bluuebunny/crossref_metadata_2025_split huggingface dataset:
16 RAM cannula versus Infant Flow Driver systems for post-extubation non-invasive ventilation support in extremely preterm infants - A retrospective cohort study
Authors: Kumar Manoj , Keil Eric 
Published: October 2022

Abstract

Background
Non-invasive ventilation (NIV) delivered by RAM cannula is being used for post-extubation support of preterm infants in some centers for its potential benefits of ease of setup and less nasal trauma.

Objectives
To assess characteristics and clinical outcomes for infants extubated to NIV support delivered via RAM cannula, as compared to those extubated to Vyaire Infant Flow Driver (IFD) systems.

Design/Methods
Retrospective cohort study. All infants born at 25 to 27 + 6 weeks of gestation during a 3-year period (2016-2018) and admitted to a regional Level-3 NICU, were eligible if: 1) they were ventilated for RDS within 48 hours of birth, and 2) extubated to NIV support using RAM cannula or IFD systems (using Viasys or FabianTM devices). Primary outcome was the failure of the primary mode of NIV support within the first 72 hours post-extubation (defined as need for reintubation or change of initial NIV mode to prevent reintubation). We adjusted for antenatal steroid use and delivery route. Data was stratified for gestational age (GA) &lt;26 wks/&gt;=26 wks. Sensitivity analysis were performed on additional parameters, e.g., inborn status, duration of initial ventilation restricted to &lt;4 days. Logistic and linear regression models were built for the categorical and continuous outcomes.

Results
150 infants were enrolled, RAM cannula (n = 62) and IFD devices (n = 88). The majority of patients in both groups were on conventional ventilation, received one dose of surfactant, and were on FiO2 &lt;0.3 prior to extubation. RAM cannula group had significantly longer duration of intubation prior to first extubation (median duration 99 hrs vs 19 hrs). There was no difference in the primary outcome between the groups [(RAM 51.6% and IFD 45.5%; adjOR 1.25(95% CIs: 0.65 – 2.4)]. However, RAM cannula group had higher rates of reintubation within &lt;=7 days after extubation (89.5% vs 68.5%; adjOR 3.87(95% CIs: 1.18, 12.73), p-value=0.026] and higher incidence of IVH [62.9% vs 38.6%; 2.77(95% CIs: 1.39, 5.53), p-value 0.004], with lesser infants weaned to room air prior to discharge [58.1% vs 76.1.6%; adjOR 0.42(95% CIs: 0.21, 0.85), p-value 0.016]. In the stratified analyses by GA, these differences were noted to be restricted to those born at &gt;=26 weeks, with an additional risk for increased BPD36 (adjORs 2.76 (95% CIs: 1.16, 6.57), p-value 0.022] associated with the RAM cannula use in this stratum.

Conclusion
Post-extubation NIV support via RAM cannula, as compared to IFD systems, was associated with higher rates of reintubation in &lt;=7 days, IVH, with a greater number of infants discharged home on supplemental oxygen.
25 Paracetamol versus Indomethacin for management of Patent Ductus Arteriosus in Premature Infants- A Systematic Review and Meta-Analysis
Authors: Kumar Manoj , Bitar Eyad , Campbell Sandra , Hyderi Abbas 
Published: October 2022

Abstract

Background
Premature infants with hemodynamically significant patent ductus arteriosus (HsPDA) have high rates of morbidity and mortality in neonatal units. Indomethacin has been the most common agent used for pharmacological closure of the PDA. Recently, paracetamol has gained interest in the neonatal community for its use for management of HsPDA.

Objectives
To conduct a systematic review of randomized controlled trials (RCTs) comparing the efficacy and safety of paracetamol with indomethacin for HsPDA management in preterm infants.

