bluuebunny/crossref_metadata_2025_split huggingface dataset:
51 Mental Health Trajectories of Children and Caregivers who Accessed School-based Health Centres during the COVID-19 Pandemic
Authors: Rasiah Saisujani , Freeman Sloane , Cohen-Silver Justine , Lebovic Gerald , Xu Keying , Maguire Jonathan 
Published: September 2023

Abstract

Background
School-based health centres (SBHCs) improve health care access for students with mental health concerns, especially for disadvantaged communities who face access barriers. During the pandemic, health care access was restricted; however our SBHCs remained accessible. How SBHCs supported children’s and parents’/caregivers’ mental health during the pandemic is unclear.

Objectives
The primary objective of this study was to compare the trajectory of mental health symptoms in children who used SBHCs during the pandemic compared to those who did not.

Design/Methods
This was a prospective longitudinal cohort study of children who used SBHCs serving disadvantaged children with developmental and mental health conditions. A mental health survey which included the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) was used at three time points during the pandemic for children registered with SBHCs. The primary analysis compared the trajectory of SDQ scores over time between children who accessed the SBHCs during the pandemic and those that did not. The secondary analysis was the same, using the GAD-7 scores for parents/caregivers.

Results
There were 435 children included in the study. The mean age was 10.7 years (SD=3.2). Two hundred and ninety-five children (67.8%) identified as male. One hundred and twenty-eight (29.4%) children had an annual family income of less than $30,000.00. After adjusting for age, gender, and diagnoses, children who attended SBHCs had higher SDQ scores over time relative to children who did not (0.15, 95% CI 0.03 to 0.28, p=0.02). Specifically, the total SDQ score increased by 0.14 (95% CI: 0.02, 0.27; p = 0.03) per month in those who accessed SBHCs during the pandemic, while the change in total SDQ score per month was -0.01 (95% CI: -0.06, 0.03; p = 0.55) in those who did not. Parents of children who attended SBHCs also had higher GAD-7 scores over time (0.16, 95% CI = 0.06 to 0.27, p = 0.002) compared with those whose children did not visit the SBHCs.

Conclusion
Mental health symptoms and anxiety symptoms worsened among children and parents/caregivers who attended a SBHC at least once during the pandemic. SBHCs may have decreased access barriers for children and parents/caregivers with socioeconomic risk factors who experienced mental health symptoms during the pandemic, when other healthcare options were limited. Longitudinal studies with longer follow up would help determine the role of SBHCs in supporting at-risk children and parents/caregivers with mental health needs during the pandemic.
55 Milk Expression Habits in Maternal Milk Donors: Should We Favor Hindmilk Banking for Extremely Preterm Infants?
Authors: Janvier Annie , Girard Melissa , Myhal Geneviève , Chouinard Marie-Claude , Fournier Diane , Lewin Antoine , Renaud Christian 
Published: September 2023

Abstract

Background
A maternal milk bank was established in 2014 in Québec. The caloric contents of pooled milk lots ranges from 58-73 calories/100 ml, whereas most babies need ≥82 calories/100 ml. Hindmilk is 2-3 times fatter than foremilk, contains more protein and would be ideal for the most fragile extremely preterm infants. This would avoid adding cow-milk protein fortifier in the first weeks of life. Hindmilk is only released 2-3 minutes post-letdown, so that the milk expression habits of donating mothers may influence caloric content. These habits are ill-documented, and precise recommendations on milk expression habits are needed.

Objectives
The objective of this study was to examine the feasibility of hindmilk expression by breastmilk donors so as to provide it for the most fragile preterm infants.

Design/Methods
In 2021, an electronic questionnaire was emailed to all active milk donors in Québec to collect data on their milk expression habits and their willingness to change them. The questionnaire contained both closed and open-ended questions. Response were analyzed using mixed methods.

