Résumé En pédiatrie, il est fondamental d’évaluer la croissance de l’enfant, mais un tableau clinique de plus en plus complexe peut compliquer l’évaluation des profils de croissance. Le présent point de pratique s’appuie sur des études de cas représentatives pour décrire les principaux éléments de l’interprétation des profils de croissance courants et la réponse à privilégier. Le clinicien qui connaît ces profils courants et leur étiologie sera mieux en mesure d’y répondre de manière appropriée et de limiter le risque de sous-diagnostiquer ou de surdiagnostiquer les retards de croissance.
{"title":"La détection et la prise en charge d’une croissance atypique","authors":"Linda Casey, Tanis R Fenton","doi":"10.1093/pch/pxad056","DOIUrl":"https://doi.org/10.1093/pch/pxad056","url":null,"abstract":"Résumé En pédiatrie, il est fondamental d’évaluer la croissance de l’enfant, mais un tableau clinique de plus en plus complexe peut compliquer l’évaluation des profils de croissance. Le présent point de pratique s’appuie sur des études de cas représentatives pour décrire les principaux éléments de l’interprétation des profils de croissance courants et la réponse à privilégier. Le clinicien qui connaît ces profils courants et leur étiologie sera mieux en mesure d’y répondre de manière appropriée et de limiter le risque de sous-diagnostiquer ou de surdiagnostiquer les retards de croissance.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"22 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138820887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is well recognized that human milk is the optimal nutritive source for all infants, including those requiring intensive care. This statement reviews evidence supporting the importance of breastfeeding and human milk for infants, and why breastfeeding practices should be prioritized in the neonatal intensive care unit (NICU). It also reviews how to optimally feed infants based on their stability and maturity, and how to support mothers to establish and maintain milk production when their infants are unable to feed at the breast.
{"title":"Breastfeeding and human milk in the NICU: From birth to discharge","authors":"Christopher Tomlinson, Laura N Haiek","doi":"10.1093/pch/pxad034","DOIUrl":"https://doi.org/10.1093/pch/pxad034","url":null,"abstract":"It is well recognized that human milk is the optimal nutritive source for all infants, including those requiring intensive care. This statement reviews evidence supporting the importance of breastfeeding and human milk for infants, and why breastfeeding practices should be prioritized in the neonatal intensive care unit (NICU). It also reviews how to optimally feed infants based on their stability and maturity, and how to support mothers to establish and maintain milk production when their infants are unable to feed at the breast.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"8 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138820802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While child growth evaluation is fundamental to paediatric practice, an increasingly complex clinical picture can complicate interpretation of growth patterns. This practice point uses representative case studies to illustrate key features of interpretation and response to commonly encountered growth patterns. Awareness of these common patterns and their etiologies will enhance the clinician’s ability to respond appropriately and minimize the risk for under- or over-diagnosis of growth impairment.
{"title":"Recognizing and addressing atypical growth","authors":"Linda Casey, Tanis R Fenton","doi":"10.1093/pch/pxad057","DOIUrl":"https://doi.org/10.1093/pch/pxad057","url":null,"abstract":"While child growth evaluation is fundamental to paediatric practice, an increasingly complex clinical picture can complicate interpretation of growth patterns. This practice point uses representative case studies to illustrate key features of interpretation and response to commonly encountered growth patterns. Awareness of these common patterns and their etiologies will enhance the clinician’s ability to respond appropriately and minimize the risk for under- or over-diagnosis of growth impairment.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"21 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138821216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Résumé Il est bien établi que le lait humain est la source nutritive optimale pour tous les nouveau-nés, y compris ceux qui ont besoin de soins intensifs. Le présent document de principes examine les données probantes qui appuient l’importance de l’allaitement et du lait humain pour les nouveau-nés, de même que les raisons pour lesquelles les pratiques d’allaitement doivent être priorisées à l’unité de soins intensifs néonatals. Il aborde aussi l’alimentation optimale des nouveau-nés en fonction de leur stabilité et de leur maturité, ainsi que la manière de soutenir les mères pour qu’elles établissent et maintiennent leur production de lait lorsque leur nouveau-né est incapable de se nourrir au sein.
