bluuebunny/crossref_metadata_2025_split huggingface dataset:
EMERGENCY DEPARTMENT AND INPATIENT CLINICAL DECISION TOOLS FOR THE MANAGEMENT OF FEBRILE YOUNG INFANTS AMONG TERTIARY PEDIATRIC CENTERS ACROSS CANADA
Authors: Burstein Brett , Gravel Jocelyn , Aronson Paul , Neuman Mark 
Published: May 2018

Abstract

BACKGROUND
With no nationally endorsed guidelines and newer diagnostic tools, there exists widespread practice variation in the management of febrile infants &lt;90 days.

OBJECTIVES
This study sought to evaluate the prevalence of clinical decision tools (CDTs) for the management of febrile young infants in the Emergency Department (ED) and inpatient settings among all tertiary paediatric centers across Canada.

DESIGN/METHODS
A cross-sectional, Internet-based survey was distributed to both an ED and an inpatient physician representative at each of the 16 Canadian tertiary paediatric centers. Participants were asked to characterize their clinical settings, diagnostic test availability and institutional febrile young infant CDTs. Copies were requested of all febrile infant-specific materials for independent classification as clinical pathway, guideline or order set, and content review using list items determined a priori. The primary analysis was the proportion of settings that use a CDT for the management of febrile infants. Chi-square testing was used to compare proportions.

RESULTS
Survey response rate was 100% (n = 32, 16 ED and 16 inpatient). Febrile young infant CDTs of any type were infrequently reported overall (9/32, 38%), and were more common in the ED than inpatient setting (50% vs. 6%, p=0.02). Prevalence of any CDT was not associated with hospital volume or physician training. Among EDs, clinical pathways, guidelines, and order sets were available at 6/16 (38%), 1/16 (6%), and 4/16 (25%) institutions, respectively. Among centers reporting existent CDTs, few reported ED or inpatient tracking of provider adherence or audits of impact (3/9, 33% overall). Review of existing CDTs revealed inter-center differences for inclusion ages, antibiotic treatment regimens, lumbar puncture recommendations, diagnostic testing and normal laboratory reference values. Despite wide availability reported at nearly all centers, C-reactive protein and respiratory viral testing were each rarely incorporated into existent CDTs (3/9, 33% for both). Procalcitonin testing was reported to be available at 2/16 (13%) centers, and was not incorporated into any existing CDTs.

CONCLUSION
CDTs for the management of febrile young infants are infrequently available among Canadian tertiary paediatric centers, and when present, rarely contain information on newer diagnostic tests. The paucity of CDTs among paediatric academic training centers may in part underlie ongoing practice variation. Heterogeneity among existent CDTs highlights the need for the establishment of updated and unified ED and inpatient national guidelines.
RELATIONSHIPS BETWEEN NEAR-INFRARED SPECTROSCOPY, PREDUCTAL PERFUSION INDEX AND CARDIAC OUTPUTS IN EXTREMELY PRETERM INFANTS IN THE FIRST 72 HOURS OF LIFE
Authors: Janaillac Marie , Beausoleil Thierry , Karam Oliver , Raboisson Marie-Josée , Barrington Keith J , Dehaes Mathieu , Lapointe Anie 
Published: May 2018

Abstract

BACKGROUND
Assessment of hemodynamics during the transitional period in preterm infants is challenging.

OBJECTIVES
We aimed to describe the relationship between cerebral regional tissue oxygenation saturation (CrSO2), preductal perfusion index (PI), echocardiographic and clinical parameters in extremely preterm infants in their first 72 hours of life.

DESIGN/METHODS
This single center prospective observational study was conducted in the level 3 neonatal intensive care unit of Sainte-Justine Hospital between July 2015 and May 2016. Twenty newborns born at <28 weeks of gestation were continuously monitored with CrSO2 and preductal PI as well as cardiac outputs measured at 6, 24, 48 and 72 hours of life. Data were assessed for normality and Pearson correlation statistics were performed. Serial data were tested using a one-way ANOVA with repeated measures and Bonferroni adjustment. The level of significance was set to 0.05

RESULTS
Median gestational age and birth weight were 25.0 weeks (24–26) and 750 g (655–920) respectively. Table 1 describes the measures over the 72 hours of the study period. CrSO2 and preductal PI were weakly correlated with mean blood pressure, PaCO2, lactates and haemoglobin. Fifteen patients had at least one episode of low left and/or right ventricular output (RVO) measured and showed strong correlation between CrSO2 and superior vena cava (SVC) flow at H6 (r=0.74) and H24 (r=0.86) and between PI and RVO at H6 (r=0.68) and H24 (r=0.92). Five patients had low SVC flowat H6 and showed strong correlation between PI and RVO (r=0.98).

