bluuebunny/crossref_metadata_2025_split huggingface dataset:
2 Excessive Exercise among Youth with a New Diagnosis of Restrictive Eating Disorder before and during the COVID-19 Pandemic
Authors: Coret Alon , Agostino Holly , Tritt Ashley , Moubayed Dina , Chadi Nicholas 
Published: September 2023

Abstract

Background
During the COVID-19 pandemic, Canadian youth with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) presented at higher rates with more severe illness. This trend was found to be more pronounced in Canadian jurisdictions where public health measures included full school closures and confinement. Disease severity in AN is multifactorial, however, excessive exercise can be associated with more severe illness. Due to closures, many adolescents turned to unregulated exercise regimes within their homes. The contribution of excessive exercise to the rise of new onset AN during the pandemic remains unknown.

Objectives
To determine the rate of excessive exercise among newly diagnosed adolescents with AN/AAN during the COVID-19 pandemic compared to the five preceding years.

Design/Methods
This was a secondary analysis of a prospectively collected intake registry of all new diagnoses of AN and AAN completed between January 1st, 2015, and November 30th, 2020 at two large, urban, tertiary paediatric hospitals in Quebec. Baseline demographic information and clinical assessment variables were collected based on standardized assessment forms. Excessive exercise was self-reported and defined as &gt;10 hours per week of moderate or vigorous physical activity at the time of diagnosis. Medical hospitalization within 1 week of assessment was used as a marker of medical severity. The primary outcome of excessive exercise was compared between the period of pandemic public health preventive measures (March 2020 to November 2020) and the pre-pandemic period (January 2015 to February 2020). Variables were compared before and during the pandemic using Chi square testing.

Results
Overall, 817 patients with new diagnoses of AN/AAN met inclusion criteria during the study period (pre=647; during=170), with 40 patients (pre=34/647 and during =6/170) excluded due to missing data on exercise frequency. Overall, median patient age was 15.9 (IQR 13.8-16.9) years; 93% female; and 59% diagnosed with AAN. During the pandemic, mean hospitalization rate increased from 2.2 to 7.2 patients per month (p=0.001). Hospitalization within one week of diagnosis increased from 23% to 40% (136/613 vs. 65/16; p=0.001). The rate of excessive exercise did not differ before versus during the pandemic overall (27% vs. 24%; p=0.48) nor in patients requiring admission (40/136 [29%] vs. 23/65[36%]; p=0.39).

Conclusion
Excessive exercise in isolation does not appear to explain the increased rate and severity of new AN/AAN diagnoses since the pandemic in this cohort. Further studies are needed to better elucidate other drivers which may have contributed to the severity of eating disorders during this period.
9 “The Child's Voice”: Perceptions of Healthcare Systems for Children Aged 8-12 Referred for Neurobehavioural Concerns: A Focus Group Study
Authors: Schatz Ryan , Gander Dr Sarah , Campbell Sarah , Flood Kate , Fana Natalia , Lunney Sarah 
Published: September 2023

Abstract

Background
Providing children with a voice to tell their story and to fully participate in the plan of care has not been commonly reported in the literature. Paediatric health assessments traditionally rely on caregiver opinions and the interpretation of the child’s view rather than the child’s first voice perspective.

Objectives
This study focused on the experiences of children seeing a paediatrician primarily for neurobehavioural issues, such as autism and attention-deficit hyperactivity disorder (ADHD). The study was designed to provide children with the opportunity to share their thoughts directly rather than through a caregiver.

Design/Methods
This study, approved by the Horizon Health Network Research Ethics Board, used a qualitative design. 11 children between 8-12 years of age were recruited. These children were interviewed across three focus groups conducted using a semi-structured approach. The interview questions focused on emotions and opinions surrounding their care. Discussions were primarily led by the children. Focus groups were transcribed and analyzed using the six phases of inductive thematic analysis.

Results
Three overarching themes were identified: trust, boredom, and resolution (Figure 1). Trusting in their parent’s ability to communicate for them and regarding the doctor as an expert appeared as two subthemes. Children also reported feeling substantial levels of boredom at appointments, although “missing school” and “getting a treat” were reported as positives. Despite these feelings of boredom, many children expressed that the doctor provided them with a feeling of change or resolution, and that their visits were addressing their problems and needs.​ They also report disagreement may be perceived as being ungrateful for the help. Overall, children felt trust in their physician and parental intentions, along wit feeling positive about results. However, children’s views of their care are possibly influenced by the belief that decisions will be made for them, regardless of their voice. When children disagree with care, they may not voice this because of possibly perceived negative consequences.

