bluuebunny/crossref_metadata_2025_split huggingface dataset:
45 Variation in the Management of Hospitalized Children with Orbital Cellulitis over Ten Years
Authors: Nguyen Emily , Mahant Sanjay , Cichon Jessica , Drouin Olivier , Pound Catherine , Quet Julie , Wahi Gita , Bayliss Ann , Vomiero Gemma , Foulds Jessica L , Kanani Ronik , Sakran Mahmoud , Sehgal Anupam , Borkhoff Cornelia M , Pullenayegum Eleanor , Widjaja Elysa , Reginald Arun , Wolter Nikolaus E , Oni Semipe , Anwar Rashid , Louriachi Hossam , Ge Yipeng , Kirolos Nardin , Patel Ashaka , Jasani Hardika , Kornelsen Emily , Chugh Ashton , Gouda Sandra , Akbaroghli Susan , McKerlie Morgyn , Parkin Patricia C , Gill Peter J , Hersi Leo 
Published: September 2023

Abstract

Background
Management of children with periorbital and orbital infections is multifaceted and interdisciplinary. However, no clinical practice guidelines exist to guide the evaluation and management of orbital cellulitis, leading to highly variable care.

Objectives
Identifying differences in management and outcomes at the hospital level can identify areas to improve care, standardize practice, reduce unnecessary testing, and rationalize pharmacotherapy. We aimed to describe variation and trends over time in diagnostic testing and imaging, adjunctive agents, empiric antibiotics, and surgical intervention in children hospitalized with orbital cellulitis.

Design/Methods
Multicentre cohort study of children aged 2 months to 18 years with orbital cellulitis infections admitted to ten hospitals from 2009 to 2018. We assessed hospital level variation using X2 tests. Trends over time were analyzed descriptively and with linear regression.

Results
Of 1579 patients, 1308 (82.8%) were admitted to a children’s hospital. There were significant differences between children’s hospitals in usage of C-reactive protein tests (P&lt;0.001), computed tomography scans (P=0.004), magnetic resonance imaging scans (P=0.003), intranasal decongestants (P&lt;0.001), intranasal corticosteroids (P&lt;0.001), intranasal saline spray (P&lt;0.001), and systemic corticosteroids (P&lt;0.001). Among children’s hospitals between 2009 and 2018, C-reactive protein test usage increased from 28.8% to 73.5% (P&lt;0.001), erythrocyte sedimentation rate decreased from 31.5% to 14.1% (P&lt;0.001), and magnetic resonance imaging scans doubled 4.1% to 8.8% (P=0.02). Use of intranasal corticosteroids (P=0.003) and saline sprays (P=0.02) increased over time, while intranasal decongestants, corticosteroids, antibiotics, surgery rates, and length of hospital stay were similar.

Conclusion
There is significant variation in usage of diagnostic tests and treatments in children hospitalized with orbital cellulitis. There were increases in test usage and interventions over time despite minimal changes in surgery rates and length of stay. These findings highlight the need to develop evidence-based clinical practice guidelines.
48 Congenital Syphilis in Canada: Findings of a Canadian Paediatric Surveillance Program Study
Authors: Bullard Jared , Krueger Carsten , Gravel Geneviève , Guedes João , Sandhu Jaskiran , Tomas Kristina , Brophy Jason 
Published: September 2023

Abstract

Background
Since 2015, the incidence of congenital syphilis (CS) in Canada has increased significantly. Vertical transmission of syphilis can be prevented through timely treatment of infected pregnant persons; however, difficulty engaging in prenatal care can preclude diagnosis, and consequently treatment. Canadian data on sociobehavioural risk factors associated with poor engagement in prenatal care is limited, yet needed to inform prevention efforts.

Objectives
Our primary objective is to identify sociobehavioural risk factors of mothers with infants affected by syphilis, as well as describe the screening and treatment they receive. Our secondary objective is to describe the presentation and management of affected infants in Canada.

