bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Continuous Digital Video Electroencephalogram (CEEG) Introduction on the Use of Anti-Epileptic Drugs (AEDS) in Neonates with Hypoxic Ischemic Encephalopathy (HIE)
Authors: Bashir RA , Espinoza L , Vayalthrikkovil S , Buchhalter J , Bello-Espinosa L , Mohammad K 
Published: September 2022

Abstract
BACKGROUND: Use of AEDs in neonates may disrupt neuronal development by synaptic re-organization and altering brain plasticity. Introduction of cEEG as part of neonatal neurocritical care long term monitoring (LTM) aims to improve seizure detection and control in neo-nates with HIE.
OBJECTIVES: To assess the impact of cEEG on seizure detection and the use of AEDs in neonates with HIE
DESIGN/METHODS: A retrospective cohort study of neonates admitted with HIE to a level III NICU two years before and after introduction of LTM in August 2013. The cEEGs were read remotely by a pediatric epileptologist. Before LTM, a 60 minute routine EEG (rEEG) was the standard practice. Primary outcome was the number of AEDs used. Secondary outcomes were AEDs used as maintenance and on discharge, and AEDs burden (total mg/kg used during hospital stay). HIE staging was based on modified Sarnat scoring system. Drug burden for each AED was calculated. Categorical variables were analysed using Chi-square test and continuous variables using student&&#x0023;39;s t test.
RESULTS: n=157 (total number of HIE patients); median gestation 40 weeks (IQR 38-40); 71 infants(45%) had LTM monitoring;103 infants(66%) were cooled. Baseline and clinical characteristics including disease severity and cooling were similar. In the pre LTM era, 12 of 52 (23%) infants with clinical seizures, only 12 had seizures by rEEG . Using cEEG, 17 out of 33 (52%) clinical seizures were confirmed by cEEG; 5/36(1%) had subclinical seizures compared to none before LTM. Detection of EEG seizures increased significantly with LTM (p 0.02). Discharge on any AEDs was less in the LTM group and the mean AEDs burden was reduced from 176 mg/kg in the pre LTM to 91 mg/kg in the post LTM group.
CONCLUSION: Introduction of cEEG improved seizure detection and control; but decreased the overall use and burden of AEDs.

p value &lt;0.05 is denoted as *
Prevalence and Characteristics of Intracranial and Extracranial Hemorrhages in Neonates with Hypoxic Ischemic Encephalopathy (HIE)
Authors: Vayalthrikkovil S , Bashir R A , Espinoza L , Irvine L , Mohammad K 
Published: September 2022

Abstract
BACKGROUND: Intracranial hemorrhages (ICH) and extracranial hemorrhages(ECH) are not uncommon in neonates with HIE. The risk factors of hemorrhages and their association with HIE severity and other therapeutic interventions are unclear.
OBJECTIVES: To examine the prevalence and risk factors associated with ICH and ECH in neonates with HIE.
DESIGN/METHODS: A retrospective cohort study of neonates admitted with HIE from September 2011 to October 2015 in a level III NICU. ICH[mainly subdural(SDH), intraventricular (IVH), intraparenchymal (IPH)] and ECH [mainly subgaleal(SGH) and cephalhematoma] were diagnosed by MRI.Perinatal and neonatal characteristics were examined, including mode of delivery, outborn status, HIE staging(using modified Sarnat scoring), therapeutic hypothermia(TH), clinical/EEG seizures, hypo/hypercarbia, inotrope use, thrombocytopenia-mild, moderate, severe(platelet count 100-150, 50-100, 1.8, activated partial thromboplas-tin time(aPTT)&gt;45 sec, fibrinogen
RESULTS: Number of HIE patients,n=157; median gestation 40 weeks(IQR 38-40); outborn=104(66%);TH used=103(66%);MRI brain done=138. . Prevalence of SDH,IPH,IVH and SGH were 47,22,9,9 (34%,16%,6.5%,6.5%) respectively. There was no significant increase in hemorrhage with mode of delivery except instrumentation, seizures, hypo/ hypercarbia, severe thrombocytopenia or deranged coagulation. Instrumental delivery significantly increased the prevalence of IPH and SGH. All hemorrhages except cephalhematoma increased with severity of HIE staging, but not with MRI severity. In the logistic regression analysis, use of dopamine was associated with increased risk of IPH(OR 2.94; 95% CI 1.42, 12.08) and trended towards increased risk of IVH (OR 4.49; 95% CI 0.98, 20.6).
CONCLUSION: SDH followed by IPH are the common ICH. Despite being frequent, thrombocytopenia and deranged coagulation did not increase the risk of ICH or ECH in HIE; dopamine use associated with significant increase in the risk of IPH.
Neurodevelopmental Outcomes Following Extensive Cardiopulmonary Resuscitation in the Delivery Room for Infants Born &lt;29 Weeks’ Gestational Age
Authors: Fischer N , Soraisham A , Lodha A , Ting J , Rabi J , Synnes A , Creighton D , Shah P , Singhal N , Dewey D , Metcalfe A , Ballantyne M , Cooper S 
Published: September 2022

