Paediatrics & Child Health

Background: The hepatic carnitine palmitoyltransferase I ( CPT1A ) p.P479L variant is common in Aboriginal populations across coastal British Columbia, Alaska, the Canadian North, and Greenland. While the high frequency of this variant suggests positive selection, other studies have shown an association with sudden unexpected death in infancy and infection. We utilized administrative health data to evaluate hospitalizations for a single year cohort of children of First Nations descent genotyped for the variant and, matched for location of birth...

Introduction: Neonatal abstinence syndrome is a growing concern in neonatal intensive care units in rural and remote settings. Methods: A retrospective chart review was conducted of 180 mother-infant dyads born with in utero exposure to buprenorphine (n=60), methadone (n=60) or to other opioids (n=60) to determine neonatal length of stay in hospital, number of days on morphine, day of life of initiation of morphine and the need for phenobarbital. Results: The length of stay in hospital for neonates was 5...

Background: The primary aims of this study were to: 1) assess barriers and facilitators of completing scholarly projects from residents and faculty mentor perspectives, 2) determine the perceived value of new initiatives designed to support resident scholarly projects and 3) determine if these initiatives led to changes in resident publications. Design and Methods: Between June and September 2014, we surveyed 18 paediatric residents and 41 faculty mentors regarding barriers to resident scholarly project completion and the value of new initiatives to support scholarly activity...

Aims: Paediatric transport in remote regions of Canada represents a huge challenge given the acuity of the patients, immense distances, weather and lack of road infrastructure. Transport of patients in the Baffin region of Nunavut is completed entirely by air transport. Two very common paediatric transports are in regards to lower respiratory tract infections and premature deliveries in small rural communities north of Iqaluit. Recently, the advent of noninvasive ventilation has been introduced to the region...

Objectives: Breech presentation is a recognized risk factor for developmental dysplasia of the hip (DDH). Within North America, there is a lack of consensus on screening guidelines for DDH in infants with a negative physical examination of the hips. This study evaluates the need for ultrasound screening in all breech born infants to detect DDH and whether this is influenced by gender, gestational age and mode of delivery. Methods: A retrospective chart review was conducted to identify breech born infants who underwent routine hip ultrasound to detect DDH between 2010 and 2015...

Parenting powerfully influences children's cognitive and social-emotional development. Parents often have behaviour concerns and seek advice from their clinician. This paper is an evidence-based clinic tool to empower clinicians to promote pro-social behaviour through developmentally-targeted strategies that parents can use to decrease problem behaviour. Typical scenarios are provided for noncompliance, aggression, attention, and bedtime worries. Parenting principles: Authoritative parenting is essential for healthy outcomes...

Background: Referrals to paediatric endocrine clinics for short stature are common. Height velocity (HV) is an essential component of the evaluation of short stature as growth deceleration often reflects an underlying paediatric endocrine diagnosis (PED). Access to previous measurements facilitates prompt calculation of HV. Objective: To determine the availability of previous measurements at time of referral for short stature and to determine predictors of a PED...

Objective: To determine the incidence, types of organisms and resistance patterns involved in early-onset neonatal sepsis in Canada. Study design: Early-onset neonatal sepsis cases were identified through the Canadian Paediatric Surveillance Program. Neonates were excluded if they were asymptomatic or if intracranial procedures preceded a positive cerebrospinal fluid culture. Results: One hundred and twenty-seven cases were identified (0.17 cases per 1000 live births)...

No abstract text is available yet for this article.

This practice point provides quick information for front-line health care providers on vaccine-preventable diseases which, given the success of immunization programs in Canada, are now uncommon or rarely seen. These infections can still occur in children and youth from Canada and elsewhere, and their clinical identification has important public health implications. Knowledge of signs and symptoms, immunizing travellers and newcomers to Canada, awareness of outbreaks in-community and elsewhere, and early consultation with an expert in infectious diseases and public health authorities in suspected cases, are key preventive care measures...