Design/Methods
Cases of confirmed and probable CS were elicited from paediatricians through the Canadian Paediatric Surveillance Program between June 2021 and October 2022. Survey responses were analyzed using descriptive statistics.

Results
In total, 143 cases were reported: 78% originated from the prairies (Alberta n=39, Saskatchewan n=50, Manitoba n=23) and 34% resided rurally. The median age was 27 years (range 17-39). Among the 143 women, 94 (66%) reported substance use, 42 (29%) child protection involvement with a previous child, and 25 (17%) housing insecurity; however, “unknown” responses were frequent for many variables. Of those reporting substance use, methamphetamines (n=46/94, 49%) and opioids (n=34/94, 36%), were the most common. Most women (n=73/143, 51%) had no known sexually transmitted co-infection, but among those who did, chlamydia was the most common (n=38/70, 54%). Only 22% (n=32/143) reported at least one prenatal visit per trimester. Of the 85/143 mothers known to have a positive syphilis screen, 22% (n=19/85) did not receive treatment. Of the 28 cases where specific barriers to accessing prenatal care were reported, 8 reported substance use, 6 reported housing insecurity, and 6 reported attitudinal barriers.
Most affected infants had no physical exam findings of CS (n=83/143, 58%), but among those who did, rash and hepatomegaly were the most common findings (n=17/143, 12% and n=15/143, 11% respectively). Of the 136 with long bone x-rays completed, 70% (n=95) were normal. Most cases (138/143, 96%) were identified within the first month of life, and 89% (n=127/143) began antibiotic treatment within a week of life.

Conclusion
Substance use during pregnancy is common in mothers of children with CS; however, the presence of other sociobehavioural risk factors is often not known by reporting paediatricians. Most affected infants are asymptomatic but are diagnosed and treated early. Findings will inform public health strategies for preventing CS and combatting the current epidemic.
49 Systematic Review and Meta-analysis of SARS-CoV-2 Vaccine Acceptance in Parents of Children Aged 5-11
Authors: Hui Caitlyn , Piche-Renaud Pierre-Philippe , Peresin Joelle , Shahrbabak Elahe Karimi , O'Kelly Ciobha , Macikunas Andrea , Yan Tingting , Chiara Costanza Di , Tailor Lauren , Farrar Daniel S , Morris Shaun K 
Published: September 2023

Abstract

Background
Despite the well-studied benefits and safety of SARS-CoV-2 vaccines, many caregivers of children aged 5 to 11 years old remain hesitant to have their child vaccinated. Reasons for vaccine non-acceptance and barriers specific to children aged 5-11 and caregivers are poorly understood.

Objectives
Our study aims to: 1) Assess proportion of parents who are acceptant of vaccines in different populations/settings; 2) Identify parent and children characteristics associated with vaccine acceptance; and 3) Identify reasons for vaccine non-acceptance.

Design/Methods
Medline, Embase, Cochrane and CINAHL were searched using predefined search terms to identify relevant studies published between October 29, 2021 and September 12, 2022. Studies were assessed for inclusion/exclusion by two authors, and discrepancies were resolved by discussion with a senior author. Random-effects meta-analysis was performed to estimate the pooled proportion of parents who are acceptant of SARS-CoV-2 vaccines.

Results
A total of 1571 articles were identified for full text review, of which 30 were included. Twenty-four studies were conducted in high income countries, three in upper middle-income countries and three in low- to middle-income countries. The pooled effects size for vaccine acceptance in caregivers of children aged 5-11 years was calculated as 54% (95% confidence interval 47–60%), with considerable between-study heterogeneity (I2 of 99.04%). Characteristics associated with vaccine acceptance included caregivers being vaccinated against SARS-CoV-2 themselves, and higher parental education. Common reasons for vaccine non-acceptance consisted of vaccine safety/efficacy concerns and perception children being less susceptible to SARS-CoV-2 infection compared with adults.