Design/Methods
We searched PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library (CDSR and Central), EBSCO CINAHL, and SCOPUS using controlled vocabulary and key words representing the concepts "preterm neonates" and "acetaminophen" and "indomethacin". Databases were searched from inception to June 15, 2021. Bibliographies of identified studies were searched for additional references. Studies were included if they enrolled preterm infants with HsPDA (diagnosed on echocardiogram), and randomised them for treatment with paracetamol or indomethacin for the primary outcome of HsPDA closure. Discrepancies among reviewers for study selection, RoB assessments, and data extraction were resolved by consensus. Data were analyzed with the help of Review Manager (RevMan) Version 5.3.

Results
Four RCTs were identified, enrolling a total of 380 subjects. There was no difference between the two interventions for the rates of PDA closure either after one course (4 studies; RR 1.04 [95% CIs: 0.84, 1.29], p-value 0.70) or after two courses of treatment (2 studies; RR 1.01 [95% CIs: 0.92, 1.12], p-value 0.77), and for PDA ligation (3 studies; RR 1.56 [95% CIs: 0.48, 5.12], p-value 0.46). However, the patients who received paracetamol had lower rates of necrotizing enterocolitis (NEC) (3 studies; RR 0.37 [95% CIs: 0.14, 0.95], p-value 0.04). There were no significant differences noted in the other important secondary outcomes, i.e., Intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity requiring treatment, and death. Two studies reported baseline and post-treatment serum markers for renal and hepatic injury; there was significant post-treatment elevation of serum creatinine and blood urea noted with the indomethacin use in each of these studies, as compared to no change noted with paracetamol use.

Conclusion
The efficacy of paracetamol is comparable to indomethacin for the outcome of PDA closure, with lesser rate of NEC and post-treatment azotemia noted with the paracetamol use. Paracetamol should be preferred over indomethacin for HsPDA management in premature infants.
29 Maternal overweight and obesity’s impact on long-term neurodevelopmental outcomes in premature infants (&lt;29 weeks) at 18-24 months corrected age
Authors: Journault Marina , Murthy Prashanth , Bansal Neha , Tang Selphee , Al-Awad Essa , Creighton Dianne , Crawford Susan , Lodha Abhay 
Published: October 2022

Abstract

Background
Increasing rates of obesity are of growing concern to maternal and child health as mothers with obesity are at risk of pregnancy complications. Infants of mothers with overweight/obese pre-pregnancy body mass index (BMI) may also be at risk of significant neurodevelopmental disorders. The relationship between maternal pre-pregnancy BMI and neurodevelopmental outcomes in preterm infants is not yet clearly defined.

Objectives
To determine the association of pre-pregnancy BMI of mothers of infants born &lt;29 weeks gestational age (GA) and neurodevelopmental impairment (NDI) at 18-24 months corrected age (CA).

Design/Methods
Preterm infants born &lt;29 weeks GA between January 2005 and December 2015 evaluated in the neonatal follow-up clinic at 18-24 months CA were included. Demographic characteristics as well as neurodevelopmental status including Bayley-III cognitive, language, and motor scores and sensory impairments were compared between three groups based on maternal pre-pregnancy BMI (BMI1 [18.5-24.9 kg/m2] vs. BMI2 [25-29.9 kg/m2] vs. BMI3 [≥30 kg/m2]) using univariate and multivariable regression models. The primary outcome was a composite of death or NDI.
NDI was defined as the presence of Bayley-III &lt;85 on one or more of the cognitive, motor, or language composite scores, any cerebral palsy (GMFCS ≥1), sensorineural or mixed hearing impairment, or unilateral or bilateral visual impairment.

