bluuebunny/crossref_metadata_2025_split huggingface dataset:
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) IN SCHOOL-AGED CHILDREN AT TWO SCHOOL BASED HEALTH CENTERS (SBHCS): A DESCRIPTIVE STUDY
Authors: Ghosh Nayantara , Aiyadurai Ramanan , Freeman Sloane 
Published: May 2018

Abstract

BACKGROUND
The number of school-aged children diagnosed with ADHD in Canada has been on the rise over the past three decades. Evidence suggests that children with ADHD dealing with risk factors, such as poverty and prolonged wait-times are more likely to have poorer outcomes due to challenges in accessing healthcare services. Schools are ideal for the early identification of children with ADHD, as they are often the setting in which attention and behavioural issues come to light. School-Based Health Centres (SBHCs) are embedded within the school system and are an ideal entry point for children with ADHD into the healthcare system.

OBJECTIVES
To examine the prevalence of ADHD and as well as demographic characteristics and time to assessment of children at two inner-city SBHCs in Toronto.

DESIGN/METHODS
A retrospective chart review was performed on 869 children from November 2010- March 2016 from two SBHCs. Frequency measures were used to determine the proportion of children that received a new diagnosis of ADHD. Within this population, the patient’s age, gender, ethnicity, parental income, home arrangement, parental education and newcomer status were described. Diagnostic wait-times within the SBHC were calculated using two specific data points – a child’s first clinic visit data and the clinic date they saw a general paediatrician, who would provide the ADHD diagnosis.

RESULTS
Of the 869 children, 9.6% of children received a new diagnosis of ADHD. The mean age of diagnosis was 7.6 years and 80% of the children were male. 74.6% of children’s families identified them as an ethnicity other than white. 60.2% of the patients’ household income was <$30,000/year. 44.5% of the families were composed of single-parent households. 52.8% of the patients’ mothers and 47.6% of fathers had completed a high school level of education or less. 34% of the children were not born in Canada, and of those, 57% had been in the country for only 0–3 years. The average wait time for a child to see a general paediatrician for a developmental assessment from initial visit date was 62.3 days.

CONCLUSION
The prevalence of ADHD at 2 SBHCs was higher than that reported in the general population. A number of barriers to health care access were identified in this cohort of children including low income, single parent homes and newcomer status. SBHCs serve as an accessible health care model that can provide timely diagnosis and management to vulnerable children with ADHD which may improve outcomes.
UTILIZATION OF COMPUTED TOMOGRAPHY FOR PEDIATRIC HEAD TRAUMA FROM 2007–2014 IN THE UNITED STATES: BEFORE AND AFTER PECARN CLINICAL DECISION RULES
Authors: Burstein Brett , Upton Julia , Fuzaro Terra Heloisa , Neuman Mark I 
Published: May 2018

Abstract

BACKGROUND
The Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules identify children at low risk of clinically important traumatic brain injury in whom computed tomography (CT) neuro-imaging can safely be avoided. Since publication in 2009, these rules have been externally validated and are widely used in the Emergency Department (ED) assessment of children with acute head trauma.

OBJECTIVES
This study sought to determine if the proportion of children receiving CT-imaging in US EDs following head trauma has decreased following the development of PECARN rules.

DESIGN/METHODS
This study was a cross-sectional study using the National Hospital Ambulatory Care Survey (NHAMCS) database from 2007–2014. NHAMCS collects data on approximately 30,000 nationally representative visits annually to 300 randomly selected U.S EDs. We included all children <18 years old presenting with a chief complaint or discharge diagnosis of head injury. We collected data on patient demographics, reason for ED visit, discharge diagnosis, patient disposition, and use of head CT. Multivariable logistic regression was used to identify characteristics of CT use, with appropriate weighting to account for the survey methodology. The primary outcome was proportion of children receiving a head CT before and after 2009.

