bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Paediatric Musculoskeletal Skills Workshop for Canadian Medical Students
Authors: Chan M , Rumsey D , Ellsworth J , Foster H 
Published: September 2022

Abstract
BACKGROUND: Musculoskeletal (MSK) complaints in children account for up to 30% of visits to general practitioners. Doctors who see children with MSK complaints are often not confident in assessing them and MSK exams are poorly documented in medical records. There has been little published literature describing the logistics of teaching MSK skills in a group setting (which is how medical students are commonly taught). At our center, no MSK examination skills were previously taught during the undergraduate paediatrics clerkship.
OBJECTIVES: 1) To develop a hands-on, paediatric MSK workshop for medical students with direct observation and feedback. 2) To evaluate student/faculty satisfaction with the workshop. 3) To develop an MSK workshop protocol as a resource for medical educators.
DESIGN/METHODS: A 1-hour interactive workshop was designed for students to practice the paediatric Gait, Arms, Legs and Spine (pGALS) screening MSK exam. Students are given pre-reading, videos and pGALS checklists. Workshops include live demonstrations and videos/images of abnormal MSK findings for pGALS practice. Students practice pGALS with their peers with staff supervision(up to 5 physicians present)and receive feedback. All students complete a post-workshop evaluation. Teachers also complete a post-workshop evaluation discussing what went well and areas for improvement.
RESULTS: Workshops are delivered every 2 months for 25 students (5 iterations completed). Feedback has been positive (median rating 4.5 on a 5-point Likert scale) for all areas evaluated: objectives, handouts, preparation time, discussion, resources, etc. Comments include: “Helpful and applicable to personal clinical practice,” and, “The hands-on practice was really appreciated, as was the chance to get feedback.” Workshops have been modified according to faculty/student evaluations, resulting in a workshop protocol (organizational template) for future workshop leaders including a teaching checklist, preparation timeline, and PowerPoint to be modified by instructors as they wish.
CONCLUSION: The paediatric MSK workshop has been a welcome addition to our undergraduate paediatrics clerkship curriculum. We aim to further develop our workshop by explicitly including applied anatomy, e.g., land-marking for joints. We also aim to make our workshop protocol available on Paediatric Musculoskeletal Matters,www.pmmonline.org, as a resource for other medical educators. Further work will include evaluating its uptake, use and applicability by users in different contexts, and modifying it for different levels of learners, e.g., paediatricians.
Serum Calcium Derangements in Neonates with Hypoxic Ischemic Encephalopathy (HIE) With and Without Therapeutic Hypothermia
Authors: Bashir R , Vayalthrikkovil S , Espinoza L , Mohammad K 
Published: September 2022

Abstract
BACKGROUND: Perinatal hypoxia is a recognized cause of hypocalcemia in neonates in the first 3 days of age. However, therapeutic hypothermia (TH), the standard care for moderate to severe HIE, promotes neuropro-tection by decreasing calcium (Ca) influx into the cells during reperfusion phase. So TH can increase serum Ca levels and may even negate the hypo-calcemic effects in HIE.
OBJECTIVES: To examine the trends in serum Ca levels in neonates with HIE with and without TH.
DESIGN/METHODS: A retrospective cohort study of neonates with moderate to severe HIE admitted to a level III NICU between September 2011 and October 2015. HIE staging was done as per modified Sarnat’s scoring system. Hypercalcemia was defined as serum ionised Ca (iCa) &gt;1.35 mmol/L and hypocalcemia was defined as serum iCa &lt;0.9 mmol/L. Acidosis was considered if pH &lt;7.2. Serum Ca and pH were followed in the first 3 days of age (Day 1-3). The relation of serum Ca levels with acidosis,seizures, intracranial hemorrhage, and MRI changes in neonates with and without TH was examined. Categorical variables were analysed using chi-square test. Logistic regression analysis was done to explore the association of hypo/hypercalcemia with various variables, adjusting for TH, HIE staging, and acidosis.
RESULTS: Total number of neonates with moderate-severe HIE= 113; 89 neonates (79%) underwent TH. Incidence of hypercalcemia was 57/89 (88%) in the TH group whereas only one-third in the no TH group, whereas for hypocalcemia, it was 11/89(12%) and 5/24(21%) for the TH and no TH groups respectively. Hypercalcemia on Day 1 was significantly higher with TH(p 0.007) and acidosis(p 0.015). Hypocalcemia did not have any such association. Hypo/hypercarbia did not seem to alter the serum Ca levels. There was no increase in intracranial hemorrhage, clinical/EEG seizures, antiepileptic drug use or hypoxic MRI changes with Ca derangements.
CONCLUSION: Incidence of hypocalcemia was reduced by almost half in TH group. Hypercalcemia on day 1 was significantly associated with TH and acidosis. On days 2 and 3, hypercalcemia occurred in TH even in the absence of acidosis, but the association was not statistically significant. Less hypocalcemia and more hypercalcemia in TH may be attributed to the neuroprotective effect of TH by inhibiting Ca influx into the cells. However, there was no correlation between Ca derangements and seizures or severity of hypoxic changes in MRI.
Location! Location! Location! The Impact of Single-Room Design on Neurodevelopment of Preterm Infants
Authors: Church P , Ng E , Weisz D , Cavanagh A , Dunn M 
Published: September 2022

