Shelley Vanderhout, Daniel Rosenfield, Ellen B Goldbloom
{"title":"A Canadian Paediatric Surveillance Program study to guide safe integration of virtual care for children","authors":"Shelley Vanderhout, Daniel Rosenfield, Ellen B Goldbloom","doi":"10.1093/pch/pxad059","DOIUrl":"https://doi.org/10.1093/pch/pxad059","url":null,"abstract":"","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135253938","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}
Abstract Transition from paediatric to adult healthcare is a normal part of the care trajectory, yet the process often leaves much to be desired. In this commentary, I share my family’s journey of this care transition, particularly the handover aspect, by providing examples of different ways that relationships were ended by paediatric healthcare professionals. The ending of these relationships often felt like ‘breaking up’. I also share an example of a supported handover, which bridged the transition from paediatric to adult care. To improve transitions, we need genuine acknowledgement of the paediatric medical trauma stress (PMTS) experienced by families such as mine following years of interactions in the healthcare system. Along with following transition checklists, patients and families need authentic and meaningful closure to longitudinal relationships and trauma-informed care practices as we move forward into the adult care system.
{"title":"Cliff or bridge: breaking up with the paediatric healthcare system","authors":"Jennifer Baumbusch","doi":"10.1093/pch/pxad061","DOIUrl":"https://doi.org/10.1093/pch/pxad061","url":null,"abstract":"Abstract Transition from paediatric to adult healthcare is a normal part of the care trajectory, yet the process often leaves much to be desired. In this commentary, I share my family’s journey of this care transition, particularly the handover aspect, by providing examples of different ways that relationships were ended by paediatric healthcare professionals. The ending of these relationships often felt like ‘breaking up’. I also share an example of a supported handover, which bridged the transition from paediatric to adult care. To improve transitions, we need genuine acknowledgement of the paediatric medical trauma stress (PMTS) experienced by families such as mine following years of interactions in the healthcare system. Along with following transition checklists, patients and families need authentic and meaningful closure to longitudinal relationships and trauma-informed care practices as we move forward into the adult care system.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135402719","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}
Bertrand Leduc, Paola Diadori, Philippe Major, Jennifer Gagné, Jonathan Bitton, Soumia Aboulamer, Gabrielle Beetz
Abstract Background Epilepsy is the most common paediatric neurological disorder. An estimated 4% of the general population will have an unprovoked epileptic seizure at least once in their lifetime. Of these, about 40% will experience a recurrence within two years. The International League Against Epilepsy (ILAE) established that one part of the definition of epilepsy was the onset of a first seizure with a recurrence risk of more than 60% over 10 years. However, except for epileptiform abnormalities and a structural-metabolic etiology present on the electroencephalogram (EEG), very few known factors are consistently associated with first epileptic seizures. Objectives Our study’s objective was to characterize neurodevelopmental comorbidities, namely attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), anxiety, depression, gross motor delay and language delay, in patients following a first epileptic seizure as compared to healthy controls. Design/Methods Children referred in neurology for a first suspected epileptic seizure, between June 2016 and June 2018 at the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), underwent EEG and neurological evaluations. For screening of comorbidities, parents completed age-appropriate M-CHAT-R/F, SCQ, ASQ-3, SCARED, and CES-DC questionnaires via a web platform adapted from CHADIS. Questionnaire scores were adjusted for age and sex and analyzed via a Student’s t-test. The prevalence of comorbidities was analyzed via a chi-square statistical test. Results A total of 72 subjects aged between 1 month and 18 years (42 males, 30 females) were enrolled in the study. Patients with a first epileptic seizure (n=37) showed significantly more comorbidities compared to the healthy subjects (54% vs. 31%, p<0.05). Patients with a first epileptic seizure had significantly more language delay (50%, p=0.015), ADHD (45%, p=0.008), and a significantly higher score in the Social Communication Questionnaire (SCQ) (p=0.03), compared to healthy subjects. Conclusion Our results confirm the increased rate of comorbidities in children with a first epileptic seizure and, thus, the importance of concomitant screening for those disorders at the time of the initial presentation.
