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Im JHB, Wahi G, Giglia L, Bayliss A, Kanani R, Pound CM, Sakran M, Schuh S, Gill PJ, Parkin PC, Barrowman N, Mahant S. Oxygen Saturation Targets in Infants Hospitalized With Bronchiolitis: A Multicenter Cohort Study. Hosp Pediatr 2024; 14:67-74. [PMID: 38164101 DOI: 10.1542/hpeds.2023-007301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To examine 2 hospital oxygen saturation target policies and clinical outcomes in infants hospitalized with bronchiolitis. METHODS This multicenter cohort study used data collected from a randomized clinical trial of infants aged 4 weeks to 24 months, hospitalized with bronchiolitis at children's and community hospitals from 2016 to 2019. We modeled the association between hospital oxygen saturation target policy, either 90% while awake and 88% while asleep (90%/88%) or 90% while awake and asleep (90%/90%), and clinical outcomes. RESULTS A total of 162 infants were enrolled at 4 hospitals using a 90%/88% oxygen saturation target and 67 infants at 2 hospitals using a 90%/90% target policy. No significant differences between the 90%/88% group and 90%/90% groups were observed for time to discharge (adjusted hazard ratio, 0.83; 95% confidence interval [CI], 0.61-1.14; P = .25), initiation of supplemental oxygen (adjusted odds ratio [aOR], 0.98; 95% CI, 0.47-2.02; P = .95), time to discontinuation of supplemental oxygen (adjusted hazard ratio, 0.75; 95% CI, 0.44-1.27; P = .28), revisits (aOR, 1.38; 95% CI, 0.52-3.71; P = .52), and parent days missed from work (aOR, 2.41; 95% CI, 0.90-6.41; P = .08). Three infants in the 90%/88% group and none in the 90%/90% group were transferred to the ICU. CONCLUSIONS Among infants hospitalized with bronchiolitis, clinical outcomes were similar between a hospital oxygen saturation target policy of 90% while awake and 88% while asleep compared with 90% while awake and asleep. These findings may inform the design of future trials of oxygen saturation targets in bronchiolitis hospital care.
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Affiliation(s)
- James H B Im
- Dalla Lana School of Public Health
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gita Wahi
- Division of General Pediatrics, Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lucy Giglia
- Division of General Pediatrics, Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ann Bayliss
- Children's Health Division, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
| | - Catherine M Pound
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Mahmoud Sakran
- Department of Pediatrics, Lakeridge Health, Oshawa, and Queens University, Kingston, Ontario, Canada
| | - Suzanne Schuh
- Department of Pediatrics
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter J Gill
- Department of Pediatrics
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Department of Pediatrics
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas Barrowman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Sanjay Mahant
- Department of Pediatrics
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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Sebastian A, Borkhoff CM, Wahi G, Giglia L, Bayliss A, Kanani R, Pound CM, Sakran M, Breen-Reid K, Gill PJ, Parkin PC, Mahant S. A Feeding Adequacy Scale for Children With Bronchiolitis: Prospective Multicenter Study. Hosp Pediatr 2023; 13:895-903. [PMID: 37712130 DOI: 10.1542/hpeds.2023-007339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVES To determine the measurement properties of the Feeding Adequacy Scale (FAS) in young children hospitalized with bronchiolitis. METHODS Multicenter cohort study of infants hospitalized with bronchiolitis at children's and community hospitals in Ontario, Canada. Caregivers and nurses completed the FAS, a 10-cm visual analog scale anchored by "not feeding at all" (score 0) and "feeding as when healthy" (score 10). The main outcome measures were feasibility, reliability, validity, and responsiveness of the FAS. RESULTS A total of 228 children were included with an average (SD) age of 6.3 (5.4) months. Completing the FAS was feasible for caregivers and nurses, with no floor or ceiling effects. Test-retest reliability was moderate for caregivers (intraclass correlation coefficient [ICC] 2,1 0.73; 95% confidence interval [CI] 0.63-0.80) and good for nurses (ICC 2,1 0.75; 95% CI 0.62-0.83). Interrater reliability between 1 caregiver and 1 nurse was moderate (ICC 1,1 0.55; 95% CI 0.45-0.64). For construct validity, the FAS was negatively associated with length of hospital stay and positively associated with both caregiver and nurse readiness for discharge scores (P values <.0001). The FAS demonstrated clinical improvement from the first FAS score at admission to the last FAS score at discharge, with significant differences between scores for both caregivers and nurses (P values for paired t test <.0001). CONCLUSIONS These results provide evidence of the feasibility, reliability, validity, and responsiveness of caregiver-completed and nurse-completed FAS as a measure of feeding adequacy in children hospitalized with bronchiolitis.
