Paediatrics & child health最新文献

Off-road vehicles (ORVs) are motorized vehicles engineered specifically for navigating rough terrain. They are often seen in rural, remote, and agricultural settings, but are widely used in Canada, primarily for recreation, and are responsible for a disproportionate number of severe injuries and deaths in the paediatric population. ORVs are becoming heavier and faster, and injuries associated with their use by children and adolescents are similar in severity to those sustained in motor vehicle crashes. However, while the automotive industry is bound by safety legislation, strict enforcement, and engineering and road strategies to prevent harm, there is no comparable regulatory framework for ORVs, leaving a gap in safety advancements. Based on a comprehensive literature search undertaken in February 2024, this statement provides an overview of the effects of ORV use by children and adolescents, factors influencing ORV crashes and resultant injuries, and recommendations for health care providers and governments to reduce preventable harms associated with ORVs in the paediatric population.

Acute head trauma (AHT) leading to traumatic brain injury is an important cause of paediatric morbidity and mortality. Injury severity depends on the mechanism of trauma and age of the child. The vast majority of childhood AHT cases are mild, require no therapy, and leave no long-term sequelae. However, it is important to identify individuals at risk for significant injury and those who require specific evaluation and intervention. This statement replaces a 2013 document from the Canadian Paediatric Society on this topic. It describes issues related to AHT in infants, children, and youth, including clinical manifestations, initial management priorities, guidelines for observation, imaging, and subsequent follow-up and treatment. The evaluation of patients with AHT at the time of initial assessment is also addressed.

Objectives: Pediatric gallstone disease is increasing in incidence, possibly due to rising rates of childhood obesity. There are concerns about delayed presentations and the need for surgery and endoscopic management. The aim of this project is to assess rates of cholecystectomy in pediatrics, distribution of pathology, impact of body mass index (BMI), and need for endoscopic retrograde cholangiopancreatography (ERCP).

Methods: We performed a retrospective cohort study of pediatric patients undergoing cholecystectomy and compared baseline characteristics and outcomes between different pathologies and between overweight (BMI ≥ 85^th percentile) and normal weight cohorts.

Results: A total of 210 patients were included with 108 (51.4%) undergoing elective gallbladder surgery, 35 (16.7%) undergoing emergent gallbladder surgery, and 67 (32.0%) requiring surgery for bile duct disease. Most were female (77.3%), overweight (69.9%), and adolescents (mean age 14.0 ± 2.9). Metabolic syndrome-associated steatotic liver disease was present in 5.3%, hereditary spherocytosis in 7.7%, and sickle cell disease in 1.4%. Thirty-eight required ERCP (18.1%). Patients presenting emergently had much longer lengths of stay than did those with elective admissions (median 3.0 ± 3.0 versus 0.0 ± 1.0 days, P < 0.001). Overweight patients more frequently experienced complications than the normal weight cohort (16% versus 7%, P = 0.044). Furthermore, length of stay (LOS) was also higher in the normal weight cohort than in the overweight group in elective biliary colic patients and emergent gallbladder patients (P = 0.007 and 0.042, respectively).

Conclusions: Gallstone disease in pediatrics often presents emergently. This is associated with worse outcomes such as prolonged LOS when compared with non-urgent cases. A significant proportion of patients present with common bile duct disease and require ERCP. Early diagnosis leading to surgical referral for patients with gallstone disease and multimodal strategies to decrease risk factors and expedite weight loss may help prevent complicated gallstone disease.

Importance: Bacteremia in children can lead to septic shock, meningitis or death. Knowledge of common pathogens and predictors is crucial for appropriate lifesaving management.

Objective: We aimed to identify pathogens and associated variables in children with bacteremia presenting to the emergency department (ED).

Methods: This retrospective cohort study was conducted in a tertiary pediatric hospital in Montreal, Canada (2018-2024). The full cohort included all children with a positive blood culture drawn in the ED while this study focused on cases of true bacteremia identified through medical record evaluation by two raters. The primary outcome was pathogen distribution. Potential pathogen-associated independent variables included demographics, vaccination status, recent travel, clinical presentation, and known risk factors. The primary analysis focused on pathogen prevalence, while secondary analysis assessed associations between predictors and pathogens using Chi-squared tests.

Results: Among 368 bacteremia cases (median age: 39 months), the most common pathogens were Staphylococcus aureus (25%), Escherichia coli (16%), Streptococcus pneumoniae (9.0%) and non-typhoidal Salmonella (8.7%). Overall, 175 (48%) had risk factors, including internal devices (n = 80, 22%), age less than 3 months (n = 59, 16%), or immunosuppression (n = 55, 15%). Significant associations emerged: 34% (n = 38) of Staphylococcus spp. infections involved internal devices, 62% (n = 24) of Salmonella spp. infections had recent travel, and 38% (n = 22) of E. coli infections and 69% (n = 11) of group B Streptococcus infections occurred in infants aged under 3 months.

Conclusions: Our study highlights current key pathogens and associated predictors in pediatric bacteremia. Travel history, internal hardware, age, and immunosuppression are crucial for clinicians to consider in its assessment and management.

Social determinants of health can profoundly impact child and adolescent health outcomes. As demands on Canadian primary health care continue to grow, there is an increasing risk that patients' needs will go unmet. Social prescribing offers a practical way to address these concerns across all ages. Using a personalized approach, social prescribing enables healthcare professionals to identify individuals' non-medical needs and connect them with appropriate community resources via dedicated community connectors. These connectors can collaborate with children, adolescents, and their families to explore their values, co-create a social prescription, support its implementation, and provide longitudinal follow-up. Pediatric healthcare providers are particularly well-poised to make these referrals to deliver comprehensive care that supports their patients' holistic development. This commentary highlights representative examples of Canadian social prescribing initiatives that can benefit pediatric patients, emphasizing how these practices can be adapted across developmental stages and grow alongside the individual.

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.