背景癫痫是儿童最常见的神经系统疾病。据估计，一般人群中有4%的人一生中至少会有一次无端癫痫发作。其中，约40%会在两年内复发。国际抗癫痫联盟(ILAE)确定癫痫定义的一部分是首次发作，10年内复发风险超过60%。然而，除了癫痫样异常和脑电图(EEG)上的结构代谢病因外，很少有已知因素与首次癫痫发作一致。本研究的目的是将首次癫痫发作患者的神经发育合并症，即注意缺陷多动障碍(ADHD)、自闭症谱系障碍(ASD)、焦虑、抑郁、大运动迟缓和语言迟缓与健康对照进行比较。设计/方法2016年6月至2018年6月期间，在圣贾斯汀大学医院中心(CHUSJ)首次疑似癫痫发作的儿童接受了脑电图和神经学评估。为了筛查合并症，家长通过CHADIS改编的网络平台完成了与年龄相适应的M-CHAT-R/F、SCQ、ASQ-3、SCARED和CES-DC问卷调查。问卷得分根据年龄和性别进行调整，并通过学生t检验进行分析。合并症的发生率通过卡方统计检验进行分析。结果共纳入受试者72例，年龄在1个月~ 18岁之间，其中男性42例，女性30例。首次癫痫发作患者(n=37)的合并症明显多于健康受试者(54% vs. 31%， p amp;lt;0.05)。首次癫痫发作患者的语言延迟(50%，p=0.015)、注意力缺陷多动障碍(45%，p=0.008)和社会沟通问卷(SCQ)得分显著高于健康者(p=0.03)。结论:我们的研究结果证实了首次癫痫发作的儿童的合并症发生率增加，因此，在首次出现时对这些疾病进行伴随筛查的重要性。
{"title":"19 Characterization of Neurodevelopmental Comorbidities within a Paediatric Population with a First Epileptic Seizure","authors":"Bertrand Leduc, Paola Diadori, Philippe Major, Jennifer Gagné, Jonathan Bitton, Soumia Aboulamer, Gabrielle Beetz","doi":"10.1093/pch/pxad055.019","DOIUrl":"https://doi.org/10.1093/pch/pxad055.019","url":null,"abstract":"Abstract Background Epilepsy is the most common paediatric neurological disorder. An estimated 4% of the general population will have an unprovoked epileptic seizure at least once in their lifetime. Of these, about 40% will experience a recurrence within two years. The International League Against Epilepsy (ILAE) established that one part of the definition of epilepsy was the onset of a first seizure with a recurrence risk of more than 60% over 10 years. However, except for epileptiform abnormalities and a structural-metabolic etiology present on the electroencephalogram (EEG), very few known factors are consistently associated with first epileptic seizures. Objectives Our study’s objective was to characterize neurodevelopmental comorbidities, namely attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), anxiety, depression, gross motor delay and language delay, in patients following a first epileptic seizure as compared to healthy controls. Design/Methods Children referred in neurology for a first suspected epileptic seizure, between June 2016 and June 2018 at the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), underwent EEG and neurological evaluations. For screening of comorbidities, parents completed age-appropriate M-CHAT-R/F, SCQ, ASQ-3, SCARED, and CES-DC questionnaires via a web platform adapted from CHADIS. Questionnaire scores were adjusted for age and sex and analyzed via a Student’s t-test. The prevalence of comorbidities was analyzed via a chi-square statistical test. Results A total of 72 subjects aged between 1 month and 18 years (42 males, 30 females) were enrolled in the study. Patients with a first epileptic seizure (n=37) showed significantly more comorbidities compared to the healthy subjects (54% vs. 31%, p&lt;0.05). Patients with a first epileptic seizure had significantly more language delay (50%, p=0.015), ADHD (45%, p=0.008), and a significantly higher score in the Social Communication Questionnaire (SCQ) (p=0.03), compared to healthy subjects. Conclusion Our results confirm the increased rate of comorbidities in children with a first epileptic seizure and, thus, the importance of concomitant screening for those disorders at the time of the initial presentation.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135433241","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}
Sydney MacDonald, Satvinder Ghotra, Alexandra Stratas, Marsha Campbell-Yeo, Anne Synnes, Prakesh Shah, Navjot Sandila
Abstract Background Most existing literature on health status (HS) and health-related quality of life (HRQL) of preterm survivors focuses on late childhood, adolescent, and adult age, with only a small body of data on preschool age children. Little is known about the relationship between parent-reported HS outcomes and standardized neurodevelopmental outcomes measured in preterm survivors at preschool age. Objectives To present parent-reported HS outcomes at 36 months of age in a population-based cohort of very preterm survivors and compare parent-reported subjective outcomes to standardized neurodevelopmental outcomes measured by clinicians at the same age. Design/Methods Infants <31 weeks’ gestation born between April 2014 and June 2016 were prospectively followed through the Perinatal Follow-Up Program and enrolled in a population-based database. HS was measured using the Health Status Classification System for Pre-School Children questionnaire, completed by parents when children reached 36 months’ age. At the same age, neurological examination and standardized developmental assessments were completed by clinicians, using the Bayley Scales of Infant and Toddler Development – III to determine neurodevelopmental impairment (NDI). NDI was categorized as none, “mild”, or “significant" (moderate or severe cerebral palsy, Bayley-III <70, blind or required hearing aid). Inter-rater reliability between the physician and parent scores was assessed using Cohen’s weighted kappa coefficient. Results Of 118 children included, there were 47 and 71 children born in <28 and ≥28 weeks’ gestational age, respectively. At 36 months’ age, 73.7% had a parental health concern, mild in >50% and severe in only 8.5%. The most affected HS attributes were language (46.6%) and self-care (39.0%). Nearly 75% of the participants did not meet the criteria for NDI. Of 11 (9.3%) children with significant NDI at 36 months’ age, all parents reported moderate (36.4%) or severe (63.6%) health concerns. Conversely, of 26 (22%) children with parents reporting moderate to severe health concerns, 11 (42.3%) met the criteria for significant NDI (Table 1). Weighted Kappa coefficient was 0.33 (CI=0.20,0.046). Conclusion Most parents expressed at least one concern for their preschool-aged child born preterm. Despite high parental concern, most children did not meet the criteria for NDI via clinician assessment. Overall, there was fair agreement between parental concerns and clinician-reported outcomes.