Results
In total, 126 out of 181 donors (70%) completed the questionnaire. Most participants (78%) had a university degree, and 65.0% had &gt;1 pregnancy. Overall, 98% were comfortable or very comfortable with current recommendations on milk expression, and 91% were aware or well aware of the benefits of maternal milk for preterm babies. Concerning breastfeeding habits, 68% reported expressing milk for banking between breastfeedings; 18% reported expressing milk for banking from one breast while keeping the milk from their other breast for their baby; and 14% reported breastfeeding their baby on each breast and keeping hindmilk for banking. Overall, 66% of participants said they would be willing to change their habits most or all the time to provide hindmilk for the most fragile babies. The main theme invoked in open-ended answers was altruism, and gratitude for being able to help others. On the other hand, few participants commented on the complexity of milk expression or reported that additional restrictions might discourage them from donating.

Conclusion
Most participating mothers were already giving foremilk and hindmilk. A significant proportion of respondents said they would agree to change their expression habits in favour of giving hindmilk to be used for only the most fragile infants. More information is needed on how changing recommendations for milk expression might impact the supply and caloric content of mothers’ milk.
58 Predicting and Preparing for the Future: Parents of Extremely Preterm Infants Give Recommendations to Clinicians
Authors: Janvier Annie , Thivierge Émilie , Luu Thuy Mai , Jaworski Magdalena , Pearce Rebecca , Bourque Claude Julie , Synnes Anne 
Published: September 2023

Abstract

Background
Parents of extremely preterm children face many challenges and uncertainties. The information and support provided by clinicians—both before and after birth—is invaluable to help them prepare for the future.

Objectives
To explore the information needs of parents of extremely preterm infants, before birth, in the NICU, and at discharge.

Design/Methods
In 2021, all parents of infants born &lt;29 weeks’ gestational age and seen for neonatal follow-up between the ages of 18 months and 7 years were consecutively recruited over a one-year period in a large academic centre. Parents were asked: “Knowing what you know now, what do you wish doctors would have told you about prematurity before and/or after your child's birth?” Answers were analyzed using mixed methods.

Results
Nearly half (45%) of the 249 parents (98% participation rate) were satisfied with the medical information and support they received, either before or after birth. Prenatally, 16% felt that more practical information was needed in terms of the function of babies born preterm (not only diagnoses), and some parents would have liked prematurity to be mentioned in their normal pregnancy follow-up. 19% of parents wanted to know more about the life trajectory of babies in the NICU, along with knowing what was “the next step”, and how they could be part of the team to help their baby (“What are the different steps during the stay?” and ”How we can help as parents”. 22% wished discharge to be improved, to be better prepared for the future: e.g., “BPD does not help. We would have liked to know what leaving on oxygen meant, that she should not go to daycare, the risk with infections, RSV shots, sleeping problems many preemies have. This could have been done weeks before we left the hospital”. 14% wished they had known more about resources for psychosocial support. Parents (14%) wished clinicians to be more optimistic and provide them with hope: e.g., “Before birth, I would have liked to know that most micro preemies do well”.

Conclusion
Although half the parents were satisfied with the information and support they received, the other half recommended improvements, mainly to make our communication positive and practical. Diagnoses did not help parents prepare for the future prenatally, in the NICU, or at discharge, but information on function and what parents could do to assist (in a practical fashion) did.
61 Antibiotic Resistant Patterns of Bacterial Pathogens Causing Invasive Neonatal Infections in Northern Alberta
Authors: Ting Joseph , Lam Adrien , Tse-Chang Alena , Lee Mao-cheng 
Published: September 2023

Abstract

Background
Antimicrobial resistance is one of the most serious global health threats facing the world today. The neonatal intensive care unit (NICU) is a clinical environment that houses newborn infants who are highly susceptible to overwhelming infection. Early and decisive treatment with powerful anti-microbials tends to be the preferred clinical choice for treating sick infants empirically. Prolonged exposure to antimicrobials can result in multi-drug resistant organisms (MDROs), which can be associated with mortality due to an increase in virulence, delay in appropriate treatment, and a lack of treatment options. An updated antibiogram is important for determining the optimal empirical antimicrobial choice for sepsis evaluations. There is currently a lack of antimicrobial susceptibility data for bacterial pathogens in the Northern Alberta region.