Abstract
BACKGROUND: The impact of neonatal intensive care unit (NICU) design on neurodevelopmental outcomes of preterm infants is uncertain. Although single room design (SRD) reduces nosocomial infections and improves breastfeeding rates and parental satisfaction, recent data suggests that SRD may be associated with language delays and alterations in cortical development.
OBJECTIVES: To compare neurodevelopmental outcomes of preterm infants who received care in a contemporary SRD environment compared with a similar cohort who received care during an earlier period with an open bay design (OBD).
DESIGN/METHODS: Retrospective single-centre cohort study comparing the neurodevelopmental outcomes of all surviving extremely low birth weight (ELBW) i nfants admitted within 24 hours of birth in 2009 (OBD epoch) and 2011 (SRD epoch). The primary outcome was moderate or severe neurodevelopmental impairment using the Bayley Scales of Infant Development, third edition (BSID-III) at 18 months corrected age. Secondary outcomes included severe NDI and BSID-III scores. Multivariable logistic regression (MLR) analysis was used to evaluate the independent association between NICU design and outcomes.
RESULTS: The study included 100 ELBW infants in 2009, and 98 in 2011. The 2 epochs were similar in follow-up rates (80% in 2009; 82% in 2011) and infant characteristics (including those lost to follow up). Mortality was 7.9% in 2009 and 6.1% in 2011. BSID-III language scores (median [interquartile range]) were similar for infants in the OBD and SRD epochs (86 [71,100] vs. 81 [71,94], p=NS). On MLR analysis, NICU design was not associated with significant differences in NDI or BSID-III language score less than 80 after adjustment for antenatal and perinatal confounders. (Table1)
CONCLUSION: There was no significant difference in NDI between cohorts of ELBW infants cared for in an SRD compared with an OBD NICU design environment. The contrast in findings from earlier studies may be attributable to the local context of government-supported parental leave and strong promotion of parental presence in the NICU.
Academic Challenges for the Preterm Infant: Parent and Educator Perspectives
Authors: Church P , Cavanagh A , Shah V 
Published: September 2022