Conclusion
The overall proportion of caregivers being acceptant of SARS-CoV-2 vaccine for their child aged 5-11 was found to be low, with the main barriers relating to vaccine safety concerns and health education. Further studies exploring these barriers and potential solutions to increase vaccine confidence and uptake in this age group are needed.
54 Preterm Parents Identified Meaningful Outcomes: Involving Parents in Implementing Change
Authors: Janvier Annie , Synnes Anne , Lam Mei Mei , Bacchini Fabiana , Jones Melissa , Bong Karen , Richter Lindsay , Luu Thuy Mai 
Published: September 2023

Abstract

Background
The Canadian Neonatal Follow-Up Network (CNFUN) reports on neurodevelopmental impairments (NDI) in the very preterm population but has never asked parents which outcomes and definitions are meaningful to them. The Parent Voices group conducted four studies which showed differences between parents and CNFUN perspectives on definitions, severity, composite outcomes, which outcomes, and the need to report positive as well as adverse outcomes. Disseminating and implementing change based on these results is the next essential step.

Objectives
To create consensus statements to guide evidence-based change.

Design/Methods
Using a modified Delphi method, Parent Voices results were reviewed and discussed with parents, clinicians and researchers in a virtual workshop in Oct 2021. The discussion was analyzed qualitatively to create statements, circulated for feedback, and 80% consensus statements identified by electronic polling. Priority items requiring further work were identified, working groups created, and results presented at a Sept 2022 workshop.

Results
In the 2021 workshop, 17 consensus statements were identified (7 from the Parent Voices results, 5 from the discussion, and 5 were out of scope). Actionable statements (n=11, Table 1) and items needing further work (n=6, Table 2) were identified and progress was made (Tables 1 and 2). To identify how to measure 7 outcomes which parents and stakeholders identified as important (child well-being, quality of life, socioemotional and behavioural, respiratory, feeding, sleeping, and caregiver well-being), working groups reviewed literature and made recommendations for minimal dataset and funded research at a virtual presentation with parent, clinicians, and researchers in Sept 2022.
In the summer of 2022, the Canadian Premature Babies Foundation (CPBF), Parent-EPIQ team members and summer students disseminated the Parent Voices results to lay stakeholder groups via CPBF blogs and webinars. They also pursued a project identified in the 2021 workshop to educate parents about the role of Neonatal Follow-Up Programs using infographics and information sheets.

Conclusion
We have successfully collaborated with parent partners to implement the actionable results from our Parent Voices Project, and have a process to implement change when further work is required. Involving parents in research, knowledge dissemination and implementation can lead to changes that accurately represent the priorities of families.
56 Survival and Long-term Outcomes of Children who Survived after End-of-Life Decisions in the NICU
Authors: Janvier Annie , Boutillier Béatrice , Biran Valérie , Barrington Keith , Caeymaex Laurence 
Published: September 2023

Abstract

Background
The majority of deaths in neonatal intensive care units (NICU) follow end-of-life decision-making. Most discussions regarding the withdrawal or withholding of life-sustaining interventions (WWLST) occur when infants are dependent on life-sustaining technology (LST) to stay alive. These children are often expected to die within a relatively short time if LST is withheld or withdrawn. The objective of this study was to investigate long-term outcomes of babies who survive despite WWLST decision-making.

Objectives
The goals of this study were to: 1) examine the prevalence of WWLST discussions with parents in a level 3 NICU; 2) investigate decisions associated with WWLST discussions; and 3) examine survival and long-term outcomes of children when life-saving interventions (LSI) are withheld or withdrawn.

Design/Methods
In 2020 and 2021, the charts of all 6 years of level 3 unit NICU admissions were reviewed for presence of WWLST discussions or decisions, as well as the functional long-term outcome at 2 years for all children who survived. The decisions taken at the time of the WWLST discussions were categorized into 4 groups, using a modification of the Verhagen classification.