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Affiliation(s)
- Agnes Sebastian
- Temerty Faculty of Medicine
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine, Department of Pediatrics
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gita Wahi
- Division of General Pediatrics, Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lucy Giglia
- Division of General Pediatrics, Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ann Bayliss
- Children's Health Division, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
| | - Catherine M Pound
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Mahmoud Sakran
- Department of Pediatrics, Lakeridge Health, Oshawa, and Queens University, Kingston, Ontario, Canada
| | - Karen Breen-Reid
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Gill
- Temerty Faculty of Medicine
- Division of Paediatric Medicine, Department of Pediatrics
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Temerty Faculty of Medicine
- Division of Paediatric Medicine, Department of Pediatrics
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Temerty Faculty of Medicine
- Division of Paediatric Medicine, Department of Pediatrics
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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Mahant S, Wahi G, Bayliss A, Giglia L, Kanani R, Pound CM, Sakran M, Kozlowski N, Breen-Reid K, Arafeh D, Moretti ME, Agarwal A, Barrowman N, Willan AR, Schuh S, Parkin PC. Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:466-474. [PMID: 33646286 PMCID: PMC7922227 DOI: 10.1001/jamapediatrics.2020.6141] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE There is low level of evidence and substantial practice variation regarding the use of intermittent or continuous monitoring in infants hospitalized with bronchiolitis. OBJECTIVE To compare the effect of intermittent vs continuous pulse oximetry on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter, pragmatic randomized clinical trial included infants 4 weeks to 24 months of age who were hospitalized with bronchiolitis from November 1, 2016, to May 31, 2019, with or without supplemental oxygen after stabilization at community and children's hospitals in Ontario, Canada. INTERVENTIONS Intermittent (every 4 hours, n = 114) or continuous (n = 115) pulse oximetry, using an oxygen saturation target of 90% or higher. MAIN OUTCOMES AND MEASURES The primary outcome was length of hospital stay from randomization to discharge. Secondary outcomes included length of stay from inpatient unit admission to discharge and outcomes measured from randomization: medical interventions, safety (intensive care unit transfer and revisits), parent anxiety and workdays missed, and nursing satisfaction. RESULTS Among 229 infants enrolled (median [IQR] age, 4.0 [2.2-8.5] months; 136 [59.4%] male; 101 [44.1%] from community hospital sites), the median length of hospital stay from randomization to discharge was 27.6 hours (interquartile range [IQR], 18.8-49.6 hours) in the intermittent group and 25.4 hours (IQR, 18.3-47.6 hours) in the continuous group (difference of medians, 2.2 hours; 95% CI, -1.9 to 6.3 hours; P = .17). No significant differences were observed between the intermittent and continuous groups in the median length of stay from inpatient unit admission to discharge: 49.1 (IQR, 37.2-87.0) hours vs 46.0 (IQR, 32.5-73.8) hours (P = .13) or in frequencies or durations of hospital interventions, such as oxygen supplementation initiation: 4 of 114 (3.5%) vs. 9 of 115 (7.8%) (P = .16) and median duration of oxygen supplementation: 20.6 (IQR, 7.6-46.1) hours vs. 21.4 (11.6-52.9) hours (P = .66). Similarly, there were no significant differences in frequencies of intensive care unit transfer: 1 of 114 (0.9%) vs 2 of 115 (2.7%) (P = .76); readmission to hospital: 3 of 114 (2.6%) in the intermittent group vs 4 of 115 (3.5%) in the continuous group (P > .99); parent anxiety: mean (SD) parent anxiety score, 2.9 (0.9) in the intermittent group vs 2.8 (0.9) in the continuous group (P = .40); or parent workdays missed: median workdays missed, 1.5 (IQR, 0.5-3.0) vs 1.5 (IQR, 0.5-2.5) (P = .36). Mean (SD) nursing satisfaction with monitoring was significantly greater in the intermittent group: 8.6 (1.7) vs 7.1 (2.8) of 10 workdays; the mean difference was 1.5 (95% CI, 0.9-2.2; P < .001). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, among infants hospitalized with stabilized bronchiolitis with and without hypoxia and managed using an oxygen saturation target of 90% or higher, clinical outcomes, including length of hospital stay and safety, were similar with intermittent vs continuous pulse oximetry. Nursing satisfaction was greater with intermittent monitoring. Given that other important clinical practice considerations favor less intense monitoring, these findings support the standard use of intermittent pulse oximetry in stable infants hospitalized with bronchiolitis. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02947204.