Abstract
BACKGROUND: Neurodevelopmental outcomes of preterm infants who receive extensive CPR (ECPR), defined as chest compression with or without epinephrine in the delivery room, remain unclear.
OBJECTIVES: To compare the neurodevelopmental outcomes of preterm infants admitted to Canadian NICUs requiring ECPR versus those who did not require ECPR in the delivery room.
DESIGN/METHODS: Preterm infants born at &lt;29 weeks GA between January 1, 2010 and September 30, 2011 and evaluated at CNFUN centers were retrospectively evaluated. The primary outcome was a composite of death or neurodevelopmental impairment (NDI) at 18-21 months CA defined as presence of any one or more of the following: definitive cerebral palsy or Bayley- III cognitive, language, motor scores &lt;85 on any one of the components or hearing impairment or visual impairment. Demographic factors, neurodevelopmental status including Bayley III cognitive, language and motor scores and sensory impairments were compared between the ECPR and the no ECPR group using univariate and multivariate analyses. RESULTS: Of 2488 eligible infants, 197 (7.9%) received ECPR. 83% of surviving infants had follow-up data. Demographic and outcomes data are summarized below in Table 1 and 2 respectively.

CONCLUSION: In very preterm neonates, ECPR was associated with increased risk of death or neurodevelopmental impairment and lower motor scores at 18-21 months CA.
The Association between Hyperlactatemia and Adverse Long-Term Outcome in Infants With Moderate-To-Severe Hypoxic Ischemic Encephalopathy
Authors: Elboraee M 
Published: September 2022

Abstract
BACKGROUND: Hypoxic ischemic encephalopathy (HIE) remains one of the most devastating events in the newborn period. Lactate is invariably produced with hypoxia and poor tissue perfusion. Initial highest lactate in the first hour of life and serial measurements of blood lactate have been found to be important predictors of moderate to severe neonatal encepha-lopathy in cases of intrapartum asphyxia.
OBJECTIVES: To examine the association between initial lactate level and the long term adverse outcome in infants with moderate to severe HIE (HIE II/III). We hypothesized that the level and duration to normalize hyperlactatemia in HIE infants can predict long term adverse neurodevel-opmental outcome.
DESIGN/METHODS: A retrospective chart and database review for all infants ≥ 35 weeks gestational age treated in the Northern Alberta Neonatal Program with HIE II/III from January 2006 to December 2012 (excluding infants who were growth restricted or with major congenital anomalies). The primary outcome was composite of death or any disability (cerebral palsy, cognitive delay &lt;2SD below the mean, hearing loss and blindness) at 18 months or 3 years of age. Univariate and multivariable regression analyses were used to compare the outcome.
RESULTS: Of 167 infants, 106 had initial lactate &gt;5.0mmol/L (63%) and 48 had initial lactate 16mmol/L is significant (P0.0015) for detection of adverse outcome; sensitivity 29.3% and specificity 90.5%.
CONCLUSION: Most term/near term infants with HIE II/III had initial lactate &gt; 5mmol/L. Initial lactate &gt;16 mmol/L and duration to normalization of lactate levels was associated with the adverse outcome.
Quantitative 3D and 2D Head Ultrasound to Determine Thresholds for Intervention In Preterm Neonates with Posthemorrhagic Ventricular Dilation
Authors: Kishimoto J , Lee D S.C. , Salehi F , Romano W , Fenster A , Ribaupierre S de 
Published: September 2022

