Paediatrics & child health最新文献

Background: Neonatal abstinence syndrome (NAS) is a set of withdrawal symptoms experienced in a newborn if they have been exposed to substances such as opioids prior to birth. The incidence of NAS in British Columbia as well as NAS-related healthcare burden, has been increasing within the last several years.

Aim: To determine whether the novel Eat, Sleep, Console (ESC) approach to NAS improves outcomes such as length of hospitalization compared to Finnegan Neonatal Abstinence Scoring System (FNASS) approach in the treatment of neonatal patients with NAS admitted to the Neonatal Intensive Care Unit (NICU).

Methods: Retrospective paper and electronic chart review of neonatal patients born at ≥35 weeks gestation and ≤28 days of life with prenatal exposure to opioids and admitted to Kelowna General Hospital (KGH) Neonatal Intensive Care Unit (NICU) between January 2018 and February 2023.

Results: The primary outcome of hospital length of stay was 19.5 days for the ESC group and 27.5 days for FNASS (p=0.039). Secondary outcomes of total weaning morphine doses (53 vs 147; p<0.001), percentage requiring maintenance dosing (43.8% vs 100%; p<0.001), and length of wean (8.2 vs 18.1 days; p=0.003) were significantly less with ESC. Percentage who received only as needed morphine was greater with ESC (37.5% vs 0%; p<0.001). Total morphine dose (11.2mg vs 22.5mg; p=0.09) and adverse events (6% vs 11.7%; p=0.54) were not statistically significantly different.

Conclusions: Compared to FNASS, ESC approach improves several outcomes for NAS patients admitted to the NICU including a reduction in length of hospitalization by 8 days.

Objectives: Evaluate clinical presentation, delays and outcome in management of children with malrotation with midgut volvulus to identify avenues for care improvement.

Methods: A retrospective cross-sectional observational study in a single tertiary care paediatric centre on patients with a final diagnosis of midgut volvulus presenting to the emergency department (ED)/neonatal intensive care unit (NICU) from January 2015 through August 2022. Data recorded included demographics, clinical presentation, imaging, surgical findings, and survival/complications. We recorded time from arrival to hospital to: (1) medical evaluation, (2) radiologic investigations, (3) surgery consultation, and (4) surgery. Outcomes included survival and major morbidity.

Results: Thirty children had a diagnosis of midgut volvulus (ED: 22, NICU: 8). Twenty-eight (93%) survived, including two with short bowel syndrome. Median age was 7 days (IQR 3-13), 70% were male. Bilious vomiting was green (13/27; 48%), yellow (9/27; 33%), or both (5/27;19%). All had an ultrasound performed, and it was diagnostic in 24 (80%). Seven (23%) had upper gastrointestinal series performed; all were diagnostic. Median time between arrival and ultrasound was 146 min (IQR 62-234), and between arrival and surgery (Ladd's procedure) was 297 minutes (IQR 206-368).

Conclusions: In our cohort, midgut volvulus had a mortality rate of 2/30 (7%). Bilious vomiting, which can be either green and/or yellow, is a reliable clinical sign of midgut volvulus in infants. Ultrasound has good diagnostic accuracy. Delay of definitive surgery was considered high with potential for improvement at different timepoints. These timepoints were targeted in the development of a clinical practice guideline to reduce delays in the management of infants with bilious vomiting.

Objectives: To evaluate the association between race and SARS-CoV-2 test positivity and outcomes in children.

Study design: Secondary analysis of a prospective cohort study recruiting children < 18 years, tested for SARS-CoV-2 between August 2020 and February 2022, in Canadian pediatric emergency departments. Race was self-reported by participants. The primary outcome was SARS-CoV-2 test positivity. Secondary outcomes were medical interventions and hospitalization within 14 days of index visit, and post-COVID condition (PCC) at 90-day follow-up. Associations were evaluated using multi-level logistic regression models.

Results: Seven thousand and two-thirty three children underwent SARS-CoV-2 testing; median age was 2.0 years (IQR: 1.0-5.0), and 3366 (46.5%) were female. 1440 (19.9%) children tested positive for SARS-CoV-2, 776 (10.7%) were hospitalized, and 153 (13.2%) test-positive children experienced PCC. Compared to White children, most racial minority groups were more likely to test positive for SARS-CoV-2 (Middle Eastern aOR [95% CI] 2.62 [2.07, 3.32], Black aOR 2.36 [1.85, 3.03], Latin American aOR 2.23 [1.58, 3.15], South Asian aOR 2.17 [1.67, 2.82], Indigenous aOR 2.09 [1.29, 3.37], Southeast Asian aOR 1.82 [1.27, 2.62], Multiracial aOR 1.35 [1.07, 1.69], and had lower odds of medical interventions. Only Indigenous children were at higher odds of hospitalization than White children (aOR [95% CI]: 2.48 [1.03, 5.95]). Black children were less likely to report PCCs than White children (aOR 0.44 [0.22-0.86]).

Conclusions: Racial disparities exist in SARS-CoV-2 test positivity and outcomes among Canadian children seeking emergency care. A better understanding of the factors contributing to these differences is needed to promote equitable health across the population.

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.