Paediatrics & child health最新文献

Background: Children with medical complexity (CMC) have unique specialized needs accessing and receiving care in paediatric hospitals.

Objectives: To identify the organizational resources available for the care of CMC in Canadian tertiary care paediatric hospitals and to assess key informants' understanding of how these resources are adapted to CMC's needs.

Methods: For this environmental scan, key informants representing paediatric hospital medicine/complex care (PHM/CC) and paediatric emergency medicine (PEM) from all 15 Canadian tertiary care paediatric hospitals completed questionnaires. Participants were identified through national research networks. Following Burns methodology, two novel survey tools were developed and administered via a teleconference or electronically.

Results: From September 2023 to June 2024, one key informant from PHM/CC and one from PEM responded from each site (n = 30, response rate: 100%). Most (12/15) hospitals had a CC program; of those with a program, 9/12 offered inpatient and outpatient services. For hospitalized CMC, few hospitals had CC dedicated wards (2/15) or healthcare professionals (4/15). Although 10/12 CC programs reported offering a consultation service to their emergency department (ED), most (9/10) were only available on weekdays. PHM/CC respondents believed their inpatient CC team communicated and coordinated effectively (9/12) and facilitated continuity of care (6/12). PEM respondents suggested improving access to patients' documents (10/15), improving CC program availability (8/15) and adapting ED physical spaces (7/15).

Conclusions: Most Canadian paediatric tertiary care hospitals have a CC program, but their resources and availability vary. There are many opportunities for improvement for the ED and inpatient care of CMC.

Introduction: The prevalence of heavy menstrual bleeding (HMB) is estimated as high as 37% in adolescents and is associated with co-morbidities, such as bleeding disorders (BD), iron deficiency anemia (IDA) and mood disorders. The Young Women's Blood Clinic (YWBC) is a multidisciplinary clinic in Hamilton, Ontario staffed with a gynaecologist, hematologist and nurse to provide diagnosis and management of HMB. This study was conducted to evaluate the diagnosis and management of HMB along with co-morbidities such as BD and IDA in adolescents seen at YWBC.

Methods: This is a retrospective cohort study between July 2017 and June 2021. Patient records were reviewed for demographics, laboratory parameters, management plans and outcomes.

Results: One hundred and three new patients with HMB were seen in the monthly YWBC during the study period. Four patients were referred with pre-existing BDs (2 von Willebrand Disease (vWD), 1 factor XI deficiency, 1 factor VII deficiency), while 4/101 (3.9%) were newly diagnosed (4 vWD). On presentation, 38 (36.9%) had IDA, while 43 patients (41.7%) had iron deficiency (ID) alone. Sixty-eight patients were treated with oral iron, while 13 required IV iron and 15 required blood transfusions. Oral contraceptive pills are the most common management option for patients diagnosed with and without BDs. Fifty-five point eight percent of patients reported improvement in HMB after 1st line treatment, 12.8% with 2nd line, 11.6% with third line or more, while 26.7% of patients reported ongoing HMB or had missing data.

Conclusion: HMB can be debilitating and requires coordinated multidisciplinary care to diagnose and manage adequately.

An estimated 20% of birthing parents develop postpartum mental disorders. Having a medically high-risk infant and/or serious obstetrical complications that precede the birth of a medically high-risk infant both increase the risk for postpartum mental disorders. Yet, existing knowledge about how to best identify and manage postpartum mental disorders in this population is limited. This commentary calls for tailored interventions to improve the identification and management of postpartum mental disorders among birthing parents with obstetrical complications and/or medically high-risk infants.

Objectives: Antineutrophil cytoplasmic antibody (ANCA) positivity occurs in up to 25% of systemic lupus erythematosus (SLE) patients, but differentiating incidental ANCA from ANCA-associated vasculitis (AAV) in SLE nephritis remains a diagnostic and therapeutic challenge.

Case: A 14-year-old female presented with a 3-month history of undiagnosed autoimmune manifestations and chronic kidney disease. Based on autoimmune workup and kidney biopsy, she was diagnosed with SLE nephritis with incidental ANCA positivity. Despite appropriate SLE nephritis-directed treatment as per guidelines, an inflammatory flare and superimposed acute kidney injury (AKI) prompted a diagnosis revision to SLE-AAV overlap syndrome. Broadening treatment to target concomitant AAV led to autoimmune remission and AKI resolution.

Conclusions: This case underscores the importance of early suspicion of autoimmune disorders by primary care providers for a timely referral and the critical role of specialists in recognizing the limitations of conventional tools, including renal histology, when distinguishing incidental ANCA positivity from SLE-AAV overlap to guide appropriate treatment.

Objectives: Resident physicians face important financial decisions; however, formal education in financial literacy within residency programs is lacking. Current literature reports that residents have poor financial knowledge, increasing levels of debt, and associated anxiety. There have been no published reports on financial well-being among paediatrics residents in Canada.

Methods: Using Kern's six-step approach for curriculum development, a targeted educational needs assessment was performed. Surveys were distributed to assess residents' financial knowledge, interest, behaviours, and to evaluate early career paediatricians' perceived readiness for managing finances upon graduation. Descriptive statistics were performed in Microsoft Excel.