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Affiliation(s)
- Sanjay Mahant
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gita Wahi
- Division of General Pediatrics, Department of Pediatrics, McMaster University and McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Ann Bayliss
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Children’s Health Division, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Lucy Giglia
- Division of General Pediatrics, Department of Pediatrics, McMaster University and McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,North York General Hospital, Toronto, Ontario, Canada
| | - Catherine M. Pound
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Mahmoud Sakran
- Department of Pediatrics, Queens University, Kingston, Ontario, Canada,Department of Pediatrics, Lakeridge Health, Oshawa, Ontario, Canada
| | | | - Karen Breen-Reid
- Learning Institute, Hospital for Sick Children and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Dana Arafeh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myla E. Moretti
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada,Ontario Child Health Support Unit, SickKids Research Institute, Toronto, Ontario, Canada
| | - Amisha Agarwal
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Andrew R. Willan
- Ontario Child Health Support Unit, SickKids Research Institute, Toronto, Ontario, Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne Schuh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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Yousuf EI, Carvalho M, Dizzell SE, Kim S, Gunn E, Twiss J, Giglia L, Stuart C, Hutton EK, Morrison KM, Stearns JC. Persistence of Suspected Probiotic Organisms in Preterm Infant Gut Microbiota Weeks After Probiotic Supplementation in the NICU. Front Microbiol 2020; 11:574137. [PMID: 33117319 PMCID: PMC7552907 DOI: 10.3389/fmicb.2020.574137] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
Probiotics are becoming a prevalent supplement to prevent necrotizing enterocolitis in infants born preterm. However, little is known about the ability of these live bacterial supplements to colonize the gut or how they affect endogenous bacterial strains and the overall gut community. We capitalized on a natural experiment resulting from a policy change that introduced the use of probiotics to preterm infants in a single Neonatal Intensive Care Unit. We used amplicon sequence variants (ASVs) derived from the v3 region of the 16S rRNA gene to compare the prevalence and abundance of Bifidobacterium and Lactobacillus in the gut of preterm infants who were and were not exposed to a probiotic supplement in-hospital. Infants were followed to 5 months corrected age. In the probiotic-exposed infants, ASVs belonging to species of Bifidobacterium appeared at high relative abundance during probiotic supplementation and persisted for up to 5 months. In regression models that controlled for the confounding effects of age and antibiotic exposure, probiotic-exposed infants had a higher abundance of the suspected probiotic bifidobacteria than unexposed infants. Conversely, the relative abundance of Lactobacillus was similar between preterm groups over time. Lactobacillus abundance was inversely related to antibiotic exposure. Furthermore, the overall gut microbial community of the probiotic-exposed preterm infants at term corrected age clustered more closely to samples collected from 10-day old full-term infants than to samples from unexposed preterm infants at term age. In conclusion, routine in-hospital administration of probiotics to preterm infants resulted in the potential for colonization of the gut with probiotic organisms post-discharge and effects on the gut microbiome as a whole. Further research is needed to fully discriminate probiotic bacterial strains from endogenous strains and to explore their functional role in the gut microbiome and in infant health.