{"title":"69 A Population-based Study of Parent-reported Health Outcomes at Preschool Age of Children Born Very Preterm","authors":"Sydney MacDonald, Satvinder Ghotra, Alexandra Stratas, Marsha Campbell-Yeo, Anne Synnes, Prakesh Shah, Navjot Sandila","doi":"10.1093/pch/pxad055.069","DOIUrl":"https://doi.org/10.1093/pch/pxad055.069","url":null,"abstract":"Abstract Background Most existing literature on health status (HS) and health-related quality of life (HRQL) of preterm survivors focuses on late childhood, adolescent, and adult age, with only a small body of data on preschool age children. Little is known about the relationship between parent-reported HS outcomes and standardized neurodevelopmental outcomes measured in preterm survivors at preschool age. Objectives To present parent-reported HS outcomes at 36 months of age in a population-based cohort of very preterm survivors and compare parent-reported subjective outcomes to standardized neurodevelopmental outcomes measured by clinicians at the same age. Design/Methods Infants &lt;31 weeks’ gestation born between April 2014 and June 2016 were prospectively followed through the Perinatal Follow-Up Program and enrolled in a population-based database. HS was measured using the Health Status Classification System for Pre-School Children questionnaire, completed by parents when children reached 36 months’ age. At the same age, neurological examination and standardized developmental assessments were completed by clinicians, using the Bayley Scales of Infant and Toddler Development – III to determine neurodevelopmental impairment (NDI). NDI was categorized as none, “mild”, or “significant\" (moderate or severe cerebral palsy, Bayley-III &lt;70, blind or required hearing aid). Inter-rater reliability between the physician and parent scores was assessed using Cohen’s weighted kappa coefficient. Results Of 118 children included, there were 47 and 71 children born in &lt;28 and ≥28 weeks’ gestational age, respectively. At 36 months’ age, 73.7% had a parental health concern, mild in &gt;50% and severe in only 8.5%. The most affected HS attributes were language (46.6%) and self-care (39.0%). Nearly 75% of the participants did not meet the criteria for NDI. Of 11 (9.3%) children with significant NDI at 36 months’ age, all parents reported moderate (36.4%) or severe (63.6%) health concerns. Conversely, of 26 (22%) children with parents reporting moderate to severe health concerns, 11 (42.3%) met the criteria for significant NDI (Table 1). Weighted Kappa coefficient was 0.33 (CI=0.20,0.046). Conclusion Most parents expressed at least one concern for their preschool-aged child born preterm. Despite high parental concern, most children did not meet the criteria for NDI via clinician assessment. Overall, there was fair agreement between parental concerns and clinician-reported outcomes.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135433243","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}
Brittany Lissinna, Chelsea Gilbert, Calla Isaac, Qaasim Mian, Karen Forbes
Abstract Introduction/Background Routine immunization is an effective public health intervention. Despite this, immunization coverage in Alberta remains below national targets. While vaccine hesitancy is a frequently cited barrier, underimmunization is likely multifactorial. Previous research has shown that hospitalization presents an opportunity to “catch-up” children who are underimmunized. Unfortunately, this is not readily available at the Stollery Children’s Hospital (SCH), a paediatric tertiary care facility serving a large catchment area. Objectives The primary objective of this study was to assess the immunization status of children admitted to paediatric clinical teaching units (CTUs) at SCH. Our secondary objective was to assess potential barriers caregivers face while attempting to immunize their children. Design/Methods Between July 2021 and October 2022, we prospectively gathered the immunization status of children aged 2 months to 18 years admitted to paediatric clinical teaching units (CTUs) at SCH. Two hundred and fifty children and their caregivers were enrolled in the research study. Demographic data and immunization records were documented, and immunization status of each participant was classified as up-to-date or not-up-to-date based on the Alberta Routine Childhood Immunization Schedule. Caregivers completed a standardized survey, Searching for Hardships and Obstacles to Shots (SHOTS), to assess potential barriers they face while attempting to immunize their children, including three subscales (access to shots, concerns about shots and importance of shots). Results Of the 250 children enrolled, immunization data was available for 240 children. Of these, 142 (59%) were up-to-date on their immunizations. Assessment of demographic data revealed no difference in immunization status between urban and rural addresses. When evaluating barriers that families face when approaching immunization, concerns about immunization were most commonly cited as barriers for all patients. However, caregivers whose children were not up-to-date on immunizations scored higher on all subscales compared to those whose children were up-to-date. Conclusion The immunization status of children admitted to paediatric CTUs at SCH falls far below national targets. Due to logistical issues, it is challenging to access routine immunizations during hospitalization. Caregivers of children who are underimmunized also identify a higher rate of barriers to immunization. These underimmunized patients represent a missed opportunity, and improving access to routine immunization while in hospital could improve the overall immunization rates for both hospitalized children and the broader community.