Results: Seventy-eight participants (35 residents and 43 early career paediatricians) were included. Seventeen (63.0%) respondents were very interested in participating in a financial curriculum, and 18 (66.7%) respondents strongly agreed that formal education in financial literacy in residency is important.

Conclusions: Participants expressed a strong desire for a financial curriculum, which represents an educational gap in residency.

Objectives: Integrated research potentiates evidence-based knowledge, particularly for uncommon diseases such as Kawasaki disease (KD). The 14th International Kawasaki Disease Symposium focussed on "Fostering global collaborations to solve KD," circulated a 23-question survey highlighting existing collaborations.

Methods: Information was collected from KD collaborative groups. One or more of the following characteristics defined a collaborative effort: recurrent clinical trials collaborations; international, national, or inter-state research; multi-institutional research; national, government-funded or government-appointed research; epidemiology group; focus group on KD practice and science or other health organization chapters.

Results: Responses from 21 groups were limited to a single country (67%). The groups had formed between 1991 and 2022. The multi-institutional groups included a median of 1 to 20 countries composed of 2-150 institutions. The groups included 10-20 active members (38%), 20-50 members (38%), 50-100 (14%), or more than 100 members (10%). A majority (67%) of collaborations produced 2-11 peer-reviewed publications. Groups operated under a centralized governance structure (62%), with a steering committee (92%), bylaws (23%), membership fees (8%), or another structure (8%). Only 33% had a written mission statement. While 48% had no formal funding sources, the remainder were funded by granting agencies (29%), governmental funding (24%), private donations and fundraising drives (19%), industry support (10%), and other sources (5%).

Conclusions: The majority of polled collaborative KD groups are multicenter and national. Despite the lack of funding, most groups demonstrate successful collaborations that result in peer-reviewed publications. There is a need for advocacy to support funding for these important collaborative groups.

Background: The evaluation of suspected late-onset sepsis in neonates and infants ≤6 months includes obtaining a sterile urine sample. Two techniques are used interchangeably in clinical practice to detect the presence of microorganisms: suprapubic aspiration (SPA) and urethral catheterization (UC). At present, it is unclear which method causes more pain. The primary objective of this systematic review and meta-analysis is to determine which technique is more painful.

Methods: Electronic databases were searched for relevant randomized and quasi-randomized trials in September 2023. The literature search was updated in June 2025 and no additional eligible articles were identified for inclusion. Title and abstract screening, followed by data extraction, were performed in duplicate. The risk of bias was assessed using Cochrane's risk of bias (RoB) 2.0 tool. The critically important outcome was pain measured using validated tools including unidimensional (behavioural) and multidimensional (combination of behavioural and physiological components) tools. Secondary outcomes included procedure success, procedure duration, and adverse events. Pooled effects estimates were standardized mean difference (SMD), mean difference (MD), and relative risk (RR) with 95% confidence intervals (CI) from random effects meta-analyses. Certainty assessment was completed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology.

Results: Of the seven included studies, five studies reported pain scores among 378 infants. Clinical heterogeneity was noted across the studies specifically differences in postnatal age, procedure details (e.g., operator skillset, use of anesthetic and analgesic, ultrasound guidance), and pain assessment tools (unidimensional vs. multidimensional pain scores). There was no difference in pain score for overall procedure for SPA versus UC (SMD 0.25 [95% CI -0.63, 1.14], I² = 84%; n = 330) and duration of cry (MD 5.26 [95% CI -43.72, 54.23], I² = 97%; n = 245). The quality of evidence was low for these outcomes. There was a statistically significant difference in procedure duration when SPA was compared to UC (MD -62.62 [95% CI -112.96, -12.27], I² = 96%; n = 299) with SPA being the procedure of shorter duration. The quality of evidence for this outcome was moderate. None of the studies reported any serious adverse events.

Discussion: There is insufficient evidence to recommend one technique over the other for reducing pain in infants ≤6 months. Healthcare professionals can select SPA or UC based on the unit preference, skillset, and available resources. Future research is required to inform clinical practice.

Objectives: The number of Canadian children living with serious illness is increasing. Access to specialist paediatric palliative care is recognized as essential for these children, their families, and their care providers, and yet programs remain under-resourced or non-existent in much of Canada. Health services planning requires current data. This study examined the initial experience of a specialist program established in 2015 at a tertiary paediatric centre in Canada.

Methods: A prospective database study of referred patients was conducted from 2015 to 2023 (prenatal referrals were first accepted in 2021). Data were collected at referral, consult, and discharge/death/end of pregnancy. Program clinician growth was tracked. The analysis included descriptive statistics and a Kaplan-Meier survival curve.

Results: The program received 650 unique paediatric referrals plus 55 prenatal referrals. The number of patients receiving care annually quadrupled over the course of the study. Two-hundred and twenty-seven children died: 99% with goal-concordant care at end-of-life and most frequently in hospital, although death at home was increasingly common. A rapid increase in program resources was required to meet care needs per modern standards of care.

Conclusions: This study demonstrates that a new paediatric palliative care program was met with demand akin to existing established comparator programs. These results are congruent with the increase in prevalence of children with serious illness and the evolution of care standards to incorporate specialist care provision. These findings can help advocacy and resource planning for modernizing Canada's paediatric palliative care infrastructure.