Paediatrics & child health最新文献

Background: Medical Assistance in Canada (MAID) has been decriminalized in Canada since 2016. Mature minors-or individuals younger than 18 deemed legally capable to provide consent-remain ineligible. While there have been numerous spaces for adults to share their reflections on MAID, mature minors have not had the same opportunities, especially those with critical, complex illnesses. Thus, this study aimed to provide the first exploration on how the lived experiences of mature minors with critical, complex illnesses, and their parents, contribute to their views on MAID for mature minors and their participation in end-of-life policy development and evaluation.

Methods: We conducted an interpretive phenomenological study with an integrated community-engagement approach. Semi-structured interviews were used to explore the experiences and perspectives of a purposive sample of mature minor participants with critical, complex illness experiences and their parents. Analysis followed an interpretive framework.

Results: Participants' perspectives were complex and revealed similarities and differences across experiences and reflections. Participant narratives were centred on three macro-themes: their cancer journeys, their reflections on death, dying, and MAD (as informed by and filtered through the lens of their illness experiences), and policy and process reflections.

Interpretation: Our study offers new insights into filling gaps related to mature minors' and parents' perspectives on MAID. Consideration of suffering was central within the participant's narratives, highlighting important takeaways for clinicians. Moreover, the sensitivity that mature minor participants applied to discussions related to MAID, along with the diversity of their perspectives, affirms the significance and value of their engagement.

Background: Adequate nutrition is essential for growth and development during infancy and early childhood; however, the healthfulness and cost of commercial infant and toddler food and beverage products (ITP) have not been documented in Canada.

Objective: This study assessed the nutritional quality and prices of ITP in the Canadian food supply.

Design: Using the Food Label Information and Price 2020 database, ITP intended for children < 4-years-old (n = 423) were examined for their energy and nutrient content (per 100 g or mL), the prevalence of products 'High in' nutrient(s)-of-concern (according to Canadian front-of-pack labelling thresholds), and their price (per 100 g or mL).

Results: Median energy level of ITP was 101 kcal [IQR: 67, 400], derived primarily from carbohydrates (21.7 g [14.1, 71.4]). Although total and saturated fat (1.2 g [0, 7.1] and 0 g [0, 0], respectively) and sodium (16 mg [4, 100]) were low, ITP were also low in protein (3.6 g [0.8, 10.0]) and iron (0.9 mg [0.4, 6.0]), and high in sugars (10.9 g [5.5, 17.6]). Based on Canadian front-of-pack labelling thresholds, 59% (n = 248) of products were 'High in' one or more nutrients-of-concern, particularly sugars (55%, n = 234). Prices varied significantly, ranging from $1.32 to $6.95, with toddler products costing more than those for infants ($3.14 vs. $1.55).

Conclusions: Overall, the nutritional quality of commercial ITP in Canada is poor, with many products 'High in' sugars, highlighting the need for healthier, more affordable options and public health policies that can support healthier food environments for infants and toddlers.

Objectives: The Canadian Paediatric Society recommends an enhanced 18-month visit, including the use of a developmental screening tool to stimulate discussion with parents about their child's development, and notes the Nipissing District Developmental Screen (NDDS) is a widely used tool. We examined the predictive validity of the NDDS in children at average-risk for developmental delay and the association between positive screening and health care utilization (HCU).

Methods: Using a prospective design, parents completed the NDDS at the 18-month primary care visit in Toronto, Canada. Child health insurance number was used to link with health administrative databases to collect HCU data. We calculated screening test properties using later neurodevelopmental consultation as the criterion measure and used multivariable negative binomial regression to estimate adjusted rate ratios (aRR) for each HCU type.

Results: Of 802 children (mean age 18 months), 35.5% screened NDDS positive. Mean age at follow-up was 8 years, 20 (2.5%) had a neurodevelopmental consultation, and 94 (11.7%) had a special paediatric consultation/assessment, including developmental and/or behavioural care. Screening test properties were: 50% sensitivity (95% CI 27%, 73%), 65% specificity (95% CI 61%, 68%), 35% false positive rate (95% CI 31%, 40%). A positive NDDS was associated with only 1 of 7 HCU types.

Conclusions: The sensitivity and specificity of the NDDS is inadequate for a developmental screening tool at 18 months, and the false positive rate is unacceptably high. The screening test properties of other widely used developmental screening tools is discussed, noting their low sensitivity, higher specificity, and lower false positive rates.

Trial registration: Clinicaltrials.gov (NCT01869530).