Conclusion
Children must have a voice to ensure that we meet them ‘where they are’ as care providers and make goals and plans tailored to their needs, regardless of parent or physician bias or opinion. This is a cornerstone to upholding the Rights of the Child and ensuring patient-centred care. ​
14 Comorbidities Affecting Children with Autism Spectrum Disorder: A Retrospective Chart Review from the Main Referral Site for ASD Evaluation in Manitoba
Authors: Burns Jessy , Phung Ryan , McNeill Shayna , Hanlon-Dearman Ana , Ricci M Florencia 
Published: September 2023

Abstract

Background
Autism Spectrum Disorder (ASD) is a developmental disorder characterized by deficits in social interaction/communication, restricted interests and repetitive behaviours. Recent discussions have emerged worldwide regarding a possible “overly-inclusive” diagnosis of ASD, adding heterogeneity around presentation/etiology and comorbidities.

Objectives
This study aimed to determine the frequency and characteristics of comorbidities among children diagnosed with ASD in Manitoba, and to evaluate differences in presentation between those with and without medical comorbidities. As comorbid neurodevelopmental disorders such as global developmental delay (GDD) and attention-deficit yyperactivity disorder (ADHD) are common in children with ASD, these were not included as “medical comorbidities” and were studied separately.

Design/Methods
We conducted a retrospective chart review of &gt;2000 electronic charts at the main referral site for children &lt;6 years requiring evaluation for ASD in Manitoba. All children aged 0-5 years diagnosed with ASD at this site between May 2016 to September 2021 were identified. X2 and t test were used to compare groups.

Results
Of the total of 1858 children identified, 1459 (78%) were male, 252 (13.5%) were born prematurely, 504 (27%) had ≥1 medical comorbidity. Most common medical comorbidities were neurological (12.7%) and allergies/eczema (6.1%). Comorbid GDD was diagnosed in 428 (23%). Age of referral to RCC and age of diagnosis did not differ between groups. Medical comorbidities were more common among preterm children (31% vs. 26%, p:&lt;0.01) and children with comorbid GDD (35% vs. 18.6%, p:&lt;0.01). There was no significant difference in overall presence of medical comorbidities by sex (29.5% vs. 26.6%, p: 0.25); however, girls had a statistically significant higher incidence of neurological comorbidities, e.g. cerebral palsy, epilepsy, hypotonia NYD (16% vs. 12%, p:0.03).

Conclusion
Results of this study are consistent with previous studies, which note high comorbidity rates among children with ASD. The high rates of associated neurological conditions, GDD, and prematurity add heterogeneity to this group and may relate to the reported “overly-inclusive” diagnosis. This study will be used as a catalyst for guiding further prospective studies in the area.
20 Developmental Outcomes of a Cohort of Preschool Children Requiring Craniosynostosis Surgery in Manitoba
Authors: Ripstein Yael , Ricci M Florencia , Pylypjuk Christy 
Published: September 2023

Abstract

Background
Historically in Manitoba, all children with craniosynostosis were referred to the Child Development Clinic (CDC) for neurodevelopmental evaluation, because craniosynostosis has been associated with developmental delay. However, due to heightened volume pressures, the CDC recently decided to limit the number of referrals accepted for evaluation of children with craniosynostosis.

Objectives
To inform best practices for neurodevelopmental screening, this study aims to describe the developmental outcomes of preschool children requiring craniosynostosis surgery in Manitoba.

Design/Methods
In this historical chart review of the CDC electronic medical record, the developmental outcomes of patients who were assessed at CDC for surgically managed craniosynostosis between July 1st, 2016 and December 1st, 2021 were described. Developmental quotients across Motor, Cognitive and Language domains were collected, and patients were categorized as Normal, Mild Delay in 1 Area or Delay in ≥2 Areas. Demographic and medical characteristics were collected, and descriptive statistics were used to describe and compare outcomes between groups.