Abstract
BACKGROUND: Preterm neonates with intraventricular hemorrhage (IVH) often acquire post hemorrhagic ventricle dilation (PHVD), which, when severe, can lead to neurological impairment. Cranial 2D ultrasound (US) images are used for the diagnosis and monitoring of PHVD; however, there is no consensus on the use of 2D US images to guide treatment. This can lead to delays in interventions, and the potential for brain injury. We have developed a 3D US system that has been shown to accurately detect changes ventricle volumes (VV).
OBJECTIVES: We investigate the utility of using 3D and 2D US measurements to determine thresholds for treatment of neonates with PHVD and to predict the need for further treatments.
DESIGN/METHODS: Neonates were imaged twice weekly in accordance to a protocol approved by the research ethics board. 3D US images were manually segmented to obtain VV. 2D measurements included ventricle index, anterior horn widths, third ventricle width, and largest thalamo-occipital distance. The rate of change for each measurement was calculated. Decisions to perform ventricular taps (VTs) to relieve intracranial pressure were made independently by neurosurgeons who were blinded to study images. Receiver operator curves (ROC) were generated using the sensitivity and specificity of the rates of change of sonographic parameters in predicting the need for V T. For each parameter optimal threshold for intervention was estimated by the area under ROC; and positive and negative predictive values (PPV, NPV) were calculated. Additionally, we investigated whether US measurements predicted the need for multiple interventions.
RESULTS: 23 neonates with PHVD were enrolled, 8 required interventions. The best predictor to determine initial intervention was the rate of change in VV when a threshold of &gt;2.04 cm3/day was used within the first three weeks of life (NPV and PPV of 1) and, this measurement was able to determine if then a patient would require further interventions when a threshold of -0.04 cm3/day was used looking at imaging time points after the first intervention (NPV and PPV of 1). 2D measurements were less sensitive and/or less specific (sensitivity of 88-57%, specificity of 100-79%, PPV of 0.88-0.57 and NPV of 0.93-0.79).
CONCLUSION: 3D US VV can predict the requirement for interven-tional ventricular tap in neonates with IVH, and can identify patients that have resolving PHVD following initial intervention, with higher sensitivity and specificity than 2D US measurements. These findings show promise for early classification of neonates using 3D US for prediction of interven-tional therapy, potentiallyaiding in timely management of these patients.
Nrp Prompt: A Randomized Controlled Trial of a Mobile App for Neonatal Resuscitation Training
Authors: Chan N , Campbell D , Mistry N 
Published: September 2022

Abstract
BACKGROUND: There is poor adherence to the Neonatal Resuscitation Program (NRP) algorithm by all levels of providers in simulated and clinical settings. While audio- visual prompting improves adherence to cardiopulmonary resuscitation, visual prompting alone has not been effective in improving NRP compliance. For this study, an iOS mobile app, NRP Prompt, was designed to provide audio -visual prompts based on user responses at NRP decision points.
OBJECTIVES: To determine if NRP Prompt improves the adherence of novice NRP providers to the NRP algorithm compared to visual- only prompting in simulated neonatal resuscitation.
DESIGN/METHODS: First year residents attending NRP training were randomized into intervention and control groups. Resident pairs used standard visual aids with NRP Prompt (intervention) or visual aids only (control) in two low- fidelity neonatal resuscitation simulations, where each resident took turns as team leader. Pairs were then evaluated in a third simulated scenario that was video -recorded, where neither group used NRP Prompt nor visual aids. The primary outcome was comparing the median checklist score in NRP Prompt versus control. Tw o independent NRP providers evaluated the video recordings of each pair using a validated NRP checklist. Secondary outcomes were: time to positive pressure ventilation (PPV), time to chest compressions and time to intubation. Inter-observer variability was determined using a two- way mixed -effects intra -class correlation coefficient (ICC). Median NRP scores and time to interventions were compared between intervention and control using the Wilcoxon ranked- sum test.
RESULTs: 39 residents participated, 8 pairs in intervention and 7 pairs (and 1 group of 3) in control. The ICC was 0.69, indicating good inter-rater agreement. Median NRP scores did not differ in intervention 21 (interquartile range (IQR): 1.5) vs. control 21 (IQR: 1.5), p=0.89. Median time in seconds did not differ for time to PPV (60.5 (IQR: 19.5) vs. 48 (IQR: 13.5) p=0.12), chest compressions (202.5 (IQR: 54) vs. 216 (IQR: 71) p=0.69), and intubation (234 (IQR: 145) vs. 264 (IQR: 94.5) p=0.25).
CONCLUSION: Training using NRP Prompt did not improve performance in simulated neonatal resuscitation. Potential reasons include voice prompts being distracting and smaller than hypothesized effect size. Future development of prompting apps should have options for different degrees of prompting tailored to user preferences.
Evaluating Caregiver Management of Asthma Exacerbations at Home
Authors: Yeung T , Amirav I 
Published: September 2022