Abstract
BACKGROUND: Preterm birth (PTB) is linked with academic challenges, attention deficit hyperactive disorder (ADHD) and behavioural problems. Emerging data suggest that educators lack awareness of the pre-term child&&#x0023;39;s educational needs while no data exists regarding par-ents&&#x0023;39; understanding of these issues.
OBJECTIVES: To explore educators' and parents' level of knowledge of the impact of PTB on academic achievement, ADHD, and behavioural problems adn identify facilitators/barriers to the use of available educational resources.
DESIGN/METHODS: A combination of focus groups and survey were used to examine educators' and parents' knowledge, attitudes, and barriers to the impact of PTB on academic performance. Focus groups were conducted at the kindergarten to grade 3 levels at 4 schools by a trained facilitator using a guide. Parents of preterm infants who were seen in Neonatal Follow Up Clinic with children being 4 to 8 years of age participated. The survey included questions on parental perception of knowledge among their child’s educator of outcomes of PTB, current educational placement for their child and perception of barriers and facilitators. Data were analyzed using thematic analyses or descriptive statistics.
RESULTS: Educators with knowledge about PTB stated that it was largely experiential and none received formal training. Current training is focused on ADHD, Autism, or Fetal Alcohol Syndrome. In regard to facilitators/ barriers, there was no consensus on what resources would be useful (e.g. enrolling child based on the expected rather than actual date of birth if they fall in separate academic enrollment years or having knowledge that the child was preterm). Survey showed that most parents informed educators about their child’s history of PTB. This disclosure increased with decreasing gestational age (GA) (92.9% for &lt;26 weeks, 85.5% for 27-32 weeks, and 54% for &gt;33 weeks). 54% of parents believed that their child had learning challenges and attributed this to the child’s PTB. 40% believed that the school met their child’s needs. One-third of parents stated that their child’s eduators knew nothing of prematurity. Factors that enhanced educators’ performance on assessment of knowledge were: having taught a preterm child or a child with an individualized education plan in their class, and additional qualifications of the educator.
CONCLUSION: Educators and parents are unprepared to address the academic needs of preterm infants. Educators need to be trained on the outcomes of PTB and parents should be prepared to advocate for their child in the school system.
3-Year Survival and Neurodevelopmental Outcomes in Extremely Premature Neonates: A 15-Year Odyssey
Authors: Bhattacharya S , Miller M , Coughlin K 
Published: September 2022

Abstract
BACKGROUND: For neonates born at limits of viability, CPS recommends resuscitation decisions should occur after detailed discussion with parents, utilizing best available data on survival and neuro-developmental morbidities. There are emerging studies reporting such outcomes beyond 18-24 months. However, there is a notably wide variation in survival and rates of long term morbidity reported in the literature for infants born before 26 weeks of gestation. Centre specific survival rates among actively resuscitated extremely premature neonates and accurate developmental outcome data that truly reflects functional abilities are crucial for both parents and healthcare providers.
OBJECTIVES: Assess mortality, neuro-developmental outcomes at 3 years of age and correlate with risk factors predictive of adverse developmental outcomes in neonates born between 23+0-26+6 weeks of gestation at a tertiary care center in Ontario, Canada
DESIGN/METHODS: This was a retrospective analysis at a Level 3 center focusing on neonates born at 23+0 to 26+ 6 weeks gestation between January 2000 to December 2014. Data was extracted from Neonatal-Perinatal Database and Developmental Clinic Database. Clinical assessment of motor impairment (GMFCS), sensory impairment(blind or deaf) and a well validated tool Child Development Inventory were used to assess developmental outcomes at 3 yrs of age. Comparative analysis of possible risk factors, extracted from the NICU database , for adverse outcomes were analyzed using multivariate regression.
RESULTS: Survival rate among actively treated neonates were 25%, 60.4% and 77.5% at 23, 24 and 25 weeks respectively. 3 year survival rates with no major motor or neuro-sensory impairment were 40% among survivors born at 23 weeks, 47.2% among those born at 24 weeks, 55.6% and 68.6% among those born at 25 and 26 weeks respectively. Those born at 23 weeks had a significantly higher risk of having CP compared to the risk at 26 weeks [OR 9.04 {CI 1.96-41.67}]. Presence of IVH [OR 2.50 {CI 1.20-5.21}] and CSF infections [OR 5.71 {CI 1.03-31.56}] were identified as significant risk factors for adverse motor outcomes. Female neonates across all gestational age groups had significantly lower C P, speech delay and significantly better CDI scores. CDI profile analysis showed that at 3 years, nearly 80% of neonates born between 24-26 weeks have normal General Development Score, while only 40% of neonates born at 23 weeks had normal General Development Score at 3 years.
CONCLUSION: Being born at 23 week increased risk of cerebral palsy when compared to risk of birth at 26 weeks. CSF infection and IVH were found to be significant risk factors for adverse motor outcomes. The functional abilities as per the CDI Profiles were remarkably similar among survivors born at 24, 25,26 weeks of gestation.
The Effect of Umbilical Cord Milking on Hemodynamic Status of Preterm Infants: A Randomized Controlled Trial
Authors: El-Naggar W , Simpson D , Hussain A , Armson A , Dodds L , Warren A , Whyte R , McMillan D 
Published: September 2022