Results
Out of a total of 67 children, 18% (n=12) demonstrated developmental delays in ≥2 areas, 23.9% (n=16) demonstrated mild developmental delays in one area, and 58.2% (n=39) were developmentally appropriate across all areas. Presence of genetic syndrome (p&lt;0.001), suture type (p=0.011), and parental SES score (p=0.028) were significantly associated with developmental delay in ≥2 areas. Odds ratios for genetic syndrome and SES score were 218.352 (95% CI 6.843, 6967.766) and 0.857 (95% CI 0.766, 0.959) respectively. 11.9% (n=8) of children were referred to Children’s Disability Services, 5 of whom had syndrome involvement.

Conclusion
To target children at highest risk for developmental delay, we suggest that children with craniosynostosis be referred for neurodevelopmental evaluation if they have multisutural craniosynostosis, suspicion or confirmed genetic syndrome, or an identified developmental concern by primary care physician screening.
23 Association between Autism Spectrum Disorder and Parental Immigration among a Cohort of Preschool Children in Manitoba
Authors: Phung Ryan , Burns Jessy , Fridell Mara , Hanlon-Dearman Ana , Narvey Stefanie , Ricci M Florencia 
Published: September 2023

Abstract

Background
Recent data indicate that rates of autism spectrum disorder (ASD) are increasing and therefore, studies exploring risk factors for ASD that can further support early diagnosis and intervention are needed. A link between immigration and autism has been made by several international studies, but despite high rates of immigration, a Canadian study examining this association has not been conducted.

Objectives
To determine the proportion of children diagnosed with ASD at Manitoba’s primary autism referral site (the only publicly funded site for ASD evaluation of children &lt;6 years of age) that were born to immigrant parents, and compare it with the known proportion of immigrants in Manitoba. Also, to compare demographic and clinical characteristics of children whose parents are immigrants with those whose parents were born in Canada.

Design/Methods
We conducted a retrospective chart review of &gt;2000 electronic records that identified all children &lt;6 years diagnosed with ASD at the referral site between May 2016 and September 2021. Data on parental immigration, demographics, diagnostic evaluation, and medical history was collected. Descriptive statistics were used to compare the relative proportion of children with ASD from immigrant parents with the proportion of immigrants in Manitoba based on 2016 census data.

Results
A total of 1865 children were diagnosed with ASD during the study period. The mean age at referral and diagnosis was 2.81 (SD 1.26) years and 3.88 (SD 2.90) years respectively; 78% were male and 13.5% were born preterm. The proportion of children with ASD from immigrant parents (36%) was greater than the expected proportion (18.3%) of immigrants based on Manitoba census data (p &lt; 0.001). The most common countries of origin of immigration were the Philippines (30.7%), India (11.6%), Nigeria (8.6%), and Ethiopia (6.4%). Overall, children of immigrants were younger at referral (2.71 years, SD = 0.98 versus 2.91 years, SD = 1.43; p &lt;0.001), less likely to have a family history of ASD (17.1% versus 35.6%; p = &lt;0.001) and less likely to have comorbidities (46.8% versus 53.9%; p &lt;0.001) including global developmental delay (18% versus 27.6%; p &lt;0.001).

Conclusion
At Manitoba’s primary autism referral site, there was a greater proportion of children diagnosed with ASD born to immigrant parents than expected when compared to the Manitoba population. Overall, children of immigrants were younger, less likely to have comorbidities, developmental delay, and a family history of ASD. Future prospective studies are required to better understand the complex relationship between immigration and ASD diagnosis.
31 Iron Deficiency in Formula-fed Very Preterm Infants: Do We Need to Revise Recommendations for Iron Supplementation?
Authors: Power Grace , Stratas Alexandra , Landry Carmen , Morrison Lisa , Kulkarni Ketan , Campbell-Yeo Marsha , Singh Balpreet , Higgins Michelle , Ghotra Satvinder 
Published: September 2023

Abstract

Background
Preterm infants are at risk for iron deficiency (ID). The Canadian Paediatric Society (CPS) recommends iron supplementation of 2 to 3mg/kg/day for breastfed (BF) preterm infants born &lt;2 kg. Additional iron supplementation is not recommended if these infants are primarily formula-fed (FF) with iron-rich formula, since formula is thought to provide enough iron. However, these recommendations are not universally accepted.

Objectives
To investigate how feeding type influences the iron status of very preterm infants (VPI) at 4 to 6 months corrected age.

