bluuebunny/crossref_metadata_2025_split huggingface dataset:
69 A Population-based Study of Parent-reported Health Outcomes at Preschool Age of Children Born Very Preterm
Authors: MacDonald Sydney , Ghotra Satvinder , Stratas Alexandra , Campbell-Yeo Marsha , Synnes Anne , Shah Prakesh , Sandila Navjot 
Published: September 2023

Abstract

Background
Most existing literature on health status (HS) and health-related quality of life (HRQL) of preterm survivors focuses on late childhood, adolescent, and adult age, with only a small body of data on preschool age children. Little is known about the relationship between parent-reported HS outcomes and standardized neurodevelopmental outcomes measured in preterm survivors at preschool age.

Objectives
To present parent-reported HS outcomes at 36 months of age in a population-based cohort of very preterm survivors and compare parent-reported subjective outcomes to standardized neurodevelopmental outcomes measured by clinicians at the same age.

Design/Methods
Infants &lt;31 weeks’ gestation born between April 2014 and June 2016 were prospectively followed through the Perinatal Follow-Up Program and enrolled in a population-based database. HS was measured using the Health Status Classification System for Pre-School Children questionnaire, completed by parents when children reached 36 months’ age. At the same age, neurological examination and standardized developmental assessments were completed by clinicians, using the Bayley Scales of Infant and Toddler Development – III to determine neurodevelopmental impairment (NDI). NDI was categorized as none, “mild”, or “significant" (moderate or severe cerebral palsy, Bayley-III &lt;70, blind or required hearing aid). Inter-rater reliability between the physician and parent scores was assessed using Cohen’s weighted kappa coefficient.

Results
Of 118 children included, there were 47 and 71 children born in &lt;28 and ≥28 weeks’ gestational age, respectively. At 36 months’ age, 73.7% had a parental health concern, mild in &gt;50% and severe in only 8.5%. The most affected HS attributes were language (46.6%) and self-care (39.0%). Nearly 75% of the participants did not meet the criteria for NDI. Of 11 (9.3%) children with significant NDI at 36 months’ age, all parents reported moderate (36.4%) or severe (63.6%) health concerns. Conversely, of 26 (22%) children with parents reporting moderate to severe health concerns, 11 (42.3%) met the criteria for significant NDI (Table 1). Weighted Kappa coefficient was 0.33 (CI=0.20,0.046).

Conclusion
Most parents expressed at least one concern for their preschool-aged child born preterm. Despite high parental concern, most children did not meet the criteria for NDI via clinician assessment. Overall, there was fair agreement between parental concerns and clinician-reported outcomes.
71 Trends, Practice Patterns, and Opportunities for Improvement in Postnatal Steroids Use for Bronchopulmonary Dysplasia – Eleven Years Observational Study
Authors: Kanagaraj Uthaya Kumaran , Shivananda Sandesh , Tan Jason 
Published: September 2023

Abstract

Background
Postnatal steroids (PNS) use in preterm infants improves pulmonary function in a select subset of patients but can potentially increase the risk of spontaneous intestinal perforation and cerebral palsy. Despite national guidelines, reducing intra-centre variation and demonstrating responsible stewardship in PNS use have been challenging.

Objectives
To describe (i) PNS type, regimen, time of initiation, use over time, and identify opportunities for improving practices in the use of PNS for bronchopulmonary dysplasia (BPD); (ii) outcome at discharge for infants who received PNS.

Design/Methods
We conducted a retrospective observational study in a quaternary NICU that included infants born at &lt;33 weeks gestational age who received PNS to prevent or treat BPD between 2011 and 2021. We initially identified all infants who received PNS from the pharmacy registry, followed by demographic, PNS use details, and outcome data collection from the Canadian Neonatal Network (CNN) database, discharge summaries and, occasionally, by reviewing individual charts.