Abstract
BACKGROUND: Delayed cord clamping may be difficult to perform in extremely preterm infants. The effects of the alternative, cord milking, have not been fully evaluated.
OBJECTIVES: To determine whether cord milking (CM) at birth improves systemic blood flow and short term outcomes, as compared with immediate cord clamping (ICC).
DESIGN/METHODS: Babies born to eligible, consenting women presenting in preterm labor between 24 and 31 weeks' gestation were randomized to receive CM or ICC. Echocardiography was performed at 4-6 and 10-12 hours after birth. The primary outcome was systemic blood flow as represented by echo-derived superior vena cava (SVC) flow. Neonatal care staff, echogardiographer and interpreter were blind to the randomization. Analysis was by intention to treat.
RESULTS: A total of 73 eligible infants were randomized (37 to CM and 36 to ICC) during the study period (November 2011-2014). There were no statistically significant differences in maternal demographic and antenatal variables. Mean (SD) gestational age was 26.1 (11) weeks and mean (SD) birth weight was 1025 (308) g. 38% of infants were born by vaginal delivery. No significant differences were found between groups in SVC flow, cardiac outputs or neonatal morbidities [table1].
CONCLUSION: There were no statistically significant differences in functional cardiac outcomes, mortality or morbidity between preterm infants who received CM and those who received ICC. Larger trials are needed to establish the best practice in managing the umbilical cord at birth in extremely preterm infants.
Epidemiology of Posthemorrhagic Ventricular Dilatation in Canadian Neonatal Intensive Care Units
Authors: Afifi J , Vincer M , Shah V , Ye X , Shah P , Barrington K , Piedboeuf B , Kelly E , El-Naggar W 
Published: September 2022

Abstract
BACKGROUND: Severe intraventricular hemorrhage (IVH) is a common cause of neonatal morbidity and mortality .The incidence and management of post-hemorrhagic ventricular dilatation (PHVD) vary among different centres.
OBJECTIVES: To assess the incidence, temporal trend, management and associated outcomes of PHVD in Canadian NICUs.
DESIGN/METHODS: We conducted a retrospective review of all pre-term infants (22+0 -32+6 weeks) who were admitted to NICUs participating in the Canadian Neonatal Network between 2010 and 2014. Infants with severe IVH (IVH with ventricular dilatation or parenchymal bleeding) who survived ≥ 72 hours were included. We compared the rates of severe IVH, PHVD and VP shunting between the 5 Canadian regions. Short-term outcomes of infants who developed PHVD (ventricles size ≥10 mm) were compared with those who did not.
RESULTS: Of 16600 eligible infants, 1964 (11.8%) developed severe IVH. Of 1815 infants with severe IVH who survived ≥72 hours, 616 (34%) developed PHVD and 91 (5%) treated with VP shunt. No significant difference in the incidence of severe IVH, PHVD or VP shunting over the last five years was noted. There was a statistically significant difference in the rates of severe IVH (p&lt;0.0001) and PHVD (p=0.02) among the 5 Canadian regions. VP shunts rates were variable with some Canadian regions with higher rates of PHVD had low rates of VP shunts. [figure 1]. Infants with PHVD had significantly higher mortality and short term morbidities. [table 1]. On regression analysis, PHVD is an independent predictor of death in infants with severe IVH [adjusted OR 1.55, 95% CI (1.18, 2.04)]. Infants with VP shunt had significantly higher rates of severe ROP (p&lt;0.0001), meningitis (p&lt;0.0001), and hospitalization (89 vs 41 days, p&lt;0.0001).
CONCLUSION: PHVD is an independent predictor of death and is associated with adverse short- term outcomes. Variability exists between different regions in managing PHVD. Further studies are needed to investigate the impact of this variability on long-term outcomes.
The Relationship between Milk Fat Content, Vitamin D and Adiposity in Early Childhood
Authors: Vanderhout S , Maguire J , Birken C , Parkin P , Lebovic G , Chen Y , O'Connor D 
Published: September 2022