Results
WWLST discussions occurred for 266 of 5251 infants admitted to the NICU: 151 were term and 115 were preterm infants. In more than two-thirds of these discussions, themes related to concerns about the future and were mainly based on severe neurological prognosis. Among all discussions, 164 led to a WWLST decision, 130 of which were followed by the infant’s death. Of 34 children who survived to discharge despite WWLST, 20 were preterms and 14 were males. Among these, 10 died before 2 years of age and 11 require frequent medical follow-up. Major functional limitations were common among survivors, but eight were classified as functionally normal or as having mild to moderate functional limitations.

Conclusion
Many discussions about WWLST do not result in a decision to withhold or withdraw life-saving interventions. When a WWLST decision is taken, survival may occur, which is usually associated with poor long-term outcomes, but this trajectory is not universal. Discussions about WWLST should recognize all possibilities.
60 NICU Manager’s Perception of High Unit Activity and Its Association with Patient Care in the Neonatal Intensive Care Unit
Authors: Herman Carla 
Published: September 2023

Abstract

Background
Each year, 15,000 critically ill neonates require specialized care that is offered in only 32 tertiary neonatal intensive care units (NICUs) in Canada. Previous studies have shown associations between nurse-to-patient ratios and higher bed occupancy with patient outcomes.

Objective
To explore neonatal managers’ perceptions of organizational factors in Canadian NICUs.

Methods
This was a web-based cross-sectional survey, consisting of 20 questions pertaining to the determinants of resource allocation, the ascertainment of high occupancy state, as well as the different challenges and mitigation strategies implemented during periods of high unit strain. The survey was designed following the CHERRIES guidelines and was critically reviewed through a two-round validation process prior to deployment. It was sent by e-mail to the unit managers of all Canadian Level-3 NICUs between August and November 2022. They were invited to respond based on their unit’s practices in 2021. The analysis was conducted using descriptive statistics, where units were dichotomized by size (small unit ˂36 beds, large unit ≥36 beds).

Results
A total of 24 unit managers (75%) completed the survey. Most respondents relied exclusively on clinical judgment to estimate the total number of nurses required per shift (33%) and the individual nurse-to-patient ratios (67%) as opposed to nursing workload assessment tools (8% and 21%, respectively). The response for the proportion of nursing shifts perceived as adequately staffed was: 0% for 100% adequately staffed, 37% for ˃80% adequately staffed, and 27% for 60%-80% adequately staffed. The response for the proportion of nursing shifts perceived as understaffed to the point of being unsafe for patient care was: 17% for no understaffed, 52% for ˂20% understaffed, and 9% for 20%-40% understaffed. The most common organizational challenges were personnel recruitment and unit occupancy (each reported as being a major issue by 38% of respondents). Although most (75%) respondents believed that high occupancy, especially when exceeding 90%, likely increases the risk of adverse patient outcomes, they revealed implementing mitigation strategies to reduce occupancy only when it exceeded 95%. At that point, the most common strategies implemented were to call for additional voluntary nurses, implement voluntary nursing overtime, and accelerate patient transfer.

Conclusion
Although Canadian NICUs form a very heterogeneous group, managers shared similar perspectives in terms of staffing and occupancy challenges. This emphasizes the need for collaborative NICU person-power resource management practices to improve neonatal intensive care service organization.
62 Neurodevelopmental Outcomes Following Preterm Prelabour Rupture of Membranes Versus Spontaneous Preterm Birth among Infants Born at &lt;29 Weeks of Gestation
Authors: Ricci M Florencia , Moddemann Diane , Zwicker Jill , Richter Lindsay , Pylypjuk Christy , Shah Prakeshkumar 
Published: September 2023

Abstract

Background
Few studies examine differences in neurodevelopmental outcomes between spontaneous preterm birth (sPTB) and those additionally complicated by preterm prelabour rupture of membranes (PPROM).