{"title":"41 Evaluating Immunization Status and Barriers to Immunization for Patients Admitted to the Stollery Children's Hospital","authors":"Brittany Lissinna, Chelsea Gilbert, Calla Isaac, Qaasim Mian, Karen Forbes","doi":"10.1093/pch/pxad055.041","DOIUrl":"https://doi.org/10.1093/pch/pxad055.041","url":null,"abstract":"Abstract Introduction/Background Routine immunization is an effective public health intervention. Despite this, immunization coverage in Alberta remains below national targets. While vaccine hesitancy is a frequently cited barrier, underimmunization is likely multifactorial. Previous research has shown that hospitalization presents an opportunity to “catch-up” children who are underimmunized. Unfortunately, this is not readily available at the Stollery Children’s Hospital (SCH), a paediatric tertiary care facility serving a large catchment area. Objectives The primary objective of this study was to assess the immunization status of children admitted to paediatric clinical teaching units (CTUs) at SCH. Our secondary objective was to assess potential barriers caregivers face while attempting to immunize their children. Design/Methods Between July 2021 and October 2022, we prospectively gathered the immunization status of children aged 2 months to 18 years admitted to paediatric clinical teaching units (CTUs) at SCH. Two hundred and fifty children and their caregivers were enrolled in the research study. Demographic data and immunization records were documented, and immunization status of each participant was classified as up-to-date or not-up-to-date based on the Alberta Routine Childhood Immunization Schedule. Caregivers completed a standardized survey, Searching for Hardships and Obstacles to Shots (SHOTS), to assess potential barriers they face while attempting to immunize their children, including three subscales (access to shots, concerns about shots and importance of shots). Results Of the 250 children enrolled, immunization data was available for 240 children. Of these, 142 (59%) were up-to-date on their immunizations. Assessment of demographic data revealed no difference in immunization status between urban and rural addresses. When evaluating barriers that families face when approaching immunization, concerns about immunization were most commonly cited as barriers for all patients. However, caregivers whose children were not up-to-date on immunizations scored higher on all subscales compared to those whose children were up-to-date. Conclusion The immunization status of children admitted to paediatric CTUs at SCH falls far below national targets. Due to logistical issues, it is challenging to access routine immunizations during hospitalization. Caregivers of children who are underimmunized also identify a higher rate of barriers to immunization. These underimmunized patients represent a missed opportunity, and improving access to routine immunization while in hospital could improve the overall immunization rates for both hospitalized children and the broader community.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135433879","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}
Abstract Background Children with sickle cell disease (SCD) suffer from lifelong episodes of unpredictable acute pain that alter their quality of life. Despite prompt pain treatment, hospitalization is often required for pain management. SCD is a multisystemic disease affecting organ function (e.g., renal hyperfiltration, change in liver blood flow). Altogether, these changes could alter pharmacokinetics (PK). Objectives We hypothesize that SCD leads to changes in PK of analgesics potentially contributing to treatment failure using regular medication doses. Design/Methods A systematic literature review to describe the current evidence on the effect of SCD on analgesic disposition in children was performed by a librarian on 5 databases from inception until February 2021 and independently assessed by two reviewers. All full text articles, including PK data in children with SCD, were included. The reported differences in PK parameters between children with and without SCD were examined. Results Among 5170 retrieved abstracts, 84 full text articles were reviewed, and 7 studies were included on 128 patients. Studied drugs were morphine (IV and PO), lidocaine (IV), methadone (IV) and rofecoxib (PO). In children with SCD, clearance of IV morphine was 42-61% higher compared with non-SCD controls. Hepatic metabolism of lidocaine was decreased in children with SCD compared to healthy controls. No significant PK changes were noted for methadone and rofecoxib compared with non-SCD controls. Conclusion SCD leads to significant changes in PK of analgesics, but data are scarce. Increased clearance of morphine suggests that higher doses may be needed in children with SCD. Data on commonly used analgesics like acetaminophen, ibuprofen and ketamine are critically missing. Dosing of analgesics adapted to SCD are needed and may potentially improve pain control in this population.