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Affiliation(s)
- Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Marilia Carvalho
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Sara E Dizzell
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Stephanie Kim
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Gunn
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Jennifer Twiss
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, ON, Canada
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Connie Stuart
- Neonatal Follow Up Clinic, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Eileen K Hutton
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Jennifer C Stearns
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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D’Alessandro M, Vanniyasingam T, Patel A, Gupta R, Giglia L, Federici G, Wahi G. 6 Factors associated with treatment failure of high flow nasal cannula (HFNC) among children with bronchiolitis: a single centre retrospective study. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bronchiolitis is the most common viral lower respiratory tract infection in children under two years of age and is the leading cause of hospital admission for children under the age of one year. Respiratory support for bronchiolitis with high flow nasal cannula (HFNC) is increasingly being used outside of critical care areas and in community hospitals. It is important to understand the patient factors associated with HFNC treatment failure in order to identify which patients are at higher risk for requiring escalation of respiratory support and transfer to a pediatric critical care centre.
Objectives
The primary objective of this study was to evaluate the patient characteristics that are associated with HFNC treatment failure in bronchiolitis.
Design/Methods
We completed a retrospective review of patients under 24 months of age with a clinical diagnosis of bronchiolitis admitted to a single tertiary level children’s hospital for supportive management with HFNC between January 2014 and December 2018. Patients who were mechanically ventilated or on non-invasive positive pressure ventilation prior to the initiation of HFNC during their hospital stay were excluded. HFNC treatment failure was the primary endpoint of the study, with treatment failure defined as escalation to non-invasive positive pressure or invasive mechanical ventilation. Multivariable logistic regression analysis was used to identify the patient demographic, clinical, and biochemical parameters associated with HFNC failure.
Results
Four hundred and thirty-five patient charts were identified, of which 208 patients met inclusion criteria for the study. Of these patients, 61 (29%) were classified as HFNC treatment failures. The likelihood of failing HFNC support was reduced with older age (OR 0.89; 95% CI 0.81, 0.97; p= 0.011) and greater time spent on HFNC (OR 0.94; 95% CI 0.92, 0.96; p<0.001). Patients with a Modified Tal score greater than 5 at 4 hours of HFNC treatment had a greater likelihood of failing HFNC support (OR 2.81; 95% CI 1.04, 7.64; p= 0.042).
Conclusion
This was the first study to examine predictors of HFNC failure among Canadian children with bronchiolitis. We found that patient age, time spent on HFNC, and severity of bronchiolitis as defined using a Modified Tal score were associated with HFNC failure. These patient factors should be considered when initiating HFNC for bronchiolitis, and may identify patients at risk for escalation of respiratory support, warranting earlier referral to pediatric critical care centres.