Design/Methods
A retrospective population-based cohort study was conducted using a provincial database of all VPI (&lt;31 weeks gestational age) born in Nova Scotia from 2005-2018. Information about feeding type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. Two groups were compared using chi-square and unpaired t-tests.

Results
392 infants were studied (gestational age: 23-30 weeks). Of these, 285 were exclusively FF with iron-rich formula, and 107 were exclusively or partially BF. Neonatal variables were comparable between the two groups. An elemental iron intake of &gt;2 mg/kg/day was obtained from formula alone in only 20.4% of FF infants. FF infants were less likely to receive additional iron supplements. However, total iron intake (from formula and supplements) was higher in FF infants. Despite this, 36.8% of infants in FF group developed ID, versus 20.6% in the BF group (Table 1).

Conclusion
Most VPI fail to receive elemental iron of &gt;2 mg/kg/day from formula alone. ID is significantly more prevalent in FF infants than in BF infants, despite higher iron intake. Our findings do not support the current CPS guidelines.
37 Improving Bronchiolitis Management at B.C. Children’s Hospital: Standardizing Care Through a Pre-printed Order
Authors: Chen-Mack Riley , Seaton Claire , McLaughlin Tom , Balleny Rosa 
Published: September 2023

Abstract

Introduction/Background
Bronchiolitis is the most common cause of hospital admissions during the first year of life. There is significant variation in the management of this disease. Despite supportive care being the hallmark of treatment, investigations and other treatments are commonly prescribed. Standardizing care for bronchiolitis leads to decreased resource utilization and improved patient outcomes. Pre-printed orders can standardize care and improve compliance with evidence-based medicine.

Objectives
To determine whether a pre-printed order (PPO) would influence length of stay and specific medication use (corticosteroids, antibiotics, bronchodilators) for patients admitted to B.C. Children’s Hospital (BCCH) with a diagnosis of bronchiolitis.

Design/Methods
We implemented a pre-printed order (PPO) for inpatient management of bronchiolitis at B.C. Children’s Hospital (BCCH), then conducted a retrospective chart review of children admitted to BCCH with a discharge diagnosis of bronchiolitis. We compared primary and secondary outcomes between the pre-PPO (November 24, 2017 to December 31, 2019) and post-PPO (September 22, 2021 to April 12, 2022) periods. The primary outcome was length of stay (LOS) in days, and secondary outcomes included the prescription of specific medications.

Results
A total of 584 patients were included in the retrospective chart review: 436 patients were from the pre-PPO period and 148 patients were from the post-PPO period. There was no difference in the LOS between the pre-PPO and post-PPO periods: median LOS was 3.00 days (2.00 to 5.00 days) and 3.00 days (2.00 to 5.00 days) in the pre- and post-PPO periods, respectively (p = 0.88). There was a decrease in prescribed antibiotics, from 36.7% to 24.7% (OR = 0.56, 95% CI = 0.37 to 0.86, p = 0.01). Additionally, there was a decrease in prescribed salbutamol, from 41.5% to 29.3% (OR = 0.58, 95% CI = 0.39 to 0.87, p = 0.01). There was no significant difference in rates of PICU admission between the pre- and post-PPO periods (23.6% vs. 26.4%, OR = 1.16, 95% CI = 0.75 to 1.76, p = 0.5).

Conclusion
The implementation of a PPO for inpatient management of bronchiolitis did not affect length of stay or PICU admissions. However, there was significant reduction in prescribed antibiotics and salbutamol (both reduced in the post-PPO period). Our results suggest that a pre-printed order can improve antimicrobial stewardship and reduce unnecessary medication use, when managing a common paediatric disease.

Graph Example for antibiotic/salbutamol and PICU
43 Far from Home: The Impact of Geographic Distance from Tertiary Paediatric Hospitals on Family Expenses and Experiences
Authors: Buuren Asia , Van Udall Britt , Carwana Matthew 
Published: September 2023

Abstract

Background
Many individuals living in rural and remote communities are required to travel to urban centres to receive essential health care. These experiences may be especially complex for children and their families. Despite this, there is a lack of available literature on the experiences of children and families travelling to receive care at tertiary paediatric hospitals in Canada, specifically regarding associated costs and psychosocial impacts.
1.Objectives: Analyze tertiary hospital-based administrative data to quantify the number of admissions and length-of-stay for families living &gt; 50 km from the hospital.
2.Describe the costs and psychosocial impacts of hospitalization on families living &gt; 50 km from the hospital.