Results
Of 771 eligible infants, 53 not seen in the follow-up clinic and 21 born to mothers with BMI &lt;18.5 kg/m2 were excluded. Of the remaining 697 participants, 315 (45%) infants were in BMI1, 235 (34%) in BMI2, and 147 (21%) in BMI3 groups. Infants in BMI1, BMI2, and BMI3 groups had mean (SD) birth weight of 897 (231), 854 (208), and 867 (234) grams and median GA (IQR) of 27 (3), 26 (2), and 27 (3) weeks respectively. Rates of associated impairments are shown in Figure 1. The odds of a composite of death or NDI in BMI2 vs. BMI1 and BMI3 vs BMI1 groups were 1.33 (95%CI 0.86-2.06) and 0.76 (95%CI 0.47-1.22) respectively (Table 1). Infants born to mothers in the BMI2 group had twice the odds of scoring &lt;85 on the Bayley-III language composite than those in BMI1 (adjusted odds ratio 2.06 [95% CI; 1.28-3.32]).

Conclusion
Pre-pregnancy body mass index was not associated with death or neurodevelopmental impairment in very preterm infants at 18-24 months corrected age. However, infants born to mothers who were overweight were more likely to have lower language scores.
30 Exploring the lived experience of non-offending caregivers in paediatric abusive head trauma
Authors: Shannon Meggie , Sahiti Qendresa , Ornstein Amy 
Published: October 2022

Abstract

Background
Abusive head trauma (AHT) is the most common cause of death due to physical abuse and despite prevention efforts, the incidence remains largely unchanged. For survivors, there can be multiple adverse health consequences with lifetime costs in the range of millions per child. While studies have focused on both short- and long-term outcomes for children with AHT, little is known about the experience of their non-offending caregivers (NOCs).

Objectives
To explore the lived experience of NOCs in paediatric AHT, including their perspectives on paediatric practice and prevention strategies.

Design/Methods
Institutional Research Ethics Board approval was obtained. Recruitment materials were shared through the National Centre on Shaken Baby Syndrome’s email, social media, and presentation at their Family Symposium. Inclusion criteria were North American NOCs in paediatric AHT, who lived with the offender. Using a phenomenological approach, six semi-structured interviews were conducted over Zoom for Healthcare, audio-recorded, transcribed, and rendered anonymous. Transcripts were coded using ATLAS.ti and classified by consensus into major themes and subthemes by the research team. Data collection and analysis continued until saturation was reached.

Results
All participants reported ongoing, multidimensional impacts of the trauma on their physical and mental health, years after occurrence. Primary themes identified included: (1) NOCs need compassion and support. Among other aspects of their experience, feeling judged and accused by healthcare providers (HCPs), compounded their trauma, (2) NOCs reported varied experiences within healthcare including a perceived lack of AHT knowledge among HCPs, and could be better served by an extension of multidisciplinary supports, (3) NOCs are resilient, devoted, and powerful advocates for their children all while managing negative emotions such as feeling betrayed, guilt and fear for their child’s life, (4) NOCs experienced challenges navigating systems and accessing supports, including financial, geographical and psychosocial barriers, and (5) There was varied exposure to AHT prevention materials, and many felt the stigma associated with AHT limits engagement with the subject, which may be a barrier to prevention efforts.

Conclusion
NOCs hold a unique and relevant perspective, not previously documented. While further research is required, our findings suggest that by extending compassion to caregivers and accessible multidisciplinary supports, the experience and overall wellbeing of NOCs could be improved. By better addressing the complex needs of NOCs, and increasing knowledge of AHT, HCPs have an opportunity to mitigate the negative impacts of the event and create better outcomes for children.
42 For the Parent, by the Parent: Creating a Program to Empower Parents of Refugee Background Using Novel Participatory Approaches
Authors: Kaur Pardeep , Ho Bernice , Kaukab Tanvir , Rashid Meb , Bowry Ashna , Yousafzai Aisha , Minhas Ripudaman 
Published: October 2022

Abstract

Background
With more than 28 million individuals of refugee or asylum-seeking background globally, the current situation has been described as one of the largest humanitarian crises of all time. Families of refugee background have complex, multigenerational mental health and developmental needs that are not accounted for in current programming frameworks. Difficulties in resettlement have been further compounded by COVID-19-related lockdowns, straining parental mental health and placing children at an increased risk for developmental or behavioural problems. Providing appropriate support services and educational resources that address the multigenerational concerns of families of refugee background will address these challenges, allowing for improved parental mental health, family cohesion, and developmental outcomes for children.