{"title":"L’allaitement et le lait humain en soins intensifs néonatals : de la naissance jusqu’au congé","authors":"Christopher Tomlinson, Laura N Haiek","doi":"10.1093/pch/pxad035","DOIUrl":"https://doi.org/10.1093/pch/pxad035","url":null,"abstract":"Résumé Il est bien établi que le lait humain est la source nutritive optimale pour tous les nouveau-nés, y compris ceux qui ont besoin de soins intensifs. Le présent document de principes examine les données probantes qui appuient l’importance de l’allaitement et du lait humain pour les nouveau-nés, de même que les raisons pour lesquelles les pratiques d’allaitement doivent être priorisées à l’unité de soins intensifs néonatals. Il aborde aussi l’alimentation optimale des nouveau-nés en fonction de leur stabilité et de leur maturité, ainsi que la manière de soutenir les mères pour qu’elles établissent et maintiennent leur production de lait lorsque leur nouveau-né est incapable de se nourrir au sein.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"115 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138821033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan McDonald, Shauna Gallaugher, Elise Kammerer, Samina Ali
Patients with specific sensory needs may face barriers to receiving their immunizations. Therefore, a Low-Stimulus Clinic was created in Alberta. Modifications to regular clinic space included lower visual and auditory input, access to longer appointment times and private clinic spaces, development of pre-appointment comfort plans, and offering of in-vehicle immunization. Between April 2021 and May 2022, 90% (641/712) of booked patients were successfully immunized. The top reasons for accessing the clinic included autism spectrum disorder (229/712, 32%), and needle fear/phobia (195/712, 27%). The Low-Stimulus Clinic had a high rate of successful vaccination for populations that may otherwise have been less likely to receive immunizations. Its workflows support the principles of choice, collaboration, and control in creating a positive immunization experience for patients and their families. Having such clinics widely available is a key step in reducing barriers to accessing vaccines for individuals with specific sensory needs.
{"title":"Creating a Low-Stimulus Clinic to improve immunization success rates for children with alternate environment needs: A quality improvement initiative","authors":"Megan McDonald, Shauna Gallaugher, Elise Kammerer, Samina Ali","doi":"10.1093/pch/pxad081","DOIUrl":"https://doi.org/10.1093/pch/pxad081","url":null,"abstract":"Patients with specific sensory needs may face barriers to receiving their immunizations. Therefore, a Low-Stimulus Clinic was created in Alberta. Modifications to regular clinic space included lower visual and auditory input, access to longer appointment times and private clinic spaces, development of pre-appointment comfort plans, and offering of in-vehicle immunization. Between April 2021 and May 2022, 90% (641/712) of booked patients were successfully immunized. The top reasons for accessing the clinic included autism spectrum disorder (229/712, 32%), and needle fear/phobia (195/712, 27%). The Low-Stimulus Clinic had a high rate of successful vaccination for populations that may otherwise have been less likely to receive immunizations. Its workflows support the principles of choice, collaboration, and control in creating a positive immunization experience for patients and their families. Having such clinics widely available is a key step in reducing barriers to accessing vaccines for individuals with specific sensory needs.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"9 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138579145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer L Bhatla, Kristin James, Kaylen (Kay) A E Lamb, Chrystal Neault-Lount, Jennifer L P Protudjer, Shayne D Reitmeier, Megan Cooney, Brandy Wicklow
Objectives Waitlist times for adolescents to be seen for initial assessment for gender-affirming hormone therapy in Manitoba, Canada are often 2 years. The purpose of this study was to understand the experiences of waitlisted youth and to assess the impact of social work contact for accessing relevant resources. Methods A qualitative, semi-structured interview study was conducted. Youth aged 14 to 17 years on the provincial transgender clinic waitlist for 12 to 24 months for gender-affirming hormone therapy assessment and their caregivers were recruited. Eight youth and nine caregivers were interviewed. Separate interviews were conducted for youth and their caregivers. All interviews were virtual, recorded, and transcribed prior to thematic analysis. Results Three themes and eight subthemes were identified. Youth (n = 8) and caregivers (n = 9) described barriers to supported transition in the following three themes: (1) ‘In a Black Hole’: Describing the lack of communication, relevant resources, and mental health supports, (2) ‘Structural Transphobia’: A summary term outlining the attitudinal, technological, physical, and architectural barriers faced by the participants, and (3) ‘Manitoba: An Information Desert’: describing the systemic barriers faced including lack of knowledgeable providers and reliable information within the province. Conclusions Although delays in gender-affirming therapy were noted, youth socially transitioned and accessed existing resources. However, mental health concerns persisted, and participants felt frustrated and unsupported during their extensive wait times. Improved experiences may be achieved by additional communication from the clinic, hands-on assistance with accessing relevant resources, and an improved online presence.