Results
The mean (SD) gestational age and birth weight of 184 eligible infants were 25(24-26) weeks and 720(625-841) grams respectively. Based on timing of first course of PNS, 2(1.1%), 93(50.5%), 85(46.2%), and 4(2.2%) infants received PNS in early (E) (&lt; 7 days), early evolving (EE) (7-28 days), late evolving (LE) (29 days – 36 + 6 weeks PMA), and established (Es) (≥ 37 weeks) phases, respectively. 157 (85.3%) infants received dexamethasone and 22 (12%) received hydrocortisone as the first PNS course. Infants in the EE group, when compared with the LE group, received more days and higher cumulative dose of PNS 13(10-28) vs. 10(10-16) p= 0.04, and 24(24-60) vs. 24(24-25) hydrocortisone equivalents in milligrams/kilograms, p=0.01, respectively. Two common regimens used at our centre were 10-day Dexamethasone: A Randomized Trial (DART) and 22-day tapering doses of hydrocortisone (STOP-BPD). Deviation from published protocols based on duration (±20%), dose (±10%) or timing was 66.7% and 33.3% with hydrocortisone and dexamethasone use. Dexamethasone usage remained stable, but a small increase in hydrocortisone use and the cumulative PNS dose received occurred over time. Survival, survival without major morbidity, moderate to severe BPD, and technology dependence at discharge were 87%, 1.6%, 90.8% and 66.9%, respectively. Identified opportunities for improvement were: adapting national guidelines to local context, creating order sets to reduce deviations, and using this study’s outcomes during PNS decision-making conversations with family.

Conclusion
Variation in the use of hydrocortisone was higher than for dexamethasone, and cumulative dose received per infant increased over time. Potential interventions to reduce variation in PNS use and optimize decision- making were identified.
73 Milking of the Cut-Cord during Stabilization of Very Preterm Infants: A Randomized Controlled Trial (The MoCC Study)
Authors: El-Naggar Walid , Mitra Souvik , Abeysekera Jayani , Disher Tim , Woolcott Christy , Hatfield Tara , McMillan Douglas , Dorling Jon 
Published: September 2023

Abstract

Background
Delayed cord clamping (DCC) for at least 30-60 seconds after birth has been recommended as the standard of care for most preterm infants. However, DCC can be contraindicated or not optimal in certain situations (for example, in cases of interrupted placental circulation). Milking of the long-cut cord (MoCC) while providing stabilization and supporting breathing of the infant after birth is proposed as an alternative to DCC.

Objectives
To investigate the feasibility of MoCC during stabilization of very preterm infants after birth.

Design/Methods
This parallel-group, randomized controlled trial was conducted at IWK Health, which is a tertiary care perinatal centre in Halifax, Canada. Infants born to eligible, consenting women presenting in preterm labor at &lt;32 weeks’ gestation were randomized to the MoCC group (where the infant received 30 seconds of DCC while initial resuscitation steps were taken by the obstetric provider, followed by milking of the long-cut cord one time over 10 seconds, with breathing supported by the neonatal team) or to the current standard of care group. For these infants, DCC for 30-60 seconds depended on whether the baby was breathing at birth or not. Primary outcome was feasibility in terms of percentage recruitment, intervention compliance, safety, and study completion. Short-term clinical outcomes were collected. Analysis was by intention-to-treat.

Results
Fifty infants were randomized to either MoCC (25) or DCC (25) (see Figure below). Baseline characteristics were similar. All infants completed the study. One infant in the MoCC group and five infants in the DCC group did not receive the allocated intervention. Median (IQR) time to cord milking was 62 seconds (54, 99) and median (IQR) length of the cut cord milked was 20 cm (14, 29). MoCC was not associated with adverse effects when compared with DCC (see Table).

Conclusion
Milking the long-cut cord one time after 30 seconds of DCC, while supporting breathing, was feasible and not associated with adverse effects. A large randomized controlled trial is required to assess the efficacy of this approach for clinical outcomes. MoCC may be especially useful when immediate clamping is indicated.

Potential competing interests
Dr. El-Naggar has 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.
74 “Dental Care for Children with Disability Is Not Considered Essential Care”: Perspectives of Parents and Dentists
Authors: Jaworski Magdalena , Cadorel Hugo , Janvier Annie , Asselin Marie-Ève 
Published: September 2023

Abstract

Background
Oral health is often overlooked in the medical care for children with disabilities. While recommendations exist, these take little account of the daily reality of the main stakeholders: parents and dentists.