{"title":"40 Analgesia in Sickle Cell Disease: Do We Give the Right Dose? A Systematic Review of Pharmacokinetic Studies","authors":"Niina Kleiber, Ann-Sophie Czech, Gabrielle Bernier, Yves Pastore, Marie-Joëlle Doré-Bergeron, Evelyne D Trottier, Yves Théorêt, Julie Autmizguine, Alix Pincivy","doi":"10.1093/pch/pxad055.040","DOIUrl":"https://doi.org/10.1093/pch/pxad055.040","url":null,"abstract":"Abstract Background Children with sickle cell disease (SCD) suffer from lifelong episodes of unpredictable acute pain that alter their quality of life. Despite prompt pain treatment, hospitalization is often required for pain management. SCD is a multisystemic disease affecting organ function (e.g., renal hyperfiltration, change in liver blood flow). Altogether, these changes could alter pharmacokinetics (PK). Objectives We hypothesize that SCD leads to changes in PK of analgesics potentially contributing to treatment failure using regular medication doses. Design/Methods A systematic literature review to describe the current evidence on the effect of SCD on analgesic disposition in children was performed by a librarian on 5 databases from inception until February 2021 and independently assessed by two reviewers. All full text articles, including PK data in children with SCD, were included. The reported differences in PK parameters between children with and without SCD were examined. Results Among 5170 retrieved abstracts, 84 full text articles were reviewed, and 7 studies were included on 128 patients. Studied drugs were morphine (IV and PO), lidocaine (IV), methadone (IV) and rofecoxib (PO). In children with SCD, clearance of IV morphine was 42-61% higher compared with non-SCD controls. Hepatic metabolism of lidocaine was decreased in children with SCD compared to healthy controls. No significant PK changes were noted for methadone and rofecoxib compared with non-SCD controls. Conclusion SCD leads to significant changes in PK of analgesics, but data are scarce. Increased clearance of morphine suggests that higher doses may be needed in children with SCD. Data on commonly used analgesics like acetaminophen, ibuprofen and ketamine are critically missing. Dosing of analgesics adapted to SCD are needed and may potentially improve pain control in this population.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434202","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}
Abstract Background General paediatricians are expected to be competent in the resuscitation of children and important to this competency is the ability to perform certain acute care procedural skills. Paediatric residents are expected to be competent in these procedural skills by the end of their training as specified by the Royal College (RCPSC). However, the extent to which residents are actually competent is not fully assessed or understood. There are currently no evidence-supported guidelines suggesting the best path toward procedural skills competency for residents, and they are less likely to receive formal training and or supervision for completing procedural skills than their nursing counterparts. They also report feeling inadequately prepared. To address this gap, the Paediatrics program at McMaster University aimed to conduct a longitudinal cross-sectional study examining the competency of their trainees in specific acute care procedures. Objectives The purpose of this first study was to present a cross-sectional observation of the entrustability of paediatric residents in 6 procedural skills. Design/Methods The procedures were bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR), and defibrillation, which are all requirements of the RCPSC. Paediatric residents attended an “Acute Care Procedure Day” where they performed each procedure with direct observation and feedback. Entrustable professional activity (EPA) scores (from 1 to 5) were recorded for each attempt. Prior, a 1-hour interactive lecture was given that included procedural information and a video demonstration of each procedure. Residents received a copy of the milestones per EPA. Demographic information, self-perceived comfort, and EPA data were collected. Descriptive statistics and Pearson correlation for PGY level versus EPA scores were performed. Results Of the 36 residents who participated, 24(67%) were in postgraduate year (PGY) 1-2, and 12 PGY 3-4(33%). Reported levels of past experience were lowest for placement of chest tubes (n=3, 8.3%), followed by IOs (n=19, 52.8%). During the sessions, residents showed the highest levels of initial entrustment with IO placement (EPA 4-5 in 28/33), BVM skills (EPA 4-5 in 27/33), and CPR (EPA 4-5 in 16/25), and lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). Despite this, self-reported overall confidence after training for these procedures was moderate to high. There was strong correlation between PGY level and EPA score for intubation, and no correlation for the other procedures. Conclusion Our findings show that entrustability of certain acute care skills is not being obtained (i.e., defibrillation, chest tube placement), and that there were large discrepancies between entrustment scores and perceived comfort among the PGY levels. Further research is needed to ch
{"title":"81 A Snapshot of Entrustability of Acute Care Procedural Skills in Paediatrics Residents","authors":"Maaz Mirza, Karen Forward, Quang Ngo, Elif Bilgic, Ronish Gupta","doi":"10.1093/pch/pxad055.081","DOIUrl":"https://doi.org/10.1093/pch/pxad055.081","url":null,"abstract":"Abstract Background General paediatricians are expected to be competent in the resuscitation of children and important to this competency is the ability to perform certain acute care procedural skills. Paediatric residents are expected to be competent in these procedural skills by the end of their training as specified by the Royal College (RCPSC). However, the extent to which residents are actually competent is not fully assessed or understood. There are currently no evidence-supported guidelines suggesting the best path toward procedural skills competency for residents, and they are less likely to receive formal training and or supervision for completing procedural skills than their nursing counterparts. They also report feeling inadequately prepared. To