{"title":"The experience of youth on the waitlist for gender-affirming care in Manitoba","authors":"Jennifer L Bhatla, Kristin James, Kaylen (Kay) A E Lamb, Chrystal Neault-Lount, Jennifer L P Protudjer, Shayne D Reitmeier, Megan Cooney, Brandy Wicklow","doi":"10.1093/pch/pxad087","DOIUrl":"https://doi.org/10.1093/pch/pxad087","url":null,"abstract":"Objectives Waitlist times for adolescents to be seen for initial assessment for gender-affirming hormone therapy in Manitoba, Canada are often 2 years. The purpose of this study was to understand the experiences of waitlisted youth and to assess the impact of social work contact for accessing relevant resources. Methods A qualitative, semi-structured interview study was conducted. Youth aged 14 to 17 years on the provincial transgender clinic waitlist for 12 to 24 months for gender-affirming hormone therapy assessment and their caregivers were recruited. Eight youth and nine caregivers were interviewed. Separate interviews were conducted for youth and their caregivers. All interviews were virtual, recorded, and transcribed prior to thematic analysis. Results Three themes and eight subthemes were identified. Youth (n = 8) and caregivers (n = 9) described barriers to supported transition in the following three themes: (1) ‘In a Black Hole’: Describing the lack of communication, relevant resources, and mental health supports, (2) ‘Structural Transphobia’: A summary term outlining the attitudinal, technological, physical, and architectural barriers faced by the participants, and (3) ‘Manitoba: An Information Desert’: describing the systemic barriers faced including lack of knowledgeable providers and reliable information within the province. Conclusions Although delays in gender-affirming therapy were noted, youth socially transitioned and accessed existing resources. However, mental health concerns persisted, and participants felt frustrated and unsupported during their extensive wait times. Improved experiences may be achieved by additional communication from the clinic, hands-on assistance with accessing relevant resources, and an improved online presence.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"12 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-24eCollection Date: 2024-11-01DOI: 10.1093/pch/pxad072
Prakash Kannan Loganathan, Alberto Nettel-Aguirre, Abhay Lodha, Essa Al Awad, Carlos Fajardo, Vrinda Nair, Jeanne Scotland, Nalini Singhal, Marilyn Young, Kristin York, Yacov Rabi
Objectives: To determine oxygen saturation (SpO2) values and their variability in healthy-term neonates at high altitude.
Methods: In a prospective multisite, non-randomized blinded study, we performed SpO2 measurements in healthy neonates admitted to postnatal wards and followed up in Public Health Nurse Clinics (PHNC) in Calgary, Alberta, Canada. We recruited healthy-term neonates (≥37 weeks) between 6 and 24 h of age. Neonates underwent simultaneous pre- and post-ductal SpO2 recordings every 12 to 24 h until hospital discharge and again in the PHNC within a few days after discharge. Neonates were followed for 8 weeks to ascertain their health status.
Results: We included data for 252 neonates in hospital and 105 neonates presenting to the PHNC for follow-up. In hospital, the mean pre- and post-ductal SpO2 were 94.3% and 96.0%, respectively. In the PHNC, mean pre- and post-ductal SpO2 were 94.4% and 95.6%, respectively. Desaturation episodes occurred frequently at a median rate of once every 5 minutes. The median duration of pre-ductal desaturation episodes was longer in hospital than in the PHNC for all SpO2 thresholds (P < 0.05).
Conclusion: SpO2 levels in healthy-term neonates at high altitude are approximately 94% and remained stable over the first few days after birth. Desaturation episodes are common in the immediate neonatal period, but their duration decreases over time, and they are not associated with clinical deterioration.Clinic trials.org (NCT02095041).