RESULTS
There were 55,253 paediatric visits during the 8-year study period. Among these, 2,783 (5.3% 95%CI 5.0%-5.6%) met inclusion criteria, representing 12,417,725 paediatric head trauma visits. Median patient age was 6 years (IQR 2–13 years), 62% were male, and a majority were evaluated in non-teaching and non-paediatric hospitals (88% and 90%, respectively). Overall, 32% (95%CI 29%-35%) underwent CT neuroimaging. There was no significant difference in CT use after 2009 (31% after vs. 33% before, p=0.41). Multivariate analysis similarly demonstrated no difference after adjustment for patient age, gender, race, insurance provider, paediatric or teaching hospital, admission status and triage acuity (AOR 1.02 after vs. before, 95%CI 0.79–1.32, p=0.85). Factors associated with increased CT use were age ≥2 years (AOR 1.4, 95%CI 1.1–1.9, p=0.02), admission (AOR 5.3, 95%CI 2.2–12.4, p<0.001), highest triage acuity (AOR 7.3, 95%CI 3.5–15.3, p<0.001) and presentation to a non-teaching (AOR 1.5, 95%CI 1.1–2.2, p=0.02) or non-paediatric (AOR 1.5, 95%CI 1.3–2.8, p<0.01) hospital.

CONCLUSION
The use of CT neuro-imaging did not decrease in the 5-year period following derivation of PECARN rules. Findings suggest an important need for quality improvement initiatives to ensure appropriate CT utilization among head injured children.
ACCELERATED GROWTH IN EARLY CHILDHOOD IS ASSOCIATED WITH INCREASED SYSTOLIC AND DIASTOLIC BLOOD PRESSURE
Authors: Eny Karen , Maguire Jonathon , Dai David , Lebovic Gerald , Adeli Khosrow , Hamilton Jill , Hanley Anthony , Mamdani Muhammad , McCrindle Brian , Tremblay Mark , Parkin Patricia , Birken Catherine 
Published: May 2018

Abstract

BACKGROUND
Maternal obesity, low birthweight, and accelerated growth have been shown to be associated with elevated blood pressure in children. However, it is unknown which growth periods are associated with blood pressure, and whether birthweight or maternal obesity modify the relationship between growth and blood pressure in early childhood.

OBJECTIVES
We examined the relationship between age- and sex-standardized body mass index (zBMI) growth trajectories with longitudinal measures of systolic (SBP) and diastolic (DBP) blood pressure in early childhood.

DESIGN/METHODS
We collected repeated measures of zBMI and blood pressure in 2502 children participating in the TARGet Kids! cohort. In stage 1 we used linear spline multilevel models to estimate each child’s zBMI at birth and zBMI growth trajectories in early infancy (0–3 m), late infancy (3–18 m) and toddler years (18–36 m). In stage 2 we used generalized estimating equations to examine the relationship between zBMI at birth and zBMI growth with repeated measures of SBP and DBP from 3 to 6 years of age. We tested for effect modification by birthweight and maternal obesity status by inclusion of interaction terms in each growth period.

RESULTS
After adjusting for confounders and prior growth, a 1 standard deviation unit increase in zBMI growth per month in early infancy (β=0.59; 95% CI 0.32,0.87) and late infancy (β=0.73; 95% CI 0.44,1.01), were associated with higher SBP. Growth in the toddler years was not significantly associated with SBP (p=0.08). Similar but smaller associations were observed for zBMI growth and DBP in early (β=0.29; 95% CI 0.04, 0.53) and late infancy (β=0.42; 95% CI 0.18, 0.66). Birthweight status modified (p=0.004) the relationship between zBMI growth and SBP during late infancy, with the strongest positive association observed in the low birthweight group. During toddler years, birthweight status modified the relationship between zBMI growth with SBP (p=0.03) and DBP (p=0.04), with the strongest positive association observed in the low birthweight group, followed by the high birthweight group. Maternal obesity status modified (p= 0.03) the relationship between zBMI growth with DBP in late infancy, with a stronger association observed among children of mothers with obesity.

CONCLUSION
Accelerated growth in early and late infancy are associated with increased blood pressure in early childhood. Growth during late infancy and toddler years may impact blood pressure differently in children born with high and low birthweights and high maternal BMI, suggesting prospective windows and risk groups to target interventions.
Anticipating pediatric patient transfers from intermediate to intensive care
Authors: Cheng Daryl , Hui Caitlyn , Langrish Kate , Beck Carolyn 
Published: May 2018

Abstract

BACKGROUND
Paediatric intermediate care units (IC) function to provide a higher level of inpatient paediatric care such as frequent monitoring or nursing intervention compared to routine inpatient general paediatric care. A small subset of these patients in IC deteriorate further and require transfer to the paediatric intensive care unit (PICU). By identifying patient characteristics at the time of admission that predict secondary transfer, specific monitoring, resource allocation and early intervention may be implemented in order to improve quality of care. Appropriate and timely patient flow and length of stay (LOS) can also be optimized.