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Affiliation(s)
| | | | | | | | - Lucy Giglia
- Department of Pediatrics, McMaster University
| | | | - Gita Wahi
- Department of Pediatrics, McMaster University
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6
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D'Alessandro M, Vanniyasingam T, Patel A, Gupta R, Giglia L, Federici G, Wahi G. Factors associated with treatment failure of high-flow nasal cannula among children with bronchiolitis: a single-centre retrospective study. Paediatr Child Health 2020; 26:e229-e235. [PMID: 34345322 DOI: 10.1093/pch/pxaa087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/03/2020] [Indexed: 11/14/2022] Open
Abstract
Objectives Bronchiolitis is the most common viral lower respiratory tract infection in children under age 2 for which high-flow nasal cannula (HFNC) is increasingly used. Understanding factors associated with HFNC failure is important to identify patients at risk for respiratory deterioration. The objective of this study was to evaluate patient characteristics associated with HFNC failure in bronchiolitis. Methods A retrospective review of patients aged 0 to 24 months, with bronchiolitis who received HFNC within a single tertiary paediatric intensive care unit, between January 2014 and December 2018 was conducted. HFNC treatment failure was defined as escalation to non-invasive positive pressure or invasive mechanical ventilation. Multivariable regression analysis was used to identify demographic, clinical, and biochemical parameters associated with HFNC failure. Results Two hundred eight patients met inclusion criteria, of which 61 (29.33%) failed HFNC. Risk factors for HFNC failure included younger age (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.03, 1.23; P=0.011) and a Modified Tal score greater than 5 at 4 hours of HFNC therapy (OR 2.81; 95% CI 1.04, 7.64; P=0.042). Duration of HFNC in hours was protective (OR 0.94; 95% CI 0.92, 0.96; P<0.001), such that deterioration is less likely once patients have remained stable on HFNC for a prolonged time. Conclusion This is the first study exploring predictors of HFNC failure among Canadian children with bronchiolitis. Patient age, HFNC duration, and Modified Tal score were associated with HFNC failure. These factors should be considered when initiating HFNC for bronchiolitis to identify patients at risk for deterioration.
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Affiliation(s)
| | - Thuva Vanniyasingam
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - Ashaka Patel
- Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Ronish Gupta
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
| | - Giuliana Federici
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
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7
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DeMatteo C, Randall S, Falla K, Lin CY, Giglia L, Mazurek MF, Koelink E. Concussion Management for Children Has Changed: New Pediatric Protocols Using the Latest Evidence. Clin Pediatr (Phila) 2020; 59:5-20. [PMID: 31625406 DOI: 10.1177/0009922819879457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Return to activity (RTA) and return to school (RTS) are important issues in pediatric concussion management. This study aims to update CanChild's 2015 RTA and RTS protocols, on the basis of empirical data and feedback collected from our recently completed prospective cohort study, focusing on concussed children and their caregivers; systematic review of evidence published since 2015; and consultation with concussion management experts. The new protocols highlight differences from the earlier versions, mainly, (1) symptom strata to allow quicker progression for those who recover most quickly; (2) a shortened rest period (24-48 hours) accompanied by symptom-guided activity; (3) the recommendation that children progress through the stages before they are symptom free, if symptoms have decreased and do not worsen with activity; (4) specific activity suggestions at each stage of the RTA protocol; (5) recommendations for the amount of time to spend per stage; and (6) integration of RTS and RTA.
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Affiliation(s)
- Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Randall
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Katie Falla
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Chia-Yu Lin
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,ARiEAL, Centre for Advanced Research in Experimental & Applied Linguistics, McMaster University, Hamilton, Ontario, Canada
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Michael F Mazurek
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Koelink
- Division of Emergency Medicine, Department of Pediatrics, McMaster University Medical Centre and McMaster University, Hamilton, Ontario, Canada
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Mungovan K, Giglia L. 63 Improving pediatric resident awareness of early childhood caries. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Pound CM, Robinson J, Giglia L, Rodd C, Sharma A, Chafe R, Collet JP, Ulanova M, McGavock J. Scholarly training objectives and requirements for paediatric residents in Canada. Paediatr Child Health 2019; 24:76-80. [PMID: 30996596 DOI: 10.1093/pch/pxy070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the absence of national standards for scholarly requirements, paediatric resident training varies significantly across Canadian programs. This variability may contribute to significant differences in trainee experiences and productivity. A panel of coordinators of paediatric resident research programs from across Canada met in 2014, to share experiences and identify barriers to successful resident scholarly activity. A survey of all programs was completed in 2015. A scoping review and series of meetings led to the development of a proposed list of expectations, timelines for successful completion and consequences for not completing a scholarly project. We propose a harmonized list of scholarly competencies and activities for paediatric residents in Canada to accomplish before completing their training. We also propose that programs implement standardized timelines and consequences in the event that a resident does not meet their program's scholarly expectations.
