Paediatrics & child health最新文献

Background: Opioids are prescribed for pain and as opioid agonist therapy for opioid use disorder. This can lead to neonatal abstinence syndrome (NAS) in newborns when used in pregnancy. Few studies have described trends in prenatal opioid prescriptions and NAS by important determinants of health.

Methods: To examine trends in prenatal opioid prescriptions and NAS diagnosis rates we conducted a population-based cohort study of live births in Manitoba, Canada, from January 1995 to March 2021. Live births were considered exposed to opioids prenatally if the pregnant person filled ≥1 opioid prescription during pregnancy. We described trends in NAS diagnosis rates by year, sex, urbanicity, and income quintile.

Results: The cohort included 381,826 live births, of which 26,382 (6.7%) were exposed to prescription opioids prenatally. The proportion of live births exposed to opioid prescriptions during pregnancy increased from 3.7% in 1995 to 7.4% in 2017; however, there was a reduction in recent years. We identified a decrease in codeine prescriptions during pregnancy and an increased number of prescriptions for more potent opioids (oxycodone, hydromorphone, morphine, and opioid agonist therapy). During the study period, there were 1318 newborns diagnosed with NAS. The incidence of NAS in Manitoba more than tripled between 1995 and 2021 (2.0 to 7.6 per 1000 live births).

Interpretation: The incidence of NAS increased over the study period, in line with other jurisdictions. Further research is needed to study the safety of different opioid agonist therapies and multidisciplinary support needed to support parents to care for newborns with NAS in the postpartum period and beyond.

Objectives: To quantify the feeding volumes and factors associated with feeding mothers-own-(breast) milk until discharge for preterm neonates born less than 32 weeks.

Methods: This was a retrospective cohort study (2010-2020). Neonates born <32 weeks and admitted to NICU with stored feeding records were eligible for inclusion. Information about daily feeding patterns (volume and sources), maternal demographics, birth data, and postnatal conditions were abstracted using standard data collection forms. Descriptive and inferential statistics were used to analyze results and compare groups.

Results: Of 436 newborns born <32 weeks, 372 met the inclusion criteria for the final analysis. While 87.9% of neonates had fed with mother's-own-milk initiated, only 53.5% continued these feeds until discharge from NICU. Over the study period, there was a significant decline in both initiation (P = 0.002) and continuation of feeds with mother's-own-milk (P < 0.0001). Factors positively associated with the continuation of mother's-own-milk to hospital discharge included older maternal age (P = 0.0002) and primiparity (P = 0.002). Continuation of mother's-own-milk was also associated with an earlier date of first feed with mother's-own-milk and higher volumes of breast milk production (P < 0.004). Volume of mother's-own-milk fed on Day 7 of admission was significant in predicting continuation to discharge. Factors negatively associated with continuation of feeds to discharge included high BMI (P = 0.009), cigarette smoking (P = 0.004), substance abuse (P = 0.0001), multiples (P = 0.038), and remote residence (P = 0.002).

Conclusions: Early initiation of mother's-own-(breast)milk improves continuation throughout NICU admission until discharge. Investigation into barriers to breastfeeding and targeted support for mothers (particularly those that are younger, multiparous, and/or from remote locations) are urgently needed.

Background: Menstrual poverty is the inability to obtain menstrual products due to financial, social, cultural, and political barriers to accessing menstrual products. It affects 65% of adolescents in Nova Scotia, but its impact on adolescents in Canada remains unknown. The adolescent Menstrual Poverty Questionnaire (aMPQ) was designed to assess the impact of menstrual poverty on adolescents living in countries with higher socioeconomic status. This study aims to translate the aMPQ into French and to validate it in both English and French to facilitate nationwide use.

Methods: The aMPQ was translated to French using forward translation by a professional translation service, then backward translation by a bilingual investigator. English and French speaking physicians specialized in adolescence care were recruited to participate in content validity assessment of the English and French aMPQs by completing a web-based survey containing rating scales from 1 to 4 on both clarity and relevance for each of the 27 items of the aMPQ. The Content Validity Index (CVI) for each Item (I-CVI) and for the general Scale (S-CVI) were calculated. An I-CVI of 0.78 or higher and an S-CVI of 0.90 or higher supports content validity.

Results: Twelve physicians completed content validity surveys for the English and French aMPQ. Each question on the aMPQ had an I-CVI above 0.78 for both relevance and clarity. The S-CVI was 0.98.

Conclusion: Content validity of the aMPQ in both English and French was established. The aMPQ is a valid bilingual tool and can be used for nationwide assessment of the impact of menstrual poverty on adolescents.

Although there is growing knowledge surrounding the value of involving patients and families in pediatrics residency training, based on a web-based survey of program directors (PDs) in Departments of Pediatrics across Canada, only 42% reported engaging patients and families in their formal residency curriculum. However, all respondents acknowledged the value of partnering with patients and families. Given this, we developed an educational intervention in partnership with our local Family Advisory Council members, that allows for (a) family voices to be heard and incorporated, and (b) direct interaction and conversation between families and pediatric residents. The intervention was divided into three sections: patient and family stories, a presentation about communicating effectively with parents, and a panel discussion. Overall, both family and resident feedback was overwhelmingly positive; hence, the success of our novel approach highlights the need to consider additional learning opportunities to actively involve patients and/or families within residency education.