CONCLUSION
CrSO2 and preductal PI were weakly correlated with clinical parameters in the preterm infants. However, CrSO2 and PI showed stronger correlation with RVO and SVC flow during low cardiac output states.
BOVINE LIPID EXTRACT SURFACTANT (BLES®) ADMINISTRATION USING A MINIMALLY INVASIVE APPROACH
Authors: da Silva Orlando , Bhattacharya Soume , Read Brooke , McGovern Evelyn 
Published: May 2018

Abstract

BACKGROUND
There is growing evidence that 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. The majority of studies evaluating the MIST technique have utilized a higher concentration; lower volume surfactant at a dose of 2.5ml/kg. Little evidence is available describing the feasibility of administering a lower concentration, larger volume surfactant at a dose of 5ml/kg utilizing the MIST technique.

OBJECTIVES
To describe the feasibility of utilizing Bovine Lipid Extract Surfactant (BLES®) with the MIST technique within a single tertiary centre after a change in practice.

DESIGN/METHODS
A guideline for surfactant administration (BLES® – 5 ml/kg) using the MIST technique was developed in our centre in 2016. Infants with a birth weight ≥ 1000 g and ≥28 weeks gestation were deemed eligible candidates for this technique if they developed RDS and met criteria for surfactant administration (FiO2 requirement greater than 40% on nasal continuous positive airway pressure (NCPAP) and were clinically well apart from respiratory distress. Surfactant was administered via a thin catheter (KimVent® Multi-Access Catheter) which was inserted into the trachea using Magill forceps, while the baby continued to breathe spontaneously on NCPAP. Depth of catheter insertion was estimated using 6 cm + weight in kg. Surfactant was instilled into the trachea over 1–3 minutes and the delivery was timed to coincide with inspiration. Administration of sucrose was recommended and of atropine was optional prior to laryngoscopy for insertion of the endotracheal catheter.

RESULTS
Since implementation of the new guidelines, a total of 22 infants received surfactant by the MIST method. The mean gestational age was 32 ± 2.6 weeks and mean birth weight was 1972 ± 788g. Five infants (22.7%) had transient bradycardia and desaturations during the procedure. Five infants (22.7%) required intubation post MIST procedure at variable times (range 6–29 hours), 3 infants (14%) for increasing oxygen requirements and a second dose of surfactant and 2 (9%) infants for hypercapnia and poor respiratory drive. Twenty infants (90%) were successfully weaned to 21% oxygen on NCPAP post procedure at a median duration of 0.5 (range 0.01–29) hours.

CONCLUSION
The delivery of BLES® using the MIST technique for RDS was overall well tolerated by the patients and shown to be an effective alternative to more invasive methods.
ÉVALUATION À LONG TERME DES PATIENTS AVEC ANNEAUX VASCULAIRES COMPLETS AU CHU DE QUÉBEC
Authors: Desjardins Laurent , Vaujois Laurence , Houde Christine , Drolet Christian , Perron Jean , Jacques Frédéric 
Published: May 2018

Abstract

BACKGROUND
Les anneaux vasculaires complets (AV) sont des anomalies rares des gros vaisseaux. Ils sont souvent symptomatiques en bas âge et nécessitent une chirurgie dans la grande majorité des cas. Les deux formes les plus communes sont les double arc aortique (DAA) et arc aortique droit avec ligament artériel et artère sous-clavière gauches aberrante (AADSCGA). L’approche chirurgicale et la prise en charge à long terme demeurent débattues dans la littérature, en plus, certains patients demeurent symptomatiques après la chirurgie.

OBJECTIVES
Évaluation à long terme des patients opérés pour un AV.

DESIGN/METHODS
Étude rétrospective observationnelle des patients diagnostiqués avec un AV.

RESULTS
Soixante-six patients ont été diagnostiqués avec un AV (16 patients avec DAA et 50 avec AADSCGA +/- diverticule de Kommerell (DK)). Au diagnostic, 61% étaient symptomatiques (39% symptômes respiratoires, 27% symptômes digestifs hauts, 6% les deux), alors que 20% ont été diagnostiqués dans le cadre d’une anomalie cardiaque associée; chez les autres, il s’agissait d’une découverte fortuite. Trente-huit pourcent des patients avaient une anomalie cardiaque associée. Vingt-trois pourcent des patients avaient un syndrome génétique, dont 53% étaient des syndromes de DiGeorge. Douze patients ont eu un diagnostic concomitant de trachéomalacie. Les patients avec DAA ont été diagnostiqués plus tôt (1.8 ± 3.6 vs 5 ± 8.3 ans, p=0.038) et opérés plus précocement après le diagnostic (82 ± 123 vs 264 ± 416 jours, p=0.036) que les patients avec AADSCGA. Une chirurgie a été effectuée chez 67% des cas, avec 34 patients (77%) subissant une division avec aortopexie. Aucun patient n’est décédé des suites de sa chirurgie. Deux patients ont dû avoir une seconde chirurgie pour des symptômes secondaires à l’AV. Au dernier suivi, 16 patients demeuraient symptomatiques au niveau respiratoire (aucun symptôme digestif), dont 9 patients opérés (20%). Sept patients ont eu une investigation supplémentaire par spirométrie, par contre, aucun n’a eu d’imagerie additionnelle.