Objectives
Our goal was to explore the perspectives of parents and dentists regarding dental care for children with special needs, and contrast their lived experience with recommended best practices.

Design/Methods
14 participants were recruited from a tertiary paediatric health centre to participate in semi-structured interviews: 9 parents of children with special needs (cerebral palsy, craniofacial anomalies, autism spectrum disorder) and 5 paediatric dentists. Interviews were conducted virtually in 2021. The participants were asked about oral health prevention, accessibility and treatment. The interviews were analyzed using qualitative methodology.

Results
Based on a thematic analysis of the content of the interviews, we identified several issues encountered by our participants in the context of the dental health of children with special needs. There were mainly issues of accessibility: ‘I work in the field and yet it was so difficult to find a dentist for my own child with disabilities’; financial barriers: ‘His dental needs are not covered because they are deemed aesthetic’; and geographical: ‘I am lucky, I have to drive 30 minutes to her appointments, but others need to drive for hours’. Parents also described difficulties in prevention: ‘I didn’t know how to care for his teeth; I used my own common sense’. The dentists emphasized the importance of communication: ‘I wish dentists were a part of the multidisciplinary healthcare team’. Also, sensitive questions regarding ethical issues, such as protective stabilization and general anesthesia were candidly answered by the majority of interviewees who accepted these practices as essential: ‘It [stabilization] is not easy to accept, but we know it is necessary’, and ‘I prefer getting the treatments done in one appointment [necessitating anaesthesia]’. These practices, in contrast, are deemed more problematic in the medical literature.

Conclusion
Dental care and prevention is essential since oral and dental problems can cause significant pain and distress. There is a significant gap between what “ought to be done” and the reality of families. Despite this, several practical recommendations emanated from the interviews that can be turned into actionable items in practice.
76 Injury-related Paediatric Emergency Department Visits during the First 2 Years of the COVID-19 Pandemic
Authors: Groulx-Boivin Emilie , del Giorgio Francesca , Gravel Jocelyn , Drouin Olivier 
Published: September 2023

Abstract

Background
The onset of the COVID-19 pandemic was associated with a decrease in injury-related paediatric emergency department (ED) visits. However, the longitudinal impact of COVID-19 on paediatric injury beyond the first 6 months of the pandemic is not well established.

Objectives
To quantify the impact of COVID-19 and associated public health measures on injury-related paediatric ED visits during the first two years of the pandemic and determine whether children of all ages were similarly affected.

Design/Methods
We conducted a longitudinal observational study of injury-related ED visits at a large paediatric tertiary care centre before and during the COVID-19 pandemic. We used negative binomial regression to assess the impact of the first two years of the pandemic (Year 1: March 2020-February 2021; Year 2: March 2021-February 2022) on the monthly incidence of injury-related ED visits and risk of hospitalization from injury. Secular time-trends and seasonality were accounted for by modelling the pre-pandemic trend using a 4-year historical control (April 2016-February 2020). In a secondary stratified analysis, changes in monthly incidence of injury-related ED visits were assessed by age group (0-4, 5-11, and 12-17 years).

Results
Of 458,799 ED visits during the 6-year study period, 21,644 (4.7%) were associated with injuries. The distribution of age categories, acuity of presentation, and frequency of hospitalization were similar between the pre-pandemic and pandemic periods (see Table below). Injury-related paediatric ED visits reached a low (−49%) in March 2020 (IRR 0.51, 95% CI 0.43-0.60), and a peak (+50%) in January 2021 (IRR 1.50, 95% CI 1.33-1.68) relative to historical controls (see Figure). All three confinement periods were associated with an initial reduction in injury-related ED visits and followed by a rapid increase in visits. Fluctuations in injury-related ED visits were found to differ between age groups. While there was evidence of no change among preschoolers 0-4 years old, there was a 52% reduction in visits at the onset of the pandemic in children ages 5-11 (RR 0.48, 95% CI 0.35-0.65) and an 87% reduction in children ages 12-17 (RR 0.13, 95% CI 0.06-0.23) followed by a surplus of cases among the 5- to 11-year-olds in January 2021 (+53%; RR 1.53, 95% CI 1.25-1.85) and March 2021 (+48%, RR 1.48, 95% CI 1.21-1.80).