Objectives: Children with medical complexity (CMC) have intense care demands, dependence on medical technology, and rely on homecare nursing. This study aimed to understand home care nurses' (HCN) experiences caring for CMCs to optimize their home-based place of employment, improve HCN-patient relationships to enhance care and promote CMCs to remain at home with their families safely.

Methods: Semi-structured interviews were conducted with 21 HCNs caring for CMC using medical technology. Interviews were analyzed using content analysis.

Results: Two themes emerged: the unique experiences of a homecare nurse and interactions with patients and their families. Interviews revealed the role is rewarding, and HCNs developed meaningful connections with patients and their families. However, HCNs experienced several challenges in providing quality care.

Conclusions: Understanding HCN's perspectives is critical to improving their experience in the role and enhancing care for their patients. These findings can inform the implementation of support needed to optimize the work experience for HCNs.

This commentary addresses the urgent need for culturally responsive approaches to concussion prevention for Indigenous children in Canada, who face disproportionately higher injury rates compared to non-Indigenous populations. Current prevention strategies do not consider Indigenous priorities of children in Canada, creating a critical gap in culturally appropriate interventions. Effective Indigenization of concussion prevention requires collaborative development between health care professionals and cultural experts, community-specific approaches that respect diverse practices across Indigenous groups, and integration of traditional knowledge with Western medicine. This call to action urges researchers to develop community-led research questions, policy-makers to adapt protocols in partnership with Indigenous communities, and health care professionals to incorporate traditional healing practices. By addressing these missing priorities, we can create more equitable, effective concussion prevention strategies for Indigenous children in Canada.

Background: Asthma is the most common chronic paediatric condition and a frequent cause of emergency department visits and hospitalizations.

Objectives: The project objective was to decrease inpatient length of stay (LOS) for asthma exacerbations between May 2021 and 2022.

Methods: The Institute for Healthcare Improvement Model for improvement was employed to study if systemic changes to asthma management could reduce hospital LOS. The inpatient asthma care bundle consisted of a discharge checklist, standardized care pathway that allowed nurse titration of bronchodilator based on an objective scoring tool and standardized team education.

Results: The pre-intervention mean inpatient LOS was 56 h, 100 h for patients with a Paediatric Intensive Care Unit (PICU) stay, and 52 h for patients without a PICU stay. While the mean PICU LOS remained unchanged, the mean LOS for patients without PICU stay decreased to 34 h and was sustained through the project's completion. The percentage of healthcare professionals feeling "comfortable"/'very comfortable' caring for asthmatic patients remained unchanged during the project (100%). Caregivers' confidence regarding asthma management mean score increased from 6/10 to 9/10 after hospital discharge. No statistical increase respiratory-based emergency department presentation within 10 days of discharge, use of high-flow ventilation and transfer to PICU was noted.

Conclusions: Implementing an inpatient asthma care bundle reduced the mean LOS for patients without PICU stay from 52 to 34 h, which represents a 35% decrease. The most impactful intervention was the implementation of the inpatient asthma management pathway.

Background: Recent evidence-based pediatric guidelines recommend a 5-day course of amoxicillin as first-line therapy for uncomplicated acute otitis media (AOM) in children 2 years and older and community-acquired pneumonia (CAP). The objective of this study was to assess the guideline consistency of antibiotic prescriptions for AOM and CAP in a Canadian quaternary care pediatric emergency department (ED) and identify opportunities to improve antibiotic prescribing.

Methods: We retrospectively reviewed antibiotic prescriptions for patients 0 to 18 years old discharged from the ED with a diagnosis of AOM or CAP from September 2022 through September 2023. Clinical information and prescription data were extracted from the electronic medical record. Analysis was completed using descriptive statistics.

Results: Of 2313 retrieved records, 1143 (85%) cases of AOM and 753 (75%) cases of CAP met the inclusion criteria. Six hundred and eighty-eight (60%) AOM prescriptions and 140 (19%) CAP prescriptions were guideline-consistent. Prescriptions were not guideline-consistent largely because of antibiotic duration (62% for AOM-67% attributable to excess duration; 93% for CAP- > 99% attributable to excess duration), followed by antibiotic dosing interval (31% for AOM; 22% for CAP), antibiotic selection (17% for AOM; 6% for CAP) and antibiotic dose (8% for AOM; 2% for CAP). Of 293 patients eligible for deferred prescriptions for AOM based on age and clinical presentation, only 52% received them.

Conclusions: Most guideline-discordant prescriptions for both AOM and CAP resulted from prolonged antibiotic duration. Given the frequency of these diagnoses, effective interventions to improve guideline consistency would have a significant impact at a population level.