Reporting of severe invasive group A streptococcal disease (IGAS) has increased in Canada over the past decade, highlighting the importance of optimal chemoprophylaxis and management strategies. Canadian guidelines have had variable uptake across Canada. This practice point updates relevant aspects of these guidelines, with a focus on chemoprophylaxis of contacts of IGAS cases and clinical management of IGAS. The importance of penicillin in treating group A streptococcal disease is reaffirmed, and the role of clindamycin is discussed...

No abstract text is available yet for this article.

Influenza has been associated with neurological complications. We describe the case of a toddler who presented with symptoms and signs of acute encephalopathy and hydrocephalus. Neuroimaging demonstrated cerebral edema and multifocal diffusion restriction in the thalamus and splenium of the corpus callosum. Influenza A was detected from the nasopharyngeal aspirate. The final diagnosis was acute influenza-associated encephalopathy. Despite treatment with a neuraminidase inhibitor and intravenous immune globulin, the toddler developed neurological sequelae...

Renal injury is known to be a risk of nonsteroidal anti-inflammatory drug (NSAID) therapy in adults. While this appears to be much less common in children, there are some groups of children who do appear to be at risk of renal injury associated with NSAID therapy and clinicians caring for these patients need to be cognizant of this potential risk.

Transitional hypoglycemia is common in at-risk newborns, frequently resulting in therapeutic interference with bonding and breastfeeding; 40% dextrose gel massaged to the buccal mucosa has been shown to decrease hypoglycemia <2.6 mmol/L and NICU admissions. However, in the absence of a newborn-specific product, over-the-counter diabetes-care products with poorly documented composition are being used for neonates. We analyzed the carbohydrate content, and compared composition of the two commercially available gels in Canada, Dex4 and Insta-Glucose...

The objective of this review was to assess the evidence on relaxation training for management of paediatric headaches. Our methodology was a rapid review of English-language peer reviewed published literature focused on studies evaluating relaxation training as a primary or adjunct management option for headache in a paediatric population (0 to 18 years of age). Seven studies involving 571 children were included in the review. The quality of evidence was very low using GRADE criteria. Headache frequency, duration, and intensity were the primary outcomes in the included studies...

An Alternate Funding Plan (AFP) was introduced at the Hospital for Sick Children in 1990 as the fee-for-service model was incapable of meeting the academic mandate of the Department of Pediatrics. The plan was challenged by some members of the Ontario Medical Association and community paediatricians as inefficient, too costly, and possibly a challenge to the fee-for-service system. At present, 28 years later, there are nine productive Department of Pediatrics AFPs across Canada. The current state of the AFPs and possible future direction of the program are discussed...

Despite robust evidence that routine immunization is effective and safe, some parents refuse some or all vaccines for their children. In 2007, concern that Canadian paediatricians and family physicians might be considering dismissal of vaccine refusers from their practices prompted an ethical, legal, and public health analysis which concluded that dismissal was professionally problematic. We now reassess this important issue in the Canadian context updating ethical, legal, and public health considerations highlighting changes since 2007...

Since first defined in 1998, paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and its later, broader iteration, paediatric acute-onset neuropsychiatric syndrome (PANS), have garnered significant attention and controversy. The role of streptococcal infection in children with explosive onset obsessive-compulsive disorder and new onset tics, the natural history of this entity, and the role of symptomatic and disease-modifying therapies, including antibiotics, immunotherapy, and psychoactive drugs, are all issues that have yet to be definitively addressed...

Opioid use in Canada continues to rise. Infants exposed to opioids in utero are at high risk for neonatal abstinence syndrome. Signs and symptoms of withdrawal may not develop before the infant is discharged home. Health professionals may be falling short in adequately identifying and supporting opioid-exposed infants and their families. In the absence of universal toxicology screening, nurses in the community play an instrumental role in assessing, referring, and supporting these families.