DESIGN/METHODS
The IC at our tertiary care institution admits predominantly general paediatric patients. Its admission criteria have been designed with input from stakeholders, and comprise a range of physiologic and resource based measures.
Data were collected on patients who were admitted to IC, including those subsequently transferred to PICU, between July 2016 - June 2017. Patients whose index IC admission was from the PICU were excluded. Data included demographic and physiologic characteristics (heart rate, respiratory rate, temperature, oxygen therapy) and the bedside paediatric early warning system (BPEWS) score, a validated score based on vital signs. Quantitative and qualitative data were analyzed using Fisher and Mann-Whitney tests respectively.

RESULTS
210 patient visits occurred in this time period, with 44 (20.95%) transferred to PICU (Table 1). Transferred patients showed no significant difference in age or sex. However, they had significantly higher median BPEWS, heart rate, respiratory rate and mean body temperature compared to non-transferred patients, as well as a significantly higher rate of respiratory support and shorter LOS on IC. There was a non-significant trend toward admission directly from the Emergency Department (ED) in transferred patients. Admission criteria and main organ systems affected were similar amongst both groups, with a predominance of respiratory conditions.
PICU transfer was predicted by most physiological characteristics, including BPEWS. This coupled with a significantly shorter length of stay is a likely reflection of higher disease acuity in this group of patients and higher risk of deterioration and subsequent transfer to PICU.

CONCLUSION
The need for close monitoring of physiologic parameters remains paramount in predicting the need for transfer from the IC to PICU.
DURATION OF SUSTAINED INFLATION DURING SUSTAINED INFLATION AND CHEST COMPRESSION IN A PORCINE MODEL OF ASPHYXIA
Authors: Mustofa Jannatul , Patel Sparsh , Cheung Po-Yin , Lee Tze-Fun , Pasquin Matteo , O’Reilly Megan , Schmolzer Georg 
Published: May 2018

Abstract

BACKGROUND
Current resuscitation guidelines recommend 3:1 C:V ratio, however the most effective C:V ratio in newborns remains controversial. We recently demonstrate that combining chest compressions (CC) with a sustained inflation (SI) (=CC+SI) significantly improves return of spontaneous circulation (ROSC) in asphyxiated newborn piglets compared to 3:1 C:V resuscitation. However, the optimal length of SI during CC+SI is unknown.

OBJECTIVES
To examine if a 60sec SI compared to a 20sec SI or 3:1 C:V will reduce will reduces ROSC during resuscitation in asphyxiated newborn piglets.

DESIGN/METHODS
Cardiac arrest with achieved was induced in newborn piglets and then randomized to receive either “3:1 C:V ratio, SI+CC-20sec” or “SS+CC-60sec”. Piglets randomized to “SI+CC+20sec” or “SI+CC+60sec” received 90/min CC during a SI of 20sec or 60sec. Piglets randomized to 3:1 C:V received 90/min CC and 30 inflations/min. The default settings for airway pressures were peak inflation pressure of 30 cm H2O and a positive end expiratory pressure of 6 cm H2O. The primary outcome was duration of CC to achieve ROSC.

RESULTS
Eight piglets were randomized to each group; the mean (SD) age and weight was similar between groups.
Median (IQR) ROSC was significantly shorter in the SI+CC-20sec and SI+CC-60sec group with 96 (68–168) sec and 78 (60–91) sec compared to the 3:1 C:V group with 235 (182–347)sec (p=0.002). 5/8 in the SI+CC-60sec group, 7/8 in the SI+CC-20sec and 8/8 in the 3:1 C:V group received epinephrine (p=0.82).

CONCLUSION
Lengths of SI during CC+SI does not affect ROSC, however CC+SI compared to 3:1 C:V does improve ROSC in newborn piglets.
DOES PRETERM INFANTS BORN OUTSIDE TERTIARY PERINATAL CENTRE HAVE AN IMPACT ON NEURODEVELOPMENTAL AND GROWTH OUTCOME AT 36 MONTHS CORRECTED AGE?
Authors: Soraisham Amuchou , Sheta Ayman , Ringtham Catherine , Tang Selphee , Creighton Diane , Hendson Leonora , Lodha Abhay 
Published: May 2018

Abstract

BACKGROUND
Infants born in tertiary perinatal centres (inborn) have higher survival and lower morbidity than outborn infants. However, there is limited information regarding the long term neurodevelopmental and growth outcomes among outborn preterm infants.