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Affiliation(s)
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Celia Rodd
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Atul Sharma
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Roger Chafe
- Pediatrics Faculty of Medicine Memorial University, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland and Labrador
| | - Jean-Paul Collet
- Medical Sciences Division, Faculty of Medicine, Northern Ontario School of Medicine, Lakehead University, Thunderbay, Ontario
| | - Marina Ulanova
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Jonathan McGavock
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
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Mahant S, Wahi G, Giglia L, Pound C, Kanani R, Bayliss A, Roy M, Sakran M, Kozlowski N, Breen-Reid K, Lavigne M, Premji L, Moretti ME, Willan AR, Schuh S, Parkin PC. Intermittent versus continuous oxygen saturation monitoring for infants hospitalised with bronchiolitis: study protocol for a pragmatic randomised controlled trial. BMJ Open 2018; 8:e022707. [PMID: 29678995 PMCID: PMC5914772 DOI: 10.1136/bmjopen-2018-022707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Bronchiolitis is the most common reason for hospitalisation in infants in developed countries. The main focus of hospital care is on supportive care, such as monitoring for hypoxia and supplemental oxygen administration, as active therapies lack effectiveness. Pulse oximetry is used to monitor hypoxia in hospitalised infants and is used either intermittently or continuously. Observational studies have suggested that continuous pulse oximetry use leads to a longer length of hospital stay in stable infants. The use of continuous pulse oximetry may lead to unnecessary clinical intervention due to readings that are of little clinical significance, false-positive readings and less reliance on the clinical status. There is a lack of high-quality evidence to guide which pulse oximetry monitoring strategy, intermittent or continuous, is superior in infants hospitalised with bronchiolitis with respect to patient and policy-relevant outcomes. METHODS AND ANALYSIS This is a multicentre, pragmatic randomised controlled trial comparing two strategies for pulse oximetry monitoring in infants hospitalised for bronchiolitis. Infants aged 1 month to 2 years presenting to Canadian tertiary and community hospitals will be randomised after stabilisation to receive either intermittent or continuous oxygen saturation monitoring on the inpatient unit until discharge. The primary outcome is length of hospital stay. Secondary outcomes include additional measures of effectiveness, acceptability, safety and cost. We will need to enrol 210 infants in order to detect a 12-hour difference in length of stay with a type 1 error rate of 5% and a power of 90%. ETHICS AND DISSEMINATION Research ethics approval has been obtained for this trial. This trial will provide data to guide hospitals and clinicians on the optimal pulse oximetry monitoring strategy in infants hospitalised with bronchiolitis. We will disseminate the findings of this study through peer-reviewed publication, professional societies and meetings. TRIAL REGISTRATION NUMBER NCT02947204.