Objectives
The objective of this study is to understand the antibiotic resistance patterns among isolates responsible for bacteremia and meningitis in the NICUs in Northern Alberta through the standard antibiograms produced by microbiology laboratories.

Design/Methods
We conducted a retrospective study to analyze antimicrobial resistance patterns found in NICUs during 2013-2021 in Northern Alberta. Bacteria isolated from blood and cerebrospinal fluid according to commonly used antibiotics in NICUs were collated to create a provincial antibiogram.

Results
A total of 5562 isolates were included in this antibiogram. The most frequently isolated organisms were Escherichia coli (1521), Staphylococcus aureus (1157), members of coagulase-negative staphylococcus (534), Enterococcus faecalis (326), and Klebsiella pneumoniae (357) in neonatal populations. Among the 1157 S. aureus isolates, 24% were resistant to oxacillin (i.e., “methicillin-resistant S. aureus” or MRSA) and 1% were resistant to vancomycin (i.e., “vancomycin-resistant S. aureus” or VRSA). Of the 326 strains of Enterococcus spp., there were no vancomycin-resistant enterococci (VRE) identified. Among gram-negative isolates, 251 out of the 2690 (9.6%) were producing extended-spectrum beta-lactamase (ESBL), in which 52% and 94% were susceptible to gentamicin and amikacin respectively. Among the non-ESBL-producing isolates, E. coli (1521) and K. pneumoniae (357), 7% of the E. coli strains and 1% of the K. pneumoniae strains were resistant to gentamicin.

Conclusion
The provincial antibiogram is a useful clinical tool that can best inform clinicians on the appropriate choice of empirical antimicrobial agent based on commonly identified invasive pathogens in neonatal infections within Northern Alberta. Our findings on these resistant patterns can aid next steps for developing an antimicrobial stewardship program.
65 Outcomes of Neonates Admitted to the NICU during the COVID-19 Pandemic: Comparison with a Pre-Pandemic Cohort
Authors: Campbell-Yeo Marsha , Bacchini Fabiana , Beltempo Marc , Alcock Lynsey , Shah Prakeshkumar , Bishop Tanya , Campbell Douglas , Chilcott Addie , Comeau Jeanette , Dol Justine , Grant Amy , Gubbay Jonathan , Hughes Brianna , Hundert Amos , Inglis Darlene , Lakoff Alanna , Lalani Yasmin , Luu Thuy Mai , MacMorton Jenna , Mitra Souvik , Narvey Michael , Robeson Karel O'Brien Paula , Science Michelle , Van Woezik Rachel , Whitehead Leah 
Published: September 2023

Abstract

Introduction/Background
The effect of the COVID-19 pandemic on neonatal outcomes is not yet completely understood.

Objectives
To compare the neonatal outcomes of very preterm infants admitted to Canadian NICUs pre- and during the COVID-19 pandemic.

Design/Methods
This retrospective cohort study included infants born &lt;33 weeks and admitted to tertiary Canadian NICUs participating in the Canadian Neonatal Network (CNN) database. The sample included 14,368 infants from two cohorts: 7,280 infants pre-pandemic (April 1, 2018 – December 31, 2019) and 7,088 infants during the pandemic (April 1, 2020 – December 31, 2021). Primary composite outcomes were mortality or major morbidity. Care practices and interventions were compared. Relative risk (RR) comparing the pandemic vs pre-pandemic periods were estimated using generalized estimated equations and adjusted for confounders.

Results
The characteristics of infants admitted before and during the pandemic were not significantly different. The incidence of mortality or major morbidity was similar pre- and during the pandemic (37%, 36% respectively; RR=1.01 [0.92, 1.01]; Table 1). Infant health outcomes were not significantly different between periods. There was a non-significant decrease in the exclusive receipt of mothers’ own milk (MOM) at discharge (45% pre- and 37% during; RR=0.85 [0.68, 1.06]).