Objectives
This prospective cohort study from the Canadian Neonatal Follow-Up Network compared mortality and neurodevelopmental outcomes (Bayley-III scores &lt;70 and &lt;85, hearing/vision loss and cerebral palsy) at 18-24 months corrected age following PPROM versus sPTB among infants &lt;29 weeks of gestation born between 2010-2018. Secondarily, this study compared neurodevelopmental outcomes between those with PPROM lasting 1-7 days, &gt;7days, and sPTB.

Design/Methods
Differences in maternal-infant characteristics and neonatal morbidities were assessed by Chi-square and Student t-tests. Raw and adjusted odds ratios (OR) with 95% CIs were calculated to compare outcomes.

Results
Study population included 4271 children, 1503 (35%) PPROM, 2768 (65%) sPTB. The sPTB group had younger mothers, and a higher proportion of maternal nulliparity, maternal hypertension, and outborn infants. In the neonatal period, PPROM neonates had lower rates of ROP and severe neurologic injury. Raw OR comparing PPROM vs. sPTB showed decreased mortality (OR: 0.75[0.65, 0.87]), and decreased total cerebral palsy rates (OR: 0.57 [0.41, 0.80]) (Table 1).

Conclusion
Among Canadian infants born at &lt;29 weeks of gestation, PPROM lasting 1-7 days associated with decreased mortality and decreased rates of non-ambulatory cerebral palsy at 18-24 months corrected age when compared to sPTB. Such findings may be explained by heightened maternal/fetal care in PPROM cases.

RESULTS
Table1 Comparisons of the neurodevelopmental outcomes between exposure groups.
77 Qualitative Needs Assessment of Child and Caregiver Perspectives to Inform Design of an Artificial Intelligence-enhanced Social Robot to Improve Paediatric Emergency Care
Authors: Hudson Summer , Nishat Fareha , Ali Samina , Litwin Sasha , Wiles Brittany , Foster Mary Ellen , Stinson Jennifer 
Published: September 2023

Abstract

Background
Children routinely experience under-treated pain and distress related to medical procedures, such as intravenous insertions (IVI), which can have negative consequences in both the short-term (e.g., fear, inability to complete procedure) and long-term (e.g., needle phobia, healthcare avoidance). Socially assistive robots (SARs) are a promising tool to manage pain and distress in paediatric healthcare settings. As we work towards building a more developmentally adaptive and interactive SAR, we must first understand how children and families perceive SAR to create a safe and ethical tool.

Objectives
The aim of this study was to understand children’s and caregivers’ perceptions of interacting with an artificial intelligence (AI)-enhanced SAR as a distraction tool in the paediatric emergency department (ED) to improve their IVI experience.

Design/Methods
We conducted semi-structured interviews and focus groups with children and their caregivers from two Canadian paediatric EDs between April 2021 to January 2022, with interview transcription and analysis conducted concurrently until thematic saturation was achieved. Qualitative content analysis was performed independently by two team members, who met regularly to discuss the coding scheme and key themes, and facilitate iterative adjustments to the interview script based on emerging themes.

Results
Nineteen children (mean age 8.42 years [SD 2.21]) and twelve caregivers were included. Three main themes were identified: (1) Overall ED experience, (2) General acceptance of a SAR, and (3) Suggested SAR features to support child engagement. Most participants were comfortable in the ED but identified long wait times and lack of technological supports (e.g., iPads) as an impediment to positive experience. Most participants expressed excitement and comfort surrounding robot technology. However, concerns were raised about photo/video capture by the SAR and the possibility of technical failure resulting in child disappointment or disengagement. Suggestions for potential robot features were unique to the phase of IVI: before IVI (developmentally appropriate procedure explanation, creation of a shared distraction plan); during IVI (variety and choice of distractions, SAR capability to stop or alter course); and after IVI (debriefing and positive reinforcement).

Conclusion
Overall, AI-enhanced SARs were perceived by children and caregivers as a promising tool to distract children. Insights collected will be used to inform the ethical and emotionally safe design of an AI-enhanced SAR. Next steps include development and usability testing of the SAR, subsequent evaluation in the paediatric ED via a randomized controlled trial, and clinical implementation.