CONCLUSION
Les AV sont des anomalies rares et se présentent habituellement dans la première année de vie. Une chirurgie est généralement curatrice et sécuritaire. Néanmoins, plusieurs patients opérés demeurent symptomatiques au dernier suivi. Il serait probablement judicieux d’investiguer ces patients par imagerie pour préciser la cause de la symptomatologie résiduelle.
EXAMINING REFERRAL PATTERNS AND DIAGNOSTIC RATES IN THE BRITISH COLUMBIA AUTISM ASSESSMENT NETWORK
Authors: Ip Angie , Weikum Whitney , Lanphear Nancy 
Published: May 2018

Abstract

BACKGROUND
Most children in British Columbia are assessed for ASD by the BC Autism Assessment Network (BCAAN). While all diagnostic clinicians in BCAAN follow the same diagnostic standards, there is no published data on the referral patterns within BCAAN.

OBJECTIVES
We aimed to examine whether patients referred by different clinician types have different ASD diagnostic rates.

DESIGN/METHODS
This was a retrospective cross-sectional study using data from the BCAAN database consisting of individual patient data from January 1, 2010 to December 31, 2016. The analysis included all patients aged 0 to 18 years. Sequential logistic regression models were built to look at the effect of referring clinician type on ASD diagnostic outcome. The ASD diagnostic outcome was a binary outcome of whether a child was diagnosed with ASD. The main predictor variables were the referring clinician type. Other predictor variables examined as confounders included age and sex of the child, the referring health region, and the year the child was assessed. Changes in effect size, standard deviation, and Akaike information criterion were used to examine model fit.

RESULTS
Twenty patients did not have data for referring clinician type, 5 did not have diagnostic outcome data, and only 27 patients were referred by a nurse; they were not included in the analysis. The final dataset included 12,058 unique patients; they were not included in the analysis. The final dataset included 12,058 unique patients; 7271 (60%) were diagnosed with ASD. The ASD positive diagnostic rate for referrals by paediatricians (n=5704) was 61%, by family physicians (n=886) was 60%, by psychiatrists (n=483) was 51%, and by speech language pathologists (SLPs, n=198) was 68%. Using paediatricians as the reference group, the odds ratio of being diagnosed with ASD in the final model for children referred by a family physician was 1 (95% CI = 0.89–1.12); for children referred by a psychiatrist, the odds ratio was 0.87 (95% CI = 0.75–1); for children referred by an SLP, the odds ratio was 1.69 (95% CI = 1.28–2.25). These findings showed that within our study population, children referred by SLPs were more likely to be diagnosed with ASD and there was no statistically significant difference in ASD diagnostic rate for children referred by paediatricians, physicians, and psychiatrists.

CONCLUSION
Electronic clinical data is a valuable tool in examining referral and diagnostic patterns and generating data guided questions and hypotheses. Findings from this study suggest that the process of SLP referrals as well as differences between family physicians who refer to BCAAN versus the general population of family physicians should be explored as areas for reducing referral delays for children at risk of ASD.
THE YIELD OF A UNIFIED SCREEN FOR THE INVESTIGATION OF INBORN ERRORS OF METABOLISM IN CHILDREN WITH NEURODEVELOPMENTAL CONDITIONS – A RETROSPECTIVE CHART REVIEW
Authors: Nahhas Norah , Peltekova Iskra , Buhas Daniela 
Published: May 2018

Abstract

BACKGROUND
Neurodevelopmental conditions (NDCs) such as Global Developmental Delay (GDD), Intellectual Disability (ID) and Autism Spectrum Disorders (ASD), are clinically heterogenous. Many of their etiologies are genetic. Previous studies report differing detection rates of inborn errors of metabolism (IEM) as causes of NDCs. Small sample sizes, poorly defined populations and variable diagnostic approaches limit these studies. Improved detection and treatment of IEM demands a better understanding of the diagnostic yield of the investigation of IEM as an etiology of NDCs. This will help establish a streamlined process in the diagnostic evaluation NDCs.