address this gap, the Paediatrics program at McMaster University aimed to conduct a longitudinal cross-sectional study examining the competency of their trainees in specific acute care procedures. Objectives The purpose of this first study was to present a cross-sectional observation of the entrustability of paediatric residents in 6 procedural skills. Design/Methods The procedures were bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR), and defibrillation, which are all requirements of the RCPSC. Paediatric residents attended an “Acute Care Procedure Day” where they performed each procedure with direct observation and feedback. Entrustable professional activity (EPA) scores (from 1 to 5) were recorded for each attempt. Prior, a 1-hour interactive lecture was given that included procedural information and a video demonstration of each procedure. Residents received a copy of the milestones per EPA. Demographic information, self-perceived comfort, and EPA data were collected. Descriptive statistics and Pearson correlation for PGY level versus EPA scores were performed. Results Of the 36 residents who participated, 24(67%) were in postgraduate year (PGY) 1-2, and 12 PGY 3-4(33%). Reported levels of past experience were lowest for placement of chest tubes (n=3, 8.3%), followed by IOs (n=19, 52.8%). During the sessions, residents showed the highest levels of initial entrustment with IO placement (EPA 4-5 in 28/33), BVM skills (EPA 4-5 in 27/33), and CPR (EPA 4-5 in 16/25), and lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). Despite this, self-reported overall confidence after training for these procedures was moderate to high. There was strong correlation between PGY level and EPA score for intubation, and no correlation for the other procedures. Conclusion Our findings show that entrustability of certain acute care skills is not being obtained (i.e., defibrillation, chest tube placement), and that there were large discrepancies between entrustment scores and perceived comfort among the PGY levels. Further research is needed to ch","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434357","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}
Marsha Campbell-Yeo, Fabiana Bacchini, Marc Beltempo, Lynsey Alcock, Prakeshkumar Shah, Tanya Bishop, Douglas Campbell, Addie Chilcott, Jeanette Comeau, Justine Dol, Amy Grant, Jonathan Gubbay, Brianna Hughes, Amos Hundert, Darlene Inglis, Alanna Lakoff, Yasmin Lalani, Thuy Mai Luu, Jenna MacMorton, Souvik Mitra, Michael Narvey, Karel O'Brien Paula Robeson, Michelle Science, Rachel Van Woezik, Leah Whitehead
Abstract Introduction/Background The effect of the COVID-19 pandemic on neonatal outcomes is not yet completely understood. Objectives To compare the neonatal outcomes of very preterm infants admitted to Canadian NICUs pre- and during the COVID-19 pandemic. Design/Methods This retrospective cohort study included infants born <33 weeks and admitted to tertiary Canadian NICUs participating in the Canadian Neonatal Network (CNN) database. The sample included 14,368 infants from two cohorts: 7,280 infants pre-pandemic (April 1, 2018 – December 31, 2019) and 7,088 infants during the pandemic (April 1, 2020 – December 31, 2021). Primary composite outcomes were mortality or major morbidity. Care practices and interventions were compared. Relative risk (RR) comparing the pandemic vs pre-pandemic periods were estimated using generalized estimated equations and adjusted for confounders. Results The characteristics of infants admitted before and during the pandemic were not significantly different. The incidence of mortality or major morbidity was similar pre- and during the pandemic (37%, 36% respectively; RR=1.01 [0.92, 1.01]; Table 1). Infant health outcomes were not significantly different between periods. There was a non-significant decrease in the exclusive receipt of mothers’ own milk (MOM) at discharge (45% pre- and 37% during; RR=0.85 [0.68, 1.06]). Conclusion There was no difference in clinical outcomes between pre-pandemic and pandemic cohorts. The possibility of lower receipt of exclusive MOM at discharge during the COVID-19 pandemic needs further study.
{"title":"65 Outcomes of Neonates Admitted to the NICU during the COVID-19 Pandemic: Comparison with a Pre-Pandemic Cohort","authors":"Marsha Campbell-Yeo, Fabiana Bacchini, Marc Beltempo, Lynsey Alcock, Prakeshkumar Shah, Tanya Bishop, Douglas Campbell, Addie Chilcott, Jeanette Comeau, Justine Dol, Amy Grant, Jonathan Gubbay, Brianna Hughes, Amos Hundert, Darlene Inglis, Alanna Lakoff, Yasmin Lalani, Thuy Mai Luu, Jenna MacMorton, Souvik Mitra, Michael Narvey, Karel O'Brien Paula Robeson, Michelle Science, Rachel Van Woezik, Leah Whitehead","doi":"10.1093/pch/pxad055.065","DOIUrl":"https://doi.org/10.1093/pch/pxad055.065","url":null,"abstract":"Abstract Introduction/Background The effect of the COVID-19 pandemic on neonatal outcomes is not yet completely understood. Objectives To compare the neonatal outcomes of very preterm infants admitted to Canadian NICUs pre- and during the COVID-19 pandemic. Design/Methods This retrospective cohort study included infants born &lt;33 weeks and admitted to tertiary Canadian NICUs participating in the Canadian Neonatal Network (CNN) database. The sample included 14,368 infants from two cohorts: 7,280 infants pre-pandemic (April 1, 2018 – December 31, 2019) and 7,088 infants during the pandemic (April 1, 2020 – December 31, 2021). Primary composite outcomes were mortality or major morbidity. Care practices and interventions were compared. Relative risk (RR) comparing the pandemic vs pre-pandemic periods were estimated using generalized estimated equations and adjusted for confounders. Results The characteristics of infants admitted before and during the pandemic were not significantly different. The incidence of mortality or major morbidity was similar pre- and during the pandemic (37%, 36% respectively; RR=1.01 [0.92, 1.01]; Table 1). Infant health outcomes were not significantly different between periods. There was a non-significant decrease in the exclusive receipt of mothers’ own milk (MOM) at discharge (45% pre- and 37% during; RR=0.85 [0.68, 1.06]). Conclusion There was no difference in clinical outcomes between pre-pandemic and pandemic cohorts. The possibility of lower receipt of exclusive MOM at discharge during the COVID-19 pandemic needs further study.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434626","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}