{"title":"Oxygen saturation in healthy-term neonates at high altitude: A multisite prospective study.","authors":"Prakash Kannan Loganathan, Alberto Nettel-Aguirre, Abhay Lodha, Essa Al Awad, Carlos Fajardo, Vrinda Nair, Jeanne Scotland, Nalini Singhal, Marilyn Young, Kristin York, Yacov Rabi","doi":"10.1093/pch/pxad072","DOIUrl":"10.1093/pch/pxad072","url":null,"abstract":"<p><strong>Objectives: </strong>To determine oxygen saturation (SpO<sub>2</sub>) values and their variability in healthy-term neonates at high altitude.</p><p><strong>Methods: </strong>In a prospective multisite, non-randomized blinded study, we performed SpO<sub>2</sub> measurements in healthy neonates admitted to postnatal wards and followed up in Public Health Nurse Clinics (PHNC) in Calgary, Alberta, Canada. We recruited healthy-term neonates (≥37 weeks) between 6 and 24 h of age. Neonates underwent simultaneous pre- and post-ductal SpO<sub>2</sub> recordings every 12 to 24 h until hospital discharge and again in the PHNC within a few days after discharge. Neonates were followed for 8 weeks to ascertain their health status.</p><p><strong>Results: </strong>We included data for 252 neonates in hospital and 105 neonates presenting to the PHNC for follow-up. In hospital, the mean pre- and post-ductal SpO<sub>2</sub> were 94.3% and 96.0%, respectively. In the PHNC, mean pre- and post-ductal SpO<sub>2</sub> were 94.4% and 95.6%, respectively. Desaturation episodes occurred frequently at a median rate of once every 5 minutes. The median duration of pre-ductal desaturation episodes was longer in hospital than in the PHNC for all SpO<sub>2</sub> thresholds (P < 0.05).</p><p><strong>Conclusion: </strong>SpO<sub>2</sub> levels in healthy-term neonates at high altitude are approximately 94% and remained stable over the first few days after birth. Desaturation episodes are common in the immediate neonatal period, but their duration decreases over time, and they are not associated with clinical deterioration.Clinic trials.org (NCT02095041).</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 7","pages":"422-428"},"PeriodicalIF":1.8,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-23eCollection Date: 2024-05-01DOI: 10.1093/pch/pxad076
Sujen Saravanabavan, Julia Upton
{"title":"Practical tips for the use of the Canadian milk ladder for paediatricians.","authors":"Sujen Saravanabavan, Julia Upton","doi":"10.1093/pch/pxad076","DOIUrl":"10.1093/pch/pxad076","url":null,"abstract":"","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 2","pages":"72-73"},"PeriodicalIF":1.8,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10996459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joel Gupta, Amy R Zipursky, Jonathan Pirie, Gabrielle Freire, Amir Karin, Mary Kathryn Bohn, Khosrow Adeli, Olivia Ostrow
Background and Objectives Significant practice variation exists in managing young infants with fever. Quality improvement strategies can aid in risk stratification and standardization of best care practices, along with a reduction of unnecessary interventions. The aim of this initiative was to safely reduce unnecessary admissions, antibiotics, and lumbar punctures (LPs) by 10% in low-risk, febrile infants aged 29 to 90 days presenting to the emergency department (ED) over a 12-month period. Methods Using the Model for Improvement, a multidisciplinary team developed a multipronged intervention: an updated clinical decision tool (CDT), procalcitonin (PCT) adoption, education, a feedback tool, and best practice advisory (BPA) banner. Outcome measures included the proportion of low-risk infants that were admitted, received antibiotics, and had LPs. Process measures were adherence to the CDT and percentage of PCT ordered. Missed bacterial infections and return visits were balancing measures. The analysis was completed using descriptive statistics and statistical process control methods. Results Five hundred and sixteen patients less than 90 days of age were included in the study, with 403 patients in the 29- to 90-day old subset of primary interest. In the low-risk group, a reduction in hospital admissions from a mean of 24.1% to 12.0% and a reduction in antibiotics from a mean of 15.2% to 1.3% was achieved. The mean proportion of LPs performed decreased in the intervention period from 7.5% to 1.8%, but special cause variation was not detected. Adherence to the CDT increased from 70.4% to 90.9% and PCT was ordered in 92.3% of cases. The proportion of missed bacterial infections was 0.3% at baseline and 0.5% in the intervention period while return visits were 6.7% at baseline and 5.0% in the intervention period. Conclusions The implementation of a quality improvement strategy, including an updated evidence-based CDT for young infant fever incorporating PCT, safely reduced unnecessary care in low-risk, febrile infants aged 29 to 90 days in the ED. Purpose To develop and implement a multipronged improvement strategy including an evidence-based CDT utilizing PCT to maximize value of care delivered to well-appearing, febrile infants presenting to EDs.