Conclusion
There was no difference in clinical outcomes between pre-pandemic and pandemic cohorts. The possibility of lower receipt of exclusive MOM at discharge during the COVID-19 pandemic needs further study.
66 Association of Low Hemoglobin at Birth and Neurodevelopmental Outcomes in Preterm Neonates &lt; 29 Weeks’ Gestation: A Retrospective Cohort Study
Authors: Elkhouli Mohamed , Raghuram Kamini , Elhanafy Thanna , Asztalos Elizabeth , Banihani Rudaina , Shah Prakesh S , Mohamed Adel 
Published: September 2023

Abstract

Background
Low hemoglobin (Hb) at birth is not an uncommon presentation for infants born preterm. The association of early anemia and neurodevelopmental outcomes in extremely preterm infants is not well studied.

Objectives
The objective of this study was to assess neurodevelopmental outcomes at 18-24 months corrected age (CA) of preterm infants with Hb &lt;120 gm/l compared to those with Hb ≥120 gm/l at birth.

Design/Methods
In this retrospective cohort study, infants of &lt;29 weeks’ gestational age (GA) with an Hb result at birth and admitted to one of two Canadian tertiary care NICUs between January 2009 and June 2018, were included. Baseline sociodemographic, antenatal, and neonatal data were compared between groups. The primary outcome was neurodevelopmental impairment (NDI), defined as the presence of one or more of: cerebral palsy; motor, cognitive, or language impairments on standardized testing; or visual or hearing impairment, at 18-24 months. Secondary outcomes included significant NDI (sNDI), death, severe retinopathy of prematurity (ROP) (≥ stage 3), grade III intraventricular hemorrhage (IVH), periventricular hemorrhagic infarction, bronchopulmonary dysplasia (BPD), and composite outcomes of death or NDI. Multivariable logistic regression adjusting for GA, small for GA (SGA), sex, birth centre, and antenatal steroids, was used to determine the association between early anemia and outcomes.

Results
Of the 2351 eligible neonates, 351 (14.9%) had Hb levels &lt;120 gm/L at birth. Baseline characteristics for groups are summarized in Table 1. Of the infants who survived, 1534 (72.5%) had developmental follow-up at 18 to 24 months CA. Low Hb was associated with significantly higher odds of NDI among survivors in univariate analyses but not in multivariable logistic regression (Table 2). The composite outcome of death or NDI was significantly higher in the low Hb group, primarily driven by the higher incidence of mortality. Neonatal death, IVH, ROP, and BPD were significantly higher in the low Hb group.

Conclusion
In preterm infants of &lt;29 weeks’ GA, low Hb at birth was not associated with significant NDI outcomes at 18-24 months. However, low Hb was associated with higher odds of death, severe IVH, severe ROP, and BPD.
68 Multimodal Monitoring of Hemodynamics in Extremely Low Birth Weight Preterm Infants in a Canadian Tertiary Level Unit: Non-Blinded Randomized Control Trial/MUSE Trial
Authors: Lalitha Renjini , Kumaran Kumar , Bitar Eyad , Surak Aimann , Hyderi Abbas , Hicks Matthew , Cheung Po-Yin , Pepper Dawn 
Published: September 2023

Abstract

Introduction/Background
Current approaches for the evaluation and treatment of transitional circulatory issues in preterm infants based primarily on blood pressure (BP) may be harmful. It is essential that these approaches are adequately investigated. This study tests a detailed hemodynamic approach with a multimodal assessment compared to standard approach, using a Vasoactive Ventilation Renal score (VVR) that incorporates inotrope use, ventilation support, and renal function along with inotrope use reflecting cardiorespiratory-renal health.

Objectives
To determine whether multimodal hemodynamic monitoring will improve cardiorespiratory-renal health as evidenced by decreasing VVR in preterm infants at one week of life.