Objectives
To gather data about the experiences, resources, referral pathways and barriers that impact the experience of parents of refugee background in the Greater Toronto Area (GTA) and to develop a novel, multi-dimensional parenting program model using Community-Based Participatory Research (CBPR) principles.

Design/Methods
This was a qualitative community-based participatory study using a formative research framework, in accordance with COREQ guidelines. In-depth interviews (IDIs) were conducted with parents of refugee background and care providers that work closely with this population. Data were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders.

Results
A total of 20 IDIs were conducted (7 parents and 13 care providers). The main topics that were identified to be incorporated into the program include features of child development, how to address resettlement issues, child advocacy, and parenting in the Canadian context. Participants felt that tackling the language barriers, addressing the overlapping responsibilities of the mothers attending the sessions, providing incentives, increasing awareness of the program, and using an anti-racist and anti-oppressive approach is key to the program’s success. Participants emphasized the need for trauma-informed mental health support within the program model.

Conclusion
This study describes the key considerations for a novel parenting program for families of refugee background, by engaging them as key stakeholders in the program design process. Future iteration of this project would involve a pilot and evaluation of the program.
49 Implementation of a Sensory Toolkit in the Emergency Department for Children with Autism Spectrum Disorder
Authors: Roy Meagan , Kinlin Ceilidh , MacEachern Sarah 
Published: October 2022

Abstract

Background
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication and restricted, repetitive patterns of behaviour, interests, or activities. Children with ASD frequently visit the emergency department (ED), and present more for primary care-related issues and other non-emergent reasons than children without ASD. Visiting the ED can be challenging and stressful for children with ASD, their caregivers, and the healthcare professionals caring for them. Sensory Toolkits are a collection of sensory items that can help to distract and calm children, including during times of stress. We hypothesized that a Sensory Toolkit will improve the experience of children with ASD and their families in our ED.

Objectives
The primary objective of this study was to evaluate the effect of a Sensory Toolkit on the experience of children with ASD and their families visiting a tertiary-care hospital ED.

Design/Methods
After ethical approval was obtained, a pre-implementation survey was conducted on parents of children with ASD about prior experiences in the ED and their interest in a Sensory Toolkit. A Sensory Toolkit specific to children with ASD was developed through literature review and in consultation with families of children with ASD. The Sensory Toolkit, which included a light wand, squeeze ball, push-pop bubble toy, and other items, was launched in a tertiary-care hospital ED in June 2021 with 50 Toolkits. A post-implementation survey was conducted to explore parents’ experiences of their child using the Sensory Toolkit in the ED and to obtain feedback to help improve the Toolkit.

Results
In the pre-implementation survey, 80% (32/40) of parents felt that a Sensory Toolkit would improve the experience of children with ASD in the ED. Post-implementation, 100% (12/12; response rate ~25% from 50 Toolkits) of parents felt that the Sensory Toolkit was helpful for their child. Parents reported that the Sensory Toolkit was “AMAZING” and “A really great idea, thank you!”. Feedback provided regarding improvements that could be made to the Sensory Toolkit was highly patient-specific and often contradictory. One parent suggested more items to chew on while another parent suggested elimination of the chewable items and one parent loved the light up toy while another suggested to remove it.