Conclusion
The consequences of COVID-19 on paediatric injury extend far beyond the first few months of the pandemic. Understanding changes in the incidence of paediatric injury around confinement periods may assist in the development of injury prevention strategies.
78 Nitrous Oxide Use for Children Experiencing Painful Procedures: A Survey of Canadian Paediatric Emergency Physicians’ Knowledge, Attitudes, and Practices
Authors: Hudson Summer , Jain Raagini , Osmond Martin , Poonai Naveen , Trottier Evelyne D , Ali Samina 
Published: September 2023

Abstract

Background
Nitrous oxide (N2O) is an inhaled analgesic/anxiolytic gas with ample evidence supporting its safety and efficacy in children. However, its prevalence of use remains low, while its indications in paediatric emergency departments (EDs) across Canada remain unknown. Optimization of safe and appropriate of N2O use in this setting requires an understanding of paediatric emergency providers’ knowledge, attitudes, and practice patterns surrounding its use.

Objectives
We aimed to characterize physicians’ perceptions and current site-specific processes and procedures surrounding N2O use to understand differences between current evidence and clinical practice and standardize care for children undergoing distressing procedures.

Design/Methods
This cross-sectional survey was distributed electronically to all physician members of Paediatric Emergency Research Canada (PERC) from February to April 2021. Survey items pertained to N2O availability, comfort with N2O use, and perceived barriers/facilitators to its use. Further, a PERC representative from each site completed a site-specific inventory of N2O policies and procedures.

Results
Response rate was 67.8% (156/230), with 53.2% (83/156) women; 66.6% (104/156) had paediatric emergency subspecialty training, and mean clinical experience was 14.7 years (SD 8.6). 40.0% (6/15) of sites had N2O available in the ED, and 83.3% (5/6) of these institutions had written policies and/or procedures in place for N2O use in the ED. Overall, 48.7% (76/156) of physicians reported using N2O in their clinical practice. The most common indications for use were fracture/dislocation reduction (69.7%, 53/76), wound closure (60.5%, 46/76), and incision and drainage (59.2%, 45/76). The most common perceived barriers to N2O included concerns about ventilation/scavenging systems (71.2%, 57/80) and unfamiliarity with equipment (52.5%, 42/80). The most common perceived facilitators were N2O availability in the ED (73.0%, 114/156) and clinical experience with N2O (71.7%, 112/156). Of the 51.3% (80/156) physicians who reported not using N2O, 93.7% (75/80) did not have access available at their site; notably, 77.3% (58/75) indicated a desire to have access to N2O.

Conclusion
Despite evidence to support its use, only half of paediatric emergency physicians in Canada currently use N2O as a tool for treating children’s procedure-related pain and distress. Increasing availability of necessary equipment, protocols, and clinical training surrounding N2O use in children may improve clinicians’ abilities to better manage children’s acute pain and distress in the ED, and other clinical contexts.
83 Success of Amoxicillin Oral Challenges in Children at Low Risk of Allergy Requiring Antibiotic in the Emergency Department
Authors: Gervais Camille , Panetta Luc , Roy Helene , Desroches Anne , Buithieu Maria , Pellerin Stephanie , Ovetchkine Philippe , Trottier Evelyne D 
Published: September 2023

Abstract

Background
Up to 10% of children are labelled as penicillin allergic, requiring the use of suboptimal antibiotics as an alternative. In these children, a low-risk oral challenge with amoxicillin can be done to evaluate the accuracy of this allergy. An oral challenge pre-written order was implemented in our institution’s emergency department (ED).

Objectives
The aim of this study was to assess the success of the amoxicillin oral challenges in children labelled penicillin allergic in the ED.