OBJECTIVES
To compare the neurodevelopmental and growth outcomes at 36 months corrected age (CA) between outborn and inborn infants born < 29 weeks.

DESIGN/METHODS
This is a retrospective cohort study. We included infants born <29 weeks admitted to Foothills Medical Centre, Calgary between January 2000 and December 2012, who had neurodevelopmental(ND) assessment up to 36 months CA. Infants with intrauterine infection, major congenital and chromosomal anomalies were excluded. Our primary outcome was composite of death or neurodevelopmental impairment (NDI). We compared ND and growth outcomes between inborn and the outborn infants using univariate and multivariate logistic regression analysis.

RESULTS
Of 1235 eligible infants, 175 (14%) were outborn. Outborn infants were lower in GA (25.8 ± 1.7 wk vs 26.2 ± 1.5 wk), had lower chorioamnionitis rate (15% vs 24%), received less antenatal steroid (55% vs 90%) and maternal antibiotics (51% vs 68%). Neonatal morbidities were similar between the two groups except that outborn infants had higher rates of severe brain injury (24% vs 12%) and mortality (22% vs 11%).
Of 1078 eligible survivors, 1048 (97%) were followed. There was no difference in ND outcomes (Table). Multivariate regression analysis controlling for potential confounders (GA, gender, chorioamnionitis, antenatal steroids and maternal age) showed outborn status was not associated with composite primary outcome of death or ND impairment (adjusted OR: 1.09, 95% CI, 0.69, 1.70). Growth outcomes were not significantly different between two groups.

CONCLUSION
In this cohort, neurodevelopmental and growth outcomes does not appear to be significantly different between outborn and infants at 36 months corrected age.
ARE CANADIAN NEONATOLOGISTS READY FOR A STEM CELL TRIAL FOR BRONCHOPULMONARY DYSPLASIA?
Authors: Guillot Mireille , Asad Sarah , Presseau Justin , Lalu Manoj M , Lemyre Brigitte , Thébaud Bernard 
Published: May 2018

Abstract

BACKGROUND
Pre-clinical studies support the role of stem cells in preventing bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurity. We are planning the first Canadian clinical trial of stem cell therapy for BPD.

OBJECTIVES
To ensure successful bench-to-bedside translation, the objective of our study was to identify the barriers and enablers that may influence neonatologists’ decision to identify extremely preterm infants at risk of BPD for participation in a stem cell trial for BPD.

DESIGN/METHODS
Semi-structured interviews were conducted with neonatologists across Canada. We used the Theoretical Domains Framework (TDF) to develop an interview topic guide covering 14 key domains that influence behavior (e.g. knowledge, intentions, goals, social influences). Two independent researchers used directed content analysis (using qualitative software NVIVO 11) to assign utterances to TDF thematic domains. We further identified sub-themes within domains to identify key barriers and enablers to neonatologists identifying infants for the planned trial.

RESULTS
Sixteen interviews were conducted with neonatologists across Canada (Western Canada n=7, Central Canada n=7, Eastern Canada n=2). Seven were practicing as a neonatologist for 10 years or less, 5 for 11–20 years and 4 for >20 years. Preliminary analyses demonstrated that neonatologists are eager to help identify patients for this study due to the importance they place on trying to treat BPD. Many participants had worries concerning the lack of evidence on long-term outcomes of stem cell therapy. Access to clear protocols, well defined eligibility criteria, and research assistants were brought up as key facilitators for screening patients. The most commonly reported barrier included the need for human resources (e.g. research assistants), funding, and institutional support to help screen patients.

CONCLUSION
Our interviews identified facilitators and barriers from a neonatologist perspective to a potential stem cells trial for BPD. Our findings will inform the design of a phase I/II clinical trial.
DOES THE TIMING OF INITIATION OF THERAPEUTIC HYPOTHERMIA INFLUENCE MRI FINDINGS AND OUTCOMES IN ENCEPHALOPATHIC BABIES?
Authors: Guillot Mireille , Philippe Marissa , Miller Elka , Davila Jorge , Borrowman Nick , Harrison Mary-Ann , Fadel Nadya Ben , Redpath Stephanie , Lemyre Brigitte 
Published: May 2018

Abstract

BACKGROUND
Therapeutic hypothermia (TH), initiated < 6h of life, is the standard treatment for infants with moderate to severe hypoxic ischemic encephalopathy (HIE). While preclinical studies show that TH is more effective when started early, little clinical data exists.