Conclusion
The Sensory Toolkit contributes positively to the experience of children with ASD and their families in a tertiary-care hospital ED. This study will help inform improvement of the Sensory Toolkit in the ED, including consideration of more specialized Sensory Toolkits to meet individual patient needs. Given the success in the ED, the Sensory Toolkit could be expanded into other areas of the tertiary-care hospital and beyond.
51 Influenza Vaccine Programs with the Cell-Based Quadrivalent Influenza Vaccine and Adjuvanted Trivalent Influenza Vaccine are Highly Cost Effective in Canada
Authors: Nguyen Van Hung , Roy Bertrand 
Published: October 2022

Abstract

Background
Influenza vaccination with quadrivalent egg-based vaccines (QIVe) in adults ≥ 65 years may be less effective due to immunosenescence. An MF59®-adjuvanted trivalent influenza vaccine (aTIV) has been developed to provide stronger, broader and longer protection in older adults. For the younger age groups, lower effectiveness may be associated to the mutagenesis of influenza viruses that are propagated in eggs. A cell- based quadrivalent influenza vaccine (QIVc) was developed to improve the vaccine effectiveness by eliminating egg-adaptation.

Objectives
The objective of this analysis was to evaluate the potential public health impact on the utilization of both vaccines in Canada.

Design/Methods
An SEIR dynamic-transmission model was created and adapted to four influenza strains for the 2013-2019 seasons. Strain-specific circulation was obtained from Canada’s national surveillance system. Influenza incidence estimates were calibrated using CDC published data. The model used rVE from peer reviewed publications for QIVc and aTIV showing superiority to QIVe vaccines. Frequency of egg-based genetic changes were estimated from a published review of Crick Institute reports. Estimates of specific vaccines efficacy and economic assumptions were derived from the published literature. Different vaccination scenarios, based on the provincial vaccination programs, were modelled.

Results
Replacing QIVe with QIVc in subjects 6 months-64 years led to an annual reduction of 462 156 symptomatic cases; 58 122 GP visits; 40,871 emerging consultations; 3 788 hospitalizations and 662 deaths versus a QIVe-for-all scenario. The adoption of QIVc and aTIV will be highly cost effective over the use of QIVe. aTIV would also be more cost effective than QIVHD. Table 1 provides the detailed results for the others scenario. Sensitivity analyses confirmed the robustness of the assumptions used in the analysis.

Conclusion
The greatest public health impact is obtained by using QIVc and aTIV in influenza vaccine programs in Canada versus other combinations of available vaccine.
62 Multicenter validation of the C-3PO rule to identify young children at risk of skull fracture following head trauma
Authors: Hoeffe Julia , Manzano Sergio , Gouin Serge , Gravel Jocelyn 
Published: October 2022

Abstract

Background
There is no widely accepted clinical tool to safely predict skull fracture in young children who sustained a head trauma. The C-3PO rule is a clinical decision rule which reported that age up to 3 months, or parietal/occipital scalp hematoma are predictors of skull fracture in young children.

Objectives
The present study prospectively evaluated the C-3PO rule in multiple new settings.

Design/Methods
This was a prospective multi-centre observational study conducted in three tertiary Emergency Departments (ED) in Canada and Switzerland. Patients were included if they were up to the age of 24 months of age and had a head trauma without high risk factors for clinically important intracranial injury according to the PECARN head trauma rule. The primary outcome was a radiologically identified skull fracture identified by any radiographic imaging modalities. The independent variables were the three components of the C-3PO rule as assessed by the treating physician. The patients were treated as per the physician’s discretion and followed up by phone if there was no initial skull radiological imaging. Criterion validity of the rule was calculated.

Results
A total of 844 patients were included with a median age of 8 months. Thirty percent of these patients (n=263) received radiological imaging, and 52 (6.2%) patients had a skull fracture. The C-3PO rule identified 51/52 children with a fracture for a sensitivity of 98% (95% CI: 90-100%), and a specificity of 70% (95% CI: 67-74%). Applying the rule would have reduced radiological imaging from 263 to 211 patients (-20%; 95%CI: 15-25%).

Conclusion
The C-3PO rule can safely be applied by pediatric emergency physicians evaluating children younger than 24 months with a head trauma. It helps ED clinicians to identify young children at low risk for skull fracture, improving decision making regarding the use of CT scan for children at intermediate risk of clinically important traumatic brain injury.