Design/Methods
This was a randomized control trial of preterm infants born &lt;29 weeks gestational age who were admitted to a tertiary neonatal intensive care unit between 15 Feb 2019 and 31 Dec 2021. Eligible infants were randomly assigned for the first 72 hours of life to either a multimodal assessment arm (consisting of early targeted neonatal echocardiogram, continuous cerebral near infrared spectroscopy [NIRS] and clinical-biochemical data) or to a standard arm (using clinical-biochemical data only). A comprehensive study guideline was used for hemodynamic assessment in the multimodal arm. Univariate and multivariate analyses compared the two arms.

Results
298 infants were screened during the study period and 147 were randomly assigned (75 multimodal arm, 72 standard arm). 68 in the multimodal and 64 in the standard arm were included in the preliminary analysis (Figure 1). Baseline characteristics were similar in both arms (Table 1). The mean VVR scores within 7 days of life were 16.5(SD 15.4) and 18.9(SD 20.2) in the multimodal and standard arm respectively (p=0.451). Mean Ventilation Index scores in the first 72 hours of life were 16.2(SD 15.7) and 17.9(SD 15.5) respectively (p=0.552, Table 1). Peak VVR scores &gt;53 at 7 days were significantly higher in the standard arm (11.1%) than in the multimodal arm (0%), p= 0.005. Outcomes of death, severe intraventricular hemorrhage and length of hospital stay were not statistically different. However, there was a trend toward decreased inotrope use in the multimodal arm compared with the standard arm (16.2% vs. 23.4% respectively, p=0.294).

Conclusion
In preterm infants, multimodal hemodynamic assessment during the transitional period was not associated with decreased VVR scores that signify improved cardiorespiratory-renal health, but led to lower incidence of VVR score greater than 90th centile and a decreasing trend in inotrope use in the first week of life.
72 Criteria for Discharge of Preterm Infants in Canadian Neonatal Intensive Care Units
Authors: El-Naggar Walid , Fieldhouse Elise , McCord Helen 
Published: September 2023

Abstract

Background
Discharging to home is a milestone that impacts preterm infants, their parents, and the neonatal intensive care units (NICU). Standardized discharge programs that are individualized for family needs can ensure a safe transfer of care to parents, decrease the length of hospital stay and costs, and improve parental satisfaction.

Objectives
To assess the degree of variability in discharge criteria for preterm infants &lt;34 weeks’ gestation across Canadian NICUs, explore different institution-specific guidelines, and evaluate the degree of adherence to Canadian Paediatric Society (CPS) guidelines.

Design/Methods
A clinical representative for each of 117 level 2, 3 and 4 Canadian NICUs was contacted via email to participate in an anonymous survey link (OPINIO) regarding their discharge criteria for preterm infants. French and English versions of the survey were available.

Results
Ninety-eight respondents (83.7%), representing all Canadian provinces and the NWT, completed the survey (Figure 1). The majority of the responders were nurse practitioners (42.8%) and neonatologists (30.7%) with &gt;5 years of experience (87%). 63% of responses came from level 3 and 4 NICUs. Most respondents (80.6%) lacked written guidelines in their units for discharging preterm infants. 60.2% did not have a dedicated discharge coordinator, and 45% did not have a post-discharge clinic. Table 1 summarizes the different discharge practices.

Conclusion
There is a significant heterogeneity in discharge practices for preterm infants in Canadian NICUs, despite the presence of CPS guidelines. This survey provides a basis for benchmarking and knowledge-sharing, but more research is needed to guide best evidence-based practice.

Potential competing interests
Dr. El-Naggar served as a consultant for Aerogen Pharma Limited and is a site investigator of its funded study: A Partially-Blind, Randomized, Controlled, Parallel-Group, Dose-Ranging Study to Determine the Efficacy, Safety and Tolerability of AeroFactTM (SF-RI 1 surfactant for inhalation combined with a dedicated drug delivery system) in Preterm Infants at Risk for Worsening Respiratory Distress Syndrome.