Design/Methods
This is an ongoing prospective observational study conducted at a tertiary care paediatric hospital. Children considered at low risk of penicillin allergy (https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Medicaments/Outil_aide-decision_allergies-EN_VF.pdf) and requiring amoxicillin according to the ED physician were prescribed an amoxicillin challenge according to a pre-written order set. In the absence of a reaction, patients were discharged with an amoxicillin prescription. Parents were contacted one month after the challenge to assess for late-onset reactions.

Results
Since June 2021, 70 children (24 female) underwent an amoxicillin challenge in the ED (Figure 1). The patients’ median age was 1 yo (6 months–12 yo). The most frequent discharge diagnoses in the ED were otitis media (65%) and pneumonia (24%). The challenge was successful in the ED for 69/70 (99%) patients. Sixty-two (89%) patients were successfully contacted for a follow-up phone call. Among them, 55/62 (89%) did not present any reaction. In total, 7/62 (11%) of the children had a reported reaction, one (1%) child had an immediate reaction to the challenge in the ED, while 6/62 (10%) had a rash appearing 1 to 61 days after the first dose of antibiotics. No severe reactions were reported by the parents after discharge from the ED. A correlation between the amoxicillin administration and the delayed reaction was considered less likely for 3/6 patients because of the later onset of symptoms (28-61 days). The three other patients were considered not to have a penicillin allergy after formal assessment at the allergy clinic.

Conclusion
Using a standardized pre-written order set for an amoxicillin challenge in the ED allowed 99% of participating children to be discharged safely with an amoxicillin prescription. Despite 10% presenting a rash after discharge, none were considered to have a late-onset reaction. This removed safely and rapidly the label of “penicillin allergy” from those paediatric ED patients, allowing optimal first-line antibiotics. It also eliminates the need for a consultation with an allergist in the majority of patients.
86 Incidence of Pulmonary Thromboembolism in Canadian Children: A 3-Year National Surveillance Study
Authors: Ramsay Lily , Krmpotic Kristina , Moorehead Paul , Chan Anthony K C , Plint Amy C 
Published: September 2023

Abstract

Introduction/Background
Pulmonary thromboembolism (PTE) is a rare but life-threatening event for which adequate epidemiological data in paediatrics are lacking. Best estimates regarding the epidemiology of PTE in Canadian children were published over two decades ago, using information obtained from a national registry of paediatric thromboembolic disease which only examined pulmonary embolism as a related complication. It is likely that the true rates of pulmonary thromboembolism in Canadian children are higher.

Objectives
To determine the minimum national incidence of PTE in children (neonate up to &lt;18 years) by age, gender, and province / territory of residence using an existing national surveillance system.

Design/Methods
Through the Canadian Paediatric Surveillance program, over 2,800 paediatricians and subspecialists practicing in Canada were contacted monthly from January 2020 to December 2022. Using a standardized definition of PTE and pre-specified diagnostic criteria, clinicians were requested to report all new suspected or confirmed cases.

Results
During the 3-year study period, 58 cases of PTE were reported, documenting a minimum average annual national incidence of 2.4 per million Canadian children. Females accounted for 77.6% (n=45) cases. Patients ranged in age from 2 months to 17.9 years (median age 15.8 years; interquartile rate 13.3 to 16.7 years). Incidence rates (reported as average annual per million children) varied by age: 0-4 years, 0.7; 5-9 years, 0.2; 10-14 years, 2.0; 15-18 years, 6.6; and also by province: Newfoundland, 21.3; Saskatchewan, 4.6; British Columbia, 4.5; New Brunswick, 4.4; Alberta, 3.5; Nova Scotia, 1.8; Ontario, 1.6; Manitoba, 1.0; Quebec, 0.9.

Conclusion
Although the overall minimum average annual national incidence of PTE in Canada is 2.4 per million children, adolescents, particularly females, appear to be at highest risk of disease. It is not clear whether geographic distribution of cases disproportionate to provincial census may be related to regional differences in diagnostic practices, population-related risk factors (e.g., obesity, genetic thrombophilias, OCP prescribing), or reporting of cases.