Abstract Introduction/Background Transcobalamin-II Deficiency (TCII-Deficiency) is a rare autosomal-recessive metabolic condition, resulting in ineffective transport and uptake of Vitamin B12. Clinical features of pancytopenia, failure to thrive, diarrhea, and developmental delay typically present between 1-12 months of age1. Case Description A 10-month-old term, previously well male with a normal newborn screen, presented with a one-month history of decreased energy, failure to thrive, and diarrhea. He had a two-week history of gross motor regression with lower limb and periorbital edema. Examination was notable for perioral rash, severe diaper dermatitis, buccal ulcerations, pallor, and generalised edema including ascites. There was no organomegaly or any dysmorphic features. Investigations revealed macrocytic anemia, thrombocytopenia, worsening neutropenia, hypoalbuminemia, hypertriglyceridemia, and hypogammaglobulinemia (Table 1). Vitamin B12 and B9 levels were normal. Bone marrow biopsy was hypocellular, and ruled out aplastic anemia and leukemia. Intestinal biopsy showed generalized edema from duodenum to rectum with GVHD-like injury pattern, and evidence for protein-losing enteropathy (PLE). Required therapy included numerous RBC, platelet, and albumin transfusions and enteral feeding. A disorder of vitamin B12 metabolism, specifically TCII-Deficiency, was suspected based on clinical presentation with no other clear explanation. Serum MMA was highly elevated at 24,154 nmol/L (0-500 nmol/L) as was homocysteine at 27.3 umol/L (4.7-10.3 umol/L). Whole-exome sequencing identified two mutations in TCN2. Treatment with intramuscular vitamin B12 resulted in reduction of urinary MMA level to 5.6 umol/mmol Cr (< 2 umol/mmol Cr) in 10 days. Discussion Over the next months of treatment with intramuscular hydroxocobalamin, the MMA, homocysteine, albumin and CBC normalized and all clinical complications were resolved. Gross motor skills returned to normal, with only mild persistent speech delay. TCII-Deficiency often presents with a heterogeneous constellation of symptoms. In this case, the differential included several hematologic and gastrointestinal pathologies, including DGAT1 deficiency (due to hypertriglyceridemia, diarrhea, and PLE) and CHAPLE syndrome (due to low immunoglobulins and PLE). MMA and homocysteine levels are often markedly elevated in B12 metabolism defects, and can justify initiation of treatment with cyanocobalamin/hydroxocobalamin (Vitamin B12) while awaiting confirmatory genetic testing2. Conclusion TCII-Deficiency is a rare cause of macrocytic anemia; early consideration and treatment with intramuscular vitamin B12 leads to dramatic symptom improvement and is important for paediatricians to recognize. Clinical Pearls: • Clinicians should consider B12 metabolism defects on their differential in a young child who has macrocytic anemia with normal B12 levels. • Paediatricians can use MMA and homocysteine levels to assess fo
{"title":"C8 (Clinical Case) A 10-Month-Old Male with Macrocytic Anemia and Hypoalbuminemia","authors":"Colleen O’Connor, Dax Bourcier, Lynette Penney","doi":"10.1093/pch/pxad055.109","DOIUrl":"https://doi.org/10.1093/pch/pxad055.109","url":null,"abstract":"Abstract Introduction/Background Transcobalamin-II Deficiency (TCII-Deficiency) is a rare autosomal-recessive metabolic condition, resulting in ineffective transport and uptake of Vitamin B12. Clinical features of pancytopenia, failure to thrive, diarrhea, and developmental delay typically present between 1-12 months of age1. Case Description A 10-month-old term, previously well male with a normal newborn screen, presented with a one-month history of decreased energy, failure to thrive, and diarrhea. He had a two-week history of gross motor regression with lower limb and periorbital edema. Examination was notable for perioral rash, severe diaper dermatitis, buccal ulcerations, pallor, and generalised edema including ascites. There was no organomegaly or any dysmorphic features. Investigations revealed macrocytic anemia, thrombocytopenia, worsening neutropenia, hypoalbuminemia, hypertriglyceridemia, and hypogammaglobulinemia (Table 1). Vitamin B12 and B9 levels were normal. Bone marrow biopsy was hypocellular, and ruled out aplastic anemia and leukemia. Intestinal biopsy showed generalized edema from duodenum to rectum with GVHD-like injury pattern, and evidence for protein-losing enteropathy (PLE). Required therapy included numerous RBC, platelet, and albumin transfusions and enteral feeding. A disorder of vitamin B12 metabolism, specifically TCII-Deficiency, was suspected based on clinical presentation with no other clear explanation. Serum MMA was highly elevated at 24,154 nmol/L (0-500 nmol/L) as was homocysteine at 27.3 umol/L (4.7-10.3 umol/L). Whole-exome sequencing identified two mutations in TCN2. Treatment with intramuscular vitamin B12 resulted in reduction of urinary MMA level to 5.6 umol/mmol Cr (&lt; 2 umol/mmol Cr) in 10 days. Discussion Over the next months of treatment with intramuscular hydroxocobalamin, the MMA, homocysteine, albumin and CBC normalized and all clinical complications were resolved. Gross motor skills returned to normal, with only mild persistent speech delay. TCII-Deficiency often presents with a heterogeneous constellation of symptoms. In this case, the differential included several hematologic and gastrointestinal pathologies, including DGAT1 deficiency (due to hypertriglyceridemia, diarrhea, and PLE) and CHAPLE syndrome (due to low immunoglobulins and PLE). MMA and homocysteine levels are often markedly elevated in B12 metabolism defects, and can justify initiation of treatment with cyanocobalamin/hydroxocobalamin (Vitamin B12) while awaiting confirmatory genetic testing2. Conclusion TCII-Deficiency is a rare cause of macrocytic anemia; early consideration and treatment with intramuscular vitamin B12 leads to dramatic symptom improvement and is important for paediatricians to recognize. Clinical Pearls: • Clinicians should consider B12 metabolism defects on their differential in a young child who has macrocytic anemia with normal B12 levels. • Paediatricians can use MMA and homocysteine levels to assess fo","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484455","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}