In 2009, the World Health Organization called for global universal birth dose hepatitis B virus (HBV) vaccination; however, in Canada, five provinces still vaccinate adolescents. The National Advisory Committee on Immunization (NACI) recommends province-to-province assessment of local epidemiology and states that if there is a failure of the routine immunization program, as indicated by HBV infection occurring in infants and children awaiting vaccination, that changes should be made. It has now been shown in Ontario that children under the age of 12 who are born in Canada are acquiring HBV prior to adolescent vaccination. In regions where birth dose vaccination was implemented decades ago, there is a lower adult HBV prevalence. In addition, birth dose vaccination has been shown to be cost-effective in Canada. With these data, we strongly encourage NACI to provide a uniform Canadian recommendation, for provincial public health policymakers to move to universal birth dose vaccination, and for providers to offer universal vaccination accross Canada.

In the last decade, hepatitis C virus (HCV) has become a curable chronic viral infection, with excellent treatment and streamlined diagnostic testing. Canada and many other countries have adopted national elimination targets; however, reaching these goals will require changes in the way care is provided. Standard of care HCV treatment is all-oral daily medication for 8 or 12 weeks and all provinces in Canada have mechanisms for public coverage. Unfortunately, vertical transmission continues to be the predominant reason for paediatric infection, but if diagnosed, children can be treated as young as 3 years old. Early paediatric diagnosis and cure are of the utmost importance to prevent complications such as adverse mental health outcomes and advanced liver disease early in life. One major barrier to paediatric diagnosis and cure is poor antibody screening uptake, as low as 23% by 18 months among children born to positive persons. In the United States, a landmark study showed a temporal decrease in screening rates from 91% at 2 months to 59% at 18 months. As such, the American Association for Study of the Liver/Infectious Disease Society of America, and very recently, the Centres for Disease Control and Prevention, now recommend screening by all children born to positive person for HCV RNA at 2-6 months of age. While antibody testing could still be completed at 18 months to determine serostatus, understanding if a child has active infection in infancy supports early linkage to care and decreases paediatric loss to follow-up.

Background: Hemodynamic instability in neonatal hypoxic-ischemic encephalopathy (HIE) can contribute to brain injury but long-term neurodevelopmental data is limited. Our objective was to compare the effect of hemodynamic instability requiring vasoactive support on radiologic brain injury and neurodevelopmental outcomes in HIE with therapeutic hypothermia (TH).

Methods: This retrospective cohort study compared infants with HIE post-TH who did not require (Group I) versus those who required vasoactive medications (Group II). The association between hemodynamic instability and MRI brain injury or Bayley Scales of Infant Development III (BSID-III) was evaluated by logistic regression.

Results: Among 185 infants, group II had higher adjusted odds of moderate-severe grey matter injury [odds ratio 5.54; 95% confidence interval 1.70 - 18.05; p < 0.001] than group I, with no differences in adjusted 18-24-month BSID-III scores.

Conclusion: Hemodynamic instability requiring vasoactive support in HIE with TH was associated with higher odds of radiologic brain injury but no difference in neurodevelopmental outcomes.

Every paediatrician's career includes the provision of care for children with life-limiting conditions. The College of Physicians and Surgeons of Ontario published a revised policy, "Decision-making for End-of-Life Care," in March 2023; in this commentary we explore the ramifications of this policy for community and acute care paediatricians in Ontario and highlight principles to contextualize this beyond provincial borders. In particular we discuss its impact upon clinicians' moral distress and the importance of: i) early and longitudinal engagement with patients and families, where possible, to contextualize the role of resuscitative measures (if any) in addition to the many other important considerations concerning high quality end-of-life care; and ii) preventing bias and calibrating decision-making with clinical colleagues (including Bioethics) to ensure CPR is never withheld because of a child's protected characteristics such as their race, age, or disability.

The high prevalence of children and adolescents living with obesity, as well as the multitude of associated risks, stress the need for refined weight management strategies for this population. While an overarching lifestyle intervention may be an ideal way to improve energy balance, more practical recommendations would likely improve adherence rates. This review set out to investigate sugar-sweetened beverage consumption and screen time as potential lifestyle targets to reduce paediatric obesity. We report strong evidence that both sugar-sweetened beverage consumption and screen time influence childhood obesity directly, as well as through interactions with sleep patterns. Potential mechanisms are discussed with focus on the energy balance framework of obesity. We also present methodological considerations to improve applicability and consistency of future studies.