Abstract
BACKGROUND: Effective management of asthma in the home setting requires asthma education from a health professional along with written plans for asthma exacerbations. These approaches can result in fewer acute asthma visits, fewer missed school days and better asthma control. Nevertheless, a large number of asthma exacerbations result in emergency department visits or hospital admission. Several studies suggest that care-givers may lack the knowledge, the skills, or the confidence to provide care for their child during an asthma exacerbation.
OBJECTIVES: The objective of this study was to determine the proportion of caregivers who appropriately manage their child’s acute asthma at home (as per the 2014 Global Initiative for Asthma guidelines) and to identify factors that may be associated with deviations from these guidelines.
DESIGN/METHODS: We studied caregivers of children who are known to suffer from asthma using a paper based questionnaire in a single-center outpatient asthma clinic. Caregivers of children aged 3 to 17 years with a physician made diagnosis of asthma greater than 6 months in duration were included. To avoid a diagnosis of bronchiolitis from our study group, new consultations for wheezing or cough without a prior diagnosis of asthma, and less than 3 years of age were excluded. For statistical analysis, we used Excel and STATA 11 for the z test of proportions and comparison of means with a one way ANOVA (a = 0.05).
RESULTS: Among the 45 caregivers surveyed, most had children with well controlled asthma based on low scores from a standard asthma control test and a limited number of emergency room visits (1.5±0.1 per year). Sixty-four percent of caregivers were able to correctly identify the initial treatment with 2 puffs of Ventolin; however, 54% did not choose repeating Ventolin treatment within 20 minutes for ongoing symptoms. Moreover, only 58% of caregivers had ever been given a written asthma action plan. Caregivers had a higher degree of confidence (reported on a scale of 1-10) in initiating management (8.9±1.5) compared with stopping treatment (7.3±2.5).
CONCLUSION: Despite a high degree of confidence in starting treatment for asthma attacks, half of the caregivers surveyed identified inappropriate steps to manage asthma exacerbations at home. Providing a written asthma action plan may improve caregiver confidence and knowledge in asthma exacerbation management. However, routine assessment and review by a healthcare professional is essential in reinforcing recommended behaviours for home asthma management.
Inner-City Fathers of Children Affected by Chronic Illness: A Systematic Scoping Review of Their Experiences
Authors: Kobylianskii A , Jegathesan T , Young E , Fung K , Huber J , Minhas R 
Published: September 2022