OBJECTIVES
The objectives of our study are to examine the effect of early vs. late TH on the severity and pattern of brain injury on MRI and on the neurodevelopmental outcomes.

DESIGN/METHODS
This retrospective cohort included infants with HIE treated with TH at a level three neonatal intensive care unit between 2009 and 2016. Babies were grouped into: early cooling (TH started ≤ 180 minutes of life) or late cooling (TH started > 180 minutes of life). Two radiologists evaluated the severity and pattern of brain injury on MRI using both NICHD and Barkovich scoring system. Neurodevelopmental outcomes were evaluated at 4, 10, 18 and 48 months.

RESULTS
Ninety-four patients (median gestational age 39 weeks; median birth weight 3.3 kg) were included in the study, 55 in the early cooling and 39 in the late cooling group. The early cooling group included more patients with severe HIE (32.7% vs 10.3%, p=0.01). No difference was observed between the 2 groups in regard to the pattern and severity of brain injury. In the late cooling group, there was a trend toward more severe watershed (WS) injury (WS score ≥3) (30.6% vs 17%, p=0.19) and more moderate to severe brain injury (33.3% vs 23.4%, p=0.33). There was no difference in the neurodevelopmental outcomes between the 2 groups.

CONCLUSION
TH initiated early (before 180 minutes of life) was neither associated with a difference in brain injury on MRI nor better neurodevelopmental outcomes. Despite having more infants with severe HIE in the early cooling group, there was a trend toward less significant brain injury in this group.
THE EFFECT OF EYEMASKS ON REDUCING DISTRESS ASSOCIATED WITH THE RETINOPATHY OF PREMATURITY EXAM
Authors: Speckert Matthew , Szigiato Andrei-Alexandru , zielonka Jeanne , Hollamby Kathleen , Ng Eugene , Altomare Filiberto , Sgro Michael , Nisenbaum Rosane 
Published: May 2018

Abstract

BACKGROUND
Retinopathy of prematurity (ROP) is a disorder of retinal development in the low birthweight preterm infant. Eye screening is routinely performed for infants at risk of developing this disorder. While these examinations help prevent blindness, they can be physiologically stressful for infants, with changes in oxygen saturation, blood pressure and heart rate occurring during the exam and increased apneic episodes reported the 24–48 hours period afterward. The cause of these increased apneic episodes is not currently known.

OBJECTIVES
To evaluate the effect of decreasing light simulation during mydriasis on the frequency of stressful episodes after ROP screening.

DESIGN/METHODS
Multi-centre randomized study. This study was approved by hospital ethics boards at all sites. After informed consent was obtained, infants with a birthweight <1500g or gestational age of ≤32 weeks and scheduled for their first ROP screening were randomized to receive either standard of care or a phototherapy mask during pupil dilation, in addition to routine care. Dilated retinal exams were performed by retinal surgeons and fellows. The primary outcome was the frequency of any desaturation, bradycardic event, or apneic event 12 hours following the examination, compared to a baseline rate 12 hours prior to the exam. Heart rate, respiratory rate and oxygen saturation were recorded for up to 48 hours following the examination and compared to baseline.

RESULTS
A total of 51 infants were enrolled; 28 randomized to the masked group and 23 to the control group. 10 and 13 infants were on ventilator support at the time of examination in each group, respectively. There was a 57.7% decrease in the total number of all stressful events in the masked group compared to controls in the 12 hour post exam period (Rate Ratio 0.42, 95% CI 0.2–0.9, P=0.024). There was a 61.3% decrease in the number of bradycardic events in the masked group compared to controls (RR 0.39, 95% CI 0.2–1.0, P=0.042). Heart rate was significantly higher in both groups after the exam (Effect by time P=0.04), with no difference in between groups (Effect by group P=0.31). There was no significant difference seen in either group in respiratory rate or oxygen saturation at 2 or 4 hours after the ROP examination compared to baseline. Risk factors that were associated with increased stress included: younger gestational age (RR=1.32 95%CI [1.2–1.5] per week), lower birthweight (RR=1.39 [1.2–1.5] per 100g), ventilator support around the time of exam (RR=2.67 [1.3–5.6]), diagnosis of intraventricular hemorrhage (RR=3.78 [1.9–7.3]), and hyponatremia (RR=3.42 [1.8–6.6]). No adverse events occurred while using eye masks.

CONCLUSION
The infants who wore a phototherapy mask during pupillary dilation had lower rates of stressful episodes following screening for retinopathy of prematurity, particularly lower episodes of bradycardia.