assent, prior to any data collection.

Results
Initial surveys were completed by 273 parents and 344 youth. This resulted in 5 highly rated health research topics for parents (behaviour, learning, and developmental disorders; mental health; food, environment and lifestyle; quality of health care; and vaccines) and 4 for youth (brain and nerve health, mental health, quality of health care, and vaccines), respectively. The research questions stemming from four parent (n=12) and six youth (n=21) focus group discussions were ranked in a second survey, completed by 43 parents and 62 youth. Parents’ highest ranked research topic was “effect of screen time on children’s neurodevelopment”, while the highest ranked topic from youth was “early signs of anxiety and depression in children and youth” (Tables 1 & 2).

Conclusion
Utilizing the knowledge and experience of Albertan parents and youth, relevant lists of priority topics in child health research were developed. These lists highlight the areas where funding and research should be directed to improve child health outcomes and patient care experiences that are important to parents and youth.