Design/Methods
Ethics approval was obtained. Family partners were involved in all aspects of the study design. We obtained a de-identified data set describing the length of stay and home community of paediatric patients admitted to our paediatrics unit. Descriptive statistics were produced to determine the relevant study population and inform subsequent data analyses. A cross-sectional survey was distributed to interested caregivers admitted to our paediatrics team. Participants were offered a $20 gift card as remuneration. The survey included optional questions to assess participant demographics, costs associated with hospitalization, and subjective stress levels. Descriptive statistics were reported.

Results
Administrative data analysis described 2,758 admissions to a paediatric tertiary hospital from January 1, 2021 to December 31, 2021. Patients from rural and remote communities were 9.54% of total admissions. Regression models found a strong statistical relationship between length of stay and distance from the tertiary centre (Pearson chi2 coefficient 58.9, p &lt; 0.001).
A total of 39 caregivers filled out the cross-sectional survey. 75% (n=29) of participants were from local communities and 25% (n=10) were from rural and remote communities. 82% (n=32) of hospital stays were unplanned. 54% (n=21) of participants paid out-of-pocket transportation costs and 13% (n=5) paid out-of-pocket accommodation costs. 82% (n=32) of participants had co-travellers. 20% (n=8) of participants reported difficulty paying for hospital-associated costs and 10% (n=4) had to borrow money to do so.

Conclusion
To our knowledge, this study is the first to look at the psychological and socioeconomic barriers facing families travelling to a tertiary paediatric hospital in Canada. Patients from outside the local area had increased odds of longer length of stay and participants described a variety of stressors associated with hospitalization. We hope to translate this data into evidence-based interventions to better support these families.
47 Clinical Approach to Febrile Urinary Tract Infections in Young Children Presenting to the Paediatric Emergency Department: A Retrospective Study of National Guideline Compliance
Authors: Morin Frances , Desai Neil 
Published: September 2023

Abstract

Background
Antimicrobial resistance is one of the greatest threats to global health. Antibiotic overuse drives antimicrobial resistance. Suspected urinary tract infection (UTI) is a key area of over-prescribing in many clinical settings but has not been investigated in the paediatric emergency department (ED).

Objectives
Here, we explore compliance with national UTI management guidelines in a paediatric emergency department setting and characterize patient and provider factors associated with guideline non-compliance.

Design/Methods
We performed retrospective chart review of patients ages 60 days to 36 months, discharged with a diagnosis of UTI from a single, urban, tertiary care paediatric emergency department (PED) with a diagnosis of UTI. Random visits were chosen using a computer algorithm. Primary outcomes were: 1) proportion of patients receiving guideline-compliant investigation and treatment, and 2) the proportion of children whose antibiotic prescriptions were appropriately adjusted upon return of urine culture and antibiotic susceptibilities (C&S). The guideline was the Canadian Paediatric Society statement on management of UTI, as well as the BC Children’s Hospital institutional UTI management guideline. Descriptive statistics and odds ratios between associations were calculated.

Results
We reviewed 402 charts. The proportion of infants receiving guideline-compliant testing and treatment was 25.9% (95% CI: 21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (95% CI: 74.7-83.8%) received a first-line recommended agent and 58.9% (95% CI: 53.8-63.8%) received fully compliant therapy with respect to agent, dose, duration, and frequency. 19.4% (15.4-24.2%) of patients who were prescribed empiric cephalexin received an inappropriately high total daily dose. The proportion of patients receiving age-appropriate testing method was 52.2% (95% CI: 47.4-57.1). Febrile children were more likely to receive age-appropriate urine sample collection by catheterized sample (OR: 2.77 95% CI: 1.81-4.25) compared with afebrile children. Ultimately, 50.7% (95% CI: 40.4-49.6%) of patients discharged with a diagnosis of UTI and prescription for antibiotic met diagnostic criteria for UTI based on urinalysis and culture results. Of patients whose C&S mandated a change in therapy, 60.8% (95% CI: 55.8-65.7%) had their agent changed or discontinued.

Conclusion
Paediatric emergency medicine physicians frequently order inappropriate investigation and empiric treatment of UTI in young children. Discontinuation of empiric antibiotics in culture-negative children may be an impactful stewardship intervention in the PED.