Abstract
BACKGROUND: Childhood chronic illness often impacts not just the child but the whole family, particularly the parents. Parents from inner-city backgrounds (defined as low income/socioeconomic status, unemployed, immigrant, refugee, or ethnic minority, and living in an urban area) face additional challenges. Research has traditionally centred on the mother’s role in caring for a child with a chronic illness, but with the increasing role of fathers caring for these children, research has shifted its focus on paternal experience. However, the experiences of inner-city fathers remain largely unknown.
OBJECTIVES: This systematic scoping review aims to explore the experiences of fathers of children with disabilities or chronic health conditions from inner city families, using the Double ABCX model as a conceptual framework.
DESIGN/METHODS: A systematic scoping review was conducted between November 2014 and January 2015 using the Arksey and O'Malley framework. Seven databases were searched (Medline, PsycInfo, Embase, Web of Science, CINAHL, Scopus, and Social Work Abstracts). Titles and abstracts meeting inclusion and exclusion criteria were included in the full text review for further assessment. Qualifying articles were critically appraised and relevant data were extracted. The Double ABCX model was used to qualitatively evaluate the articles in terms of stressors, resources, perception, coping, and adaptation.
RESULTS: 5114 articles were initially identified and 14 articles met the inclusion criteria. Most of the included studies were conducted in the USA. Most articles discussed fathers from low income/SES backgrounds, while others discussed ethnic minority, immigrant/refugee, and unemployed fathers. Fathers' stressors included financial strain and barriers to accessing healthcare. Fathers' resources, or sources of support, ranged from immediate to extended family members, depending on ethnicity. In terms of perceptions, fathers had different approaches to reconciling the care-giver role with cultural gender norms. Inner-city fathers had more desire for information about their children’s health, but some were uncomfortable with asking physicians. Inner-city fathers were more at risk for coping difficulties and used different coping strategies compared to higher income fathers. Inner-city fathers were at higher risk for maladaptation, including depression, PTSD and less acceptance of the child.
CONCLUSION: Fathers from inner-city backgrounds caring for their children affected by chronic illnesses and disabilities have unique experiences requiring a comprehensive approach to providing and communicating care to these children and caregivers. Findings from this review can be used to guide pediatricians in advocating for resources to reduce stressors, enhance coping, and promote positive adaptation for inner-city fathers.
Use of Mobile Technology in the Care of Adolescents With Diabetes
Authors: Ranawaya J , Saleh D , Gregroire K , Ruhland L 
Published: September 2022

Abstract
BACKGROUND: The advent of personalised cell phones and mobile technology has created an increasing desire to integrate these resources into the care of pediatric patients with diabetes. Adolescents in particular often have poor diabetes self-management practises and fail to meet glyce-mic targets. Mobile technology use is prevalent among adolescents and the idea of using this technology to assist with diabetes self-care is appealing. However, integrating this technology into clinical practice is challenging and many practitioners do notknow where to start.
OBJECTIVES: To describe the use, benefits, and limitations of mobile technology in diabetes care among adolescents and their parents, and to assess if mobile technology use is linked to lower HbA1c levels.
DESIGN/METHODS: This cross sectional study involved adolescents age 11-18 years and their parents who were recruited during their regular diabetes patient care visits at two separate pediatric diabetes centres. Patients and parents completed a questionnaire designed by study authors. Patients' two most recent HbA1c levels were recorded following survey completion.
RESULTS: 100 adolescents and 80 parents completed the questionnaire. Device ownership was high, with 89% of adolescents and 100% of parents owning at least 1 device. Only one third of the cohort reported using mobile technology for their diabetes care. The commonest reason for non-use was lack of awareness of apps for diabetes care (53% adolescents, 60% parents). Among mobile technology users, texting and calculation were the most frequently used apps. Apps for calorie and carb counting were also frequently used, among which CalorieKing™ was the highest reported (44% adolescents; 47% parents). Insulin pump specific programs including Diasend® and Medtronic CareLink® were reported by 14.8% adolescents and 14.3% parents. The average HbA1c for the entire cohort was 8.0%, with no statistically significant difference between adolescent mobile technology users and non-users (7.8% vs 8.3%; p=0.22). However, mean HbA1c was found to be lower among those adolescents whose parents used mobile technology for their management (7.6 % vs 8.2 %; p=0.04).
CONCLUSION: Only a minority of adolescents use mobile technology for their diabetes care, and lack of awareness was the major barrier to mobile technology use. Basic smartphone functions including texting and calculation were the most cited apps used. Parental technology use was associated with improved glycemic control. Considering the widespread use of mobile technology among young people, there remains untapped potential for greater use of this technology towards improved self-care in adolescents with diabetes.