OBJECTIVES
The objective of this project is to establish the detection rate of IEM in a well-characterized cohort of children with NDCs, investigated for IEM with a unified screening test panel. This study was approved by the Research Ethics Board.

DESIGN/METHODS
This is a retrospective medical chart review of children with NDCs (GDD, ID and/or ASD), aged 0 to 18 years, diagnosed at a Canadian quaternary center. Charts were collected between March 2015 and 2016. The children were seen for a diagnostic work-up in Developmental Paediatrics, Neurology or Genetics clinics. As part of the standard investigation these services use a unified test panel for screening for IEM. Data was collected on the yield of metabolic testing.

RESULTS
Out of 188 children with NDCs fulfilling the inclusion criteria, 115 (61.1%) underwent the complete IEM screening panel, 52 (27.6%) had partial work-up and 21 (11.2%) did not undergo tests for IEM. The average age of the children was 5 years. Children had the following: ASD (104, 55.3%), GDD (68, 36.2%), ID (10, 5.3%), ASD and ID (6, 3.2%). The diagnostic yield for IEM in those who underwent the entire IEM screening panel was 2.6% (3 confirmed IEM). Three additional children have results suspicious for IEM, but are awaiting confirmatory testing. This suggests that the yield may be as high as 5.2%. Two (3.8%) children with partial IEM work-up also have abnormal metabolic results but diagnoses of IEM are pending.

CONCLUSION
The detection rate of IEM in the children with NDCs, who underwent screening with a unified test panel, was 2.6%. However, given that confirmatory investigations for other children were pending at the time of our study, the actual yield is likely higher. Therefore, IEM should be considered as an etiology in the routine investigation of NDCs. Screening for IEM should be done in a systematic manner.
LIKELY BACTERIAL ACUTE CERVICAL LYMPHADENITIS IN CHILDREN: FACTORS PREDICTIVE OF FAVORABLE OUTCOME
Authors: Deshaies-Poliquin Karina , Arsenault-Blanchard Laurence , Marceau Alexandre , Belanger Richard , Berthelot Simon , Philippon Daniel , Gagnon Josee Anne 
Published: May 2018

Abstract

BACKGROUND
Cervical lymphadenitis is frequent in the paediatric population and usually the result of infectious agents. Management of likely bacterial acute cervical lymphadenitis (LBACL) mainly relies on expert advice and may vary widely from antibiotherapy to surgery as no official guidelines have been published over the last decade.

OBJECTIVES
To identify factors associated with favorable outcome in the management of LBACL in children in order to create a decision algorithm and its further evaluation.

DESIGN/METHODS
This retrospective observational study was based on the review of medical records of patient from 1 month to 18 years old who have consulted for LBACL between July 2010 and July 2015 at a tertiary care paediatric center. LBACL were identified using electronic record databases (hospitalization, emergency). Patients were included if they had acute (≤10 days) episode of unilateral cervical mass of which the final diagnosis was LBACL. Exclusion criteria were: mycobacterial adenitis, Kawasaki disease, Cat-scratch disease, bilateral cervical lymph node involvement, congenital malformation, immunodeficiency or underlying neoplasia. Favorable evolution was defined as outpatient treatment or hospital stay of 48 hours or less without surgical drainage. To identify factors at initial consultation predictive of a favorable outcome, we performed univariate logistic regression models with several potential independent covariates, including, among others, age (years), size of lymph node (mm), fever (38,5°C), an antibiotic use prior to consultation, fluctuation, absolute white blood cell count (x10^9/L), and purulent material at ultrasonography (yes/no).

RESULTS
Our final study cohort was composed of 166 patients with a mean age of 4,5 years (3,5SD) and 62% male. Ultrasound was obtained in 139(83,7%) patients and cervical tomodensitometry in 31(18,7%). Surgical drainage was performed in 35(21,1%). Overall, 68(41,0%) patients presented a favorable evolution from which 27(16,9%) were treated as outpatient (figure1). Factors associated with favorable outcome were (OR; 95%CI): age (1.17; 1.06–1.29; p=0.002), absolute white blood cell count (0.91; 0.87–0.96; p=0.001), no antibiotic use prior to consultation (0.26; 0.07–0.92; p=0.037) and absence of purulent material on ultrasound (0.07; 0.02–0.29; p<0.001). Size of lymph node (0.98; 0.96–1.00; p=0,057) or fluctuation (0.71; 0.21–2.39; p=0.57) did not achieved statistical significance.