Abstract
BACKGROUND: Fortified cow’s milk is the main dietary source of vitamin D and an important source of dietary fat for North American children. Current guidelines recommend reduced milk fat consumption to reduce childhood obesity, yet the relationship between lower milk fat, vitamin D stores and adiposity is unclear.
OBJECTIVES: The objective of this study was to determine the association between percent fat content of milk and both zBMI and 25-hydroxyvi-tamin D; secondly, to explore if volume of milk consumed modified this relationship.
DESIGN/METHODS: A cross-sectional study of healthy urban children 12-72 months of age was conducted. Bivariate multiple linear regression was used to test the association between percent milk fat content and child 25-hydroxyvitamin D and zBMI concurrently. The interaction between volume of milk consumed and percent milk fat content was examined to explore how milk volume might modify these relationships.
RESULTS: 2745 children were included in the analysis. Percent fat content of milk was positively associated with 25-hydroxyvitamin D (p=0.006), and negatively associated with zBMI (p&lt;0.0001). Children who drank homogenized milk (3.25% fat) had 6.6 nmol/L (95% CI 5.49 to 7.71) higher median 25(OH)D concentration and 0.72 lower (95% CI 0.68 to 0.76) zBMI score than children who drank skim milk (0.1% fat). Volume of milk consumed potentiated the effect of percent fat content of milk on 25-hydroxyvitamin D (p=0.003) but not on zBMI (p=0.77). Children who drank 1 cup of homogenized milk each day had a similar 25-hydroxyvita-min D as children who drank 2.85 cups (95% CI 2.71 to 2.99) of skim milk, but had zBMI score 0.78 (95% CI 0.63, 0.93) units lower.
CONCLUSION: Homogenized milk may be more appropriate than reduced fat milk in maximizing serum 25-hydroxyvitamin D and minimizing adiposity in early childhood. Current guidelines for reduced milk fat consumption in childhood may require further study to achieve desired outcomes.
Characteristics and Trends in Intentional Acetaminophen Intoxication in Adolescents Over Two Decades
Authors: Caudron M , Gosselin-Papadopoulos R , Jamoulle O , Swaleh S , Taddeo D , Frappier JY 
Published: September 2022

Abstract
BACKGROUND: Acetaminophen is a common drug used for self-poisoning in adolescents, and an important cause of acute liver failure in the pediatric population. Data regarding intentional acetaminophen intoxication in Canadian youths is limited.
OBJECTIVES: The purpose of the study was to describe the characteristics of intentional acetaminophen intoxications in Canadian adolescents and evaluate its evolution over two decades.
DESIGN/METHODS: We performed a retrospective chart review of intentional acetaminophen ingestions in adolescents (11-18 years old) hospitalized at a Canadian pediatric tertiary care centre between 1989 and 2009. We recorded the patients’ sociodemographic data, as well as the characteristics, complications and treatments of the intoxications. Data was compared across approximately five year periods as a group, then in both sexes separately.
RESULTS: A total of 383 cases were examined, 53 of which were in male patients and 330 in female patients. Given the small number of male patients, only female patients were included in this analysis. There were 200 cases within the time intervals 1 and 2 (1989-1993, 1994-1998) and 130 cases within the time intervals 3 and 4 (1999-2003, 2004-2009). Demographics were relatively constant across the time periods. Impulsive gestures were indicated as the motivation in almost 80% of cases, which remained stable over time (p=0.56). The ingestion of additional substances and the quantity of acetaminophen also remained constant over time (p=0.79 and p=0.46). Mean time to physician consultation significantly increased in time from 6h in interval 1 to 13.4h in interval 4 (p=0.0001). The proportion of ICU admissions, coagulopathy and multiple organ failures also increased across time intervals (p=0.01, 0.03 and 0.03 respectively). There was no definitive linear trend in cases of hepatitis, encephalopathy or acute kidney injury (p=0.26, 0.81 and 0.27 respectively). There were two deaths, and one liver transplant over the 21-year period. Treatment significantly changed over time with progressive increase in N-acetylcysteine use from 47.4% to 81.1% (p=&lt;0.0001) and progressive decline in charcoal use from 70.2% to 17.6% (p&lt;0.0001) in intervals 1 to 4. Poison centre consultations significantly increased in time from 14.4% in interval 1 to 67.7% in interval 4 (p&lt;0.0001).
CONCLUSION: We suggest that the apparent severity increase in adolescent acetaminophen intoxication is related to the progressive increase in time to physician consultation with associated delays in treatment. The changes in management observed over the 21-year period is likely reflective of the evolution and availability of treatment protocols. Furthermore, the increase in poison centre consultations may account for part of the decrease in treatment variability across patients.