{"title":"Coming in Hot: A quality improvement approach to improving care of febrile infants","authors":"Joel Gupta, Amy R Zipursky, Jonathan Pirie, Gabrielle Freire, Amir Karin, Mary Kathryn Bohn, Khosrow Adeli, Olivia Ostrow","doi":"10.1093/pch/pxad070","DOIUrl":"https://doi.org/10.1093/pch/pxad070","url":null,"abstract":"Background and Objectives Significant practice variation exists in managing young infants with fever. Quality improvement strategies can aid in risk stratification and standardization of best care practices, along with a reduction of unnecessary interventions. The aim of this initiative was to safely reduce unnecessary admissions, antibiotics, and lumbar punctures (LPs) by 10% in low-risk, febrile infants aged 29 to 90 days presenting to the emergency department (ED) over a 12-month period. Methods Using the Model for Improvement, a multidisciplinary team developed a multipronged intervention: an updated clinical decision tool (CDT), procalcitonin (PCT) adoption, education, a feedback tool, and best practice advisory (BPA) banner. Outcome measures included the proportion of low-risk infants that were admitted, received antibiotics, and had LPs. Process measures were adherence to the CDT and percentage of PCT ordered. Missed bacterial infections and return visits were balancing measures. The analysis was completed using descriptive statistics and statistical process control methods. Results Five hundred and sixteen patients less than 90 days of age were included in the study, with 403 patients in the 29- to 90-day old subset of primary interest. In the low-risk group, a reduction in hospital admissions from a mean of 24.1% to 12.0% and a reduction in antibiotics from a mean of 15.2% to 1.3% was achieved. The mean proportion of LPs performed decreased in the intervention period from 7.5% to 1.8%, but special cause variation was not detected. Adherence to the CDT increased from 70.4% to 90.9% and PCT was ordered in 92.3% of cases. The proportion of missed bacterial infections was 0.3% at baseline and 0.5% in the intervention period while return visits were 6.7% at baseline and 5.0% in the intervention period. Conclusions The implementation of a quality improvement strategy, including an updated evidence-based CDT for young infant fever incorporating PCT, safely reduced unnecessary care in low-risk, febrile infants aged 29 to 90 days in the ED. Purpose To develop and implement a multipronged improvement strategy including an evidence-based CDT utilizing PCT to maximize value of care delivered to well-appearing, febrile infants presenting to EDs.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"1 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan Skakum, Audrey Katako, Jenna Mitchell-Dueck, M Florencia Ricci, Kelly Russell
Objectives The risk of attention deficit hyperactivity disorder (ADHD) following multiple exposures to anesthesia has been debated. Our objective was to systematically review the literature to examine the association between multiple exposures to general anesthesia before age 5 and subsequent diagnosis of ADHD. Methods A systematic search of EMBASE, PubMed, and SCOPUS was performed using key search terms in February 2022. We included studies that: were published after 1980, included only otherwise healthy children who experienced two or more exposures to general anesthetic before age 5, diagnosed ADHD by a medical professional before age 19 years after exposure to general anesthetic, were cross-sectional, case–control, or cohort study, and were published in English. The results (expressed as hazard ratios [HR] and associated 95% confidence intervals [CI]) were pooled using meta-analytic techniques. Studies which did not present their results as HR and 95% CI were analyzed separately. GRADE was used to determine the certainty of the findings. PRISMA guidelines were followed at each stage of the review. Results Eight studies (196,749 children) were included. Five reported HR and 95% CI and were subsequently pooled for meta-analysis. Multiple exposures to anesthesia were associated with diagnosis of ADHD before the 19th year of life (HR: 1.71; 95% CI: 1.59, 1.84). Two of the three studies not used in the meta-analysis also found an increased risk of ADHD diagnosis following multiple anesthetic exposures. Conclusions There was an association between multiple early exposures to general anesthesia and later diagnosis of ADHD.
{"title":"Risk of attention deficit hyperactivity disorder diagnosis following multiple exposures to general anesthesia in the paediatric population: A systematic review and meta-analysis","authors":"Megan Skakum, Audrey Katako, Jenna Mitchell-Dueck, M Florencia Ricci, Kelly Russell","doi":"10.1093/pch/pxad074","DOIUrl":"https://doi.org/10.1093/pch/pxad074","url":null,"abstract":"Objectives The risk of attention deficit hyperactivity disorder (ADHD) following multiple exposures to anesthesia has been debated. Our objective was to systematically review the literature to examine the association between multiple exposures to general anesthesia before age 5 and subsequent diagnosis of ADHD. Methods A systematic search of EMBASE, PubMed, and SCOPUS was performed using key search terms in February 2022. We included studies that: were published after 1980, included only otherwise healthy children who experienced two or more exposures to general anesthetic before age 5, diagnosed ADHD by a medical professional before age 19 years after exposure to general anesthetic, were cross-sectional, case–control, or cohort study, and were published in English. The results (expressed as hazard ratios [HR] and associated 95% confidence intervals [CI]) were pooled using meta-analytic techniques. Studies which did not present their results as HR and 95% CI were analyzed separately. GRADE was used to determine the certainty of the findings. PRISMA guidelines were followed at each stage of the review. Results Eight studies (196,749 children) were included. Five reported HR and 95% CI and were subsequently pooled for meta-analysis. Multiple exposures to anesthesia were associated with diagnosis of ADHD before the 19th year of life (HR: 1.71; 95% CI: 1.59, 1.84). Two of the three studies not used in the meta-analysis also found an increased risk of ADHD diagnosis following multiple anesthetic exposures. Conclusions There was an association between multiple early exposures to general anesthesia and later diagnosis of ADHD.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"59 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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