Doug McMillan, Nalini Singhal, Stella Kyoyagala, Susan Niermeyer, Julieth Kabirigi, William Keenan, Ashish KC, Majeeda Kamaluddeen, Khalid Aziz
Abstract Introduction/Background Kangaroo Mother Care (KMC) improves outcome for small newborns, but implementation has been slow. This lag may be associated with lack of short, effective learning programs for healthcare workers, and limited ability to overcome barriers to KMC program development. Objectives To develop a practical learning program for KMC with focus on facilitating healthcare workers assisting the learning of mothers and other family members in KMC care of small babies. To integrate KMC with quality improvement to assist healthcare workers overcome barriers to implementation and improve practice. Design/Methods Six neonatologists, with other global experts, developed as simulation-based, interactive, 12-contact-hour learning program with virtual pilot testing in Uganda, Tanzania, and Nepal, prior to implementation in Mbarara Regional Referral Hospital in Uganda. Revisions in QIiKMC course content and integration with quality improvement were accompanied by development of A KMC Readiness, Survey, Knowledge and Confidence Check, Parent Information, and Course Evaluation, with all components available at www.cnf-fnc.ca. Results Thirty-three nurses and physicians increased knowledge scores from 79% to 88% post-learning. 77% indicated the course was useful or very useful, appreciating “The link between EPIQ and KMC in identification and solving problems” and the “Usefulness of family involvement in caring for the newborn in the hospital and home”. Participants indicated preferences for face-to-face learning and more time for hands-on practice. KMC for small babies increased from 0% to 65% (by August-October 2022). Length of hospital stay decreased by 5 days. Government increased KMC beds from 4 to 8. Staff reported increased job satisfaction along with increased quality improvement activities. Family members in addition to mothers were involved (especially with multiple births or if the mother was ill). Families helped other families with learning. One father reported that “When my baby grows up, I will let him know that it was my warmth which kept him alive”. Conclusion Development of a short, practical KMC learning program was feasible. Integration with quality improvement was empowering and impactful. Acknowledgements Funding from the Royal College of Physicians and Surgeons of Canada and a Rotary Global Grant is appreciated. Potential competing interests Funding for learning program development was received from the Royal College of Physicians and Surgeons of Canada. Funding for KMC implementation in Uganda was supported by a Rotary Global Grant.
{"title":"36 Quality Improvement Integrated Kangaroo Mother Care (QIiKMC)-Development with Evidence-based Practice for Improving Quality (EPIQ) to Improve Learning and Implementation","authors":"Doug McMillan, Nalini Singhal, Stella Kyoyagala, Susan Niermeyer, Julieth Kabirigi, William Keenan, Ashish KC, Majeeda Kamaluddeen, Khalid Aziz","doi":"10.1093/pch/pxad055.036","DOIUrl":"https://doi.org/10.1093/pch/pxad055.036","url":null,"abstract":"Abstract Introduction/Background Kangaroo Mother Care (KMC) improves outcome for small newborns, but implementation has been slow. This lag may be associated with lack of short, effective learning programs for healthcare workers, and limited ability to overcome barriers to KMC program development. Objectives To develop a practical learning program for KMC with focus on facilitating healthcare workers assisting the learning of mothers and other family members in KMC care of small babies. To integrate KMC with quality improvement to assist healthcare workers overcome barriers to implementation and improve practice. Design/Methods Six neonatologists, with other global experts, developed as simulation-based, interactive, 12-contact-hour learning program with virtual pilot testing in Uganda, Tanzania, and Nepal, prior to implementation in Mbarara Regional Referral Hospital in Uganda. Revisions in QIiKMC course content and integration with quality improvement were accompanied by development of A KMC Readiness, Survey, Knowledge and Confidence Check, Parent Information, and Course Evaluation, with all components available at www.cnf-fnc.ca. Results Thirty-three nurses and physicians increased knowledge scores from 79% to 88% post-learning. 77% indicated the course was useful or very useful, appreciating “The link between EPIQ and KMC in identification and solving problems” and the “Usefulness of family involvement in caring for the newborn in the hospital and home”. Participants indicated preferences for face-to-face learning and more time for hands-on practice. KMC for small babies increased from 0% to 65% (by August-October 2022). Length of hospital stay decreased by 5 days. Government increased KMC beds from 4 to 8. Staff reported increased job satisfaction along with increased quality improvement activities. Family members in addition to mothers were involved (especially with multiple births or if the mother was ill). Families helped other families with learning. One father reported that “When my baby grows up, I will let him know that it was my warmth which kept him alive”. Conclusion Development of a short, practical KMC learning program was feasible. Integration with quality improvement was empowering and impactful. Acknowledgements Funding from the Royal College of Physicians and Surgeons of Canada and a Rotary Global Grant is appreciated. Potential competing interests Funding for learning program development was received from the Royal College of Physicians and Surgeons of Canada. Funding for KMC implementation in Uganda was supported by a Rotary Global Grant.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484499","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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