CONCLUSION
Older patients without prior antibiotic use, those with lower absolute white blood cell count and no purulent material on ultrasound seem to better evolve than other children with likely bacterial acute cervical lymphadenitis. A decision algorithm to identify patients eligible for conservative management should include those predictive factors.
PEDIATRIC IDIOPATHIC INTERVERTEBRAL DISC CALCIFICATION: A SINGLE INSTITUTION CASE SERIES OF A RARE DISORDER
Authors: Dushnicky Molly , Laxer Ronald , Kulkarni Abhaya , Shroff Manohar , Okura Hidehiro 
Published: May 2018

Abstract

BACKGROUND
Paediatric idiopathic intervertebral disc calcification (PIIVDC) is a rare, poorly understood condition with just over 300 reported cases in the literature since the first report in 1924. The condition is characterized by calcification of an intervertebral disc which can progress to inflammation or extrusion and lead to neck or spinal pain in some patients.

OBJECTIVES
We report a series of patients seen at a single institution with PIIVDC and outline the disease course, management and outcome and review the literature.

DESIGN/METHODS
A retrospective chart review was performed at a single institution spanning the period between January 2001 and February 2016 for diagnoses of PIIVDC. Patient age, gender, symptoms, and medical history and physical and neurologic findings were reviewed. Laboratory and imaging findings, management, follow-up, and outcome were also studied.
A literature review was carried out by MEDLINE and Embase, using the search terms “pediatric disc calcification” and “disc calcification in children” between the years 1997 and 2017, in the English language. Articles were reviewed and data was extracted.

RESULTS
Nine cases of PIIVDC were identified (6 males, 3 females) with an age range of 1 to 14 years. Two patients were asymptomatic and PIIVDC was discovered incidentally. Of the remaining patients, five presented with neck/back pain, one painless torticollis, and one painful torticollis. One patient was noted to have pain radiating along one dermatome. Disc spaces affected were five cervical, five thoracic, and two lumbar, with two patients having more than one space affected. All patients were managed conservatively. In one case, symptoms and lesions persisted after 5-years, but the remainder had complete symptom resolution, generally within 6 months.

CONCLUSION
Although the etiology of PIIVDC remains unknown it appears to occur spontaneously, without preceding trauma or underlying medical condition. A conservative approach to patients without severe neurologic deficit with out-patient close follow-up is supported.
ANTIBIOTIC USE FOR INPATIENT BRONCHIOLITIS: DID NATIONAL GUIDELINES CHANGE PRACTICE?
Authors: Lopez Alison 
Published: May 2018

Abstract

BACKGROUND
Millions of infants and young children are affected by bronchiolitis annually around the globe. This viral lower respiratory tract infection often results in hospital admissions, thus impacting the cost of the healthcare system. Because of its heterogeneous clinical presentation, inpatient management practices amongst paediatricians varies widely. The publication of national guidelines by the Canadian Paediatric Society (CPS) in 2014 was aimed at decreasing the use of unnecessary investigations and therapies for inpatient management of bronchiolitis.

OBJECTIVES
To evaluate the levels of antibiotic prescriptions and supportive investigations for inpatient management of bronchiolitis before and after the publication of national guidelines.

DESIGN/METHODS
This study is a single-centre retrospective chart review of inpatients with confirmed cases of bronchiolitis. We included children with no other relevant co-morbidities, aged 1- 24 months, who were admitted from November 2011 – October 2016. We excluded those who were born less than 35 weeks gestational age and patients with chronic complex medical problems. Our inclusion and exclusion criteria mirrored those used in the CPS guidelines. Those admitted prior to December 2014 were analysed in the pre-guidelines cohort and the remaining were placed in the post-guidelines cohort. The main outcome was antibiotic prescription during the hospital stay. Secondary outcomes included the frequency of chest x-rays, nasopharyngeal swabs, and blood cultures.

RESULTS
131 patients were included in the first (pre-guideline) cohort and 71 in the second (post- guideline) cohort. The overall initiation of antibiotics was almost equal in both cohorts, regardless of whether a chest x-ray was ordered (p=1.000). There was no significant difference in the number of chest x-rays ordered between cohorts (p=0.099). The percentage of patients discharged on antibiotics were significantly lower in the second cohort (p=0.018). More antibiotics were discontinued after a viral cause was isolated in the second cohort (p=0.001). The gender distribution, mean age and mean length of stay were almost equivalent between the cohorts.

CONCLUSION
Our study did not show a significant change in antibiotic prescription despite the release of national guidelines. We found that isolating a viral aetiology often leads to the discontinuation of antibiotics. This study emphasizes the need for local antimicrobial stewardship initiatives to reduce the use of unnecessary antibiotics.