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Affiliation(s)
- Sanjay Mahant
- Division of Paediatric Medicine, Paediatric Outcomes Research Team (PORT), Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Research Institute, Hospital for Sick Children, Hamilton, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Lucy Giglia
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Pound
- Department of Paediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ronik Kanani
- Department of Paediatrics, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Madan Roy
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Sakran
- Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, Ontario, Canada
| | | | - Karen Breen-Reid
- Interprofessional Education, Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mollie Lavigne
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Laila Premji
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myla E Moretti
- Clinical Trials Unit-Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew R Willan
- Dalla Lana School of Public Health, Ontario Child Health Support Unit, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suzanne Schuh
- Division of Emergency Medicine, Department of Paediatrics, University of Toronto Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine, Paediatric Outcomes Research Team (PORT), Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Research Institute, Hospital for Sick Children, Hamilton, Ontario, Canada
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11
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Lutsiv O, Hulman A, Woolcott C, Beyene J, Giglia L, Armson BA, Dodds L, Neupane B, McDonald SD. Examining the provisional guidelines for weight gain in twin pregnancies: a retrospective cohort study. BMC Pregnancy Childbirth 2017; 17:330. [PMID: 28962593 PMCID: PMC5622523 DOI: 10.1186/s12884-017-1530-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Weight gain during pregnancy has an important impact on maternal and neonatal health. Unlike the Institute of Medicine (IOM) recommendations for weight gain in singleton pregnancies, those for twin gestations are termed "provisional", as they are based on limited data. The objectives of this study were to determine the neonatal and maternal outcomes associated with gaining weight below, within and above the IOM provisional guidelines on gestational weight gain in twin pregnancies, and additionally, to explore ranges of gestational weight gain among women who delivered twins at the recommended gestational age and birth weight, and those who did not. METHODS A retrospective cohort study of women who gave birth to twins at ≥20 weeks gestation, with a birth weight ≥ 500 g was conducted in Nova Scotia, Canada (2003-2014). Our primary outcome of interest was small for gestational age (<10th percentile). In order to account for gestational age at delivery, weekly rates of 2nd and 3rd trimester weight gain were used to categorize women as gaining below, within, or above guidelines. We performed traditional regression analyses for maternal outcomes, and to account for the correlated nature of the neonatal outcomes in twins, we used generalized estimating equations (GEE). RESULTS A total of 1482 twins and 741 mothers were included, of whom 27%, 43%, and 30% gained below, within, and above guidelines, respectively. The incidence of small for gestational age in these three groups was 30%, 21%, and 20%, respectively, and relative to gaining within guidelines, the adjusted odds ratios were 1.44 (95% CI 1.01-2.06) for gaining below and 0.92 (95% CI 0.62-1.36) for gaining above. The gestational weight gain in women who delivered twins at 37-42 weeks with average birth weight ≥ 2500 g and those who delivered twins outside of the recommend ranges were comparable to each other and the IOM recommendations. CONCLUSIONS While gestational weight gain below guidelines for twins was associated with some adverse neonatal outcomes, additional research exploring alternate ranges of gestational weight gain in twin pregnancies is warranted, in order to optimize neonatal and maternal outcomes.
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Affiliation(s)
- Olha Lutsiv
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Room 3N52B, Hamilton, ON L8S 4K1 Canada
| | - Adam Hulman
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Room 3N52B, Hamilton, ON L8S 4K1 Canada
| | - Christy Woolcott
- Departments of Obstetrics and Gynaecology, and Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, ON Canada
| | - B. Anthony Armson
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS Canada
| | - Linda Dodds
- Departments of Obstetrics and Gynaecology, and Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Binod Neupane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
| | - Sarah D. McDonald
- Departments of Obstetrics and Gynecology, Radiology, and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
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Livingston MH, Mahant S, Ratjen F, Connolly BL, Thorpe K, Mamdani M, Maclusky I, Laberge S, Giglia L, Walton JM, Yang CL, Roberts A, Shawyer AC, Brindle M, Parsons SJ, Stoian CA, Cohen E. Intrapleural Dornase and Tissue Plasminogen Activator in pediatric empyema (DTPA): a study protocol for a randomized controlled trial. Trials 2017. [PMID: 28646887 PMCID: PMC5482972 DOI: 10.1186/s13063-017-2026-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND A randomized controlled trial of adults with empyema recently demonstrated decreased length of stay in hospital in patients treated with intrapleurally administered dornase alfa and fibrinolytics compared to fibrinolytics alone. Whether this treatment strategy is safe and effective in children remains unknown. METHODS/DESIGN This study protocol is for a superiority, placebo-controlled, parallel-design, multicenter randomized controlled trial. The participants are previously well children admitted to a children's hospital with a diagnosis of empyema requiring chest tube insertion and fibrinolytics administered intrapleurally. Children will be randomized after the treating physician has decided that pleural drainage is required but prior to chest tube insertion. After chest tube insertion, participants in the treatment group will receive intrapleurally administered tissue plasminogen activator (tPA) 4 mg followed by dornase alfa 5 mg. Participants in the placebo group will receive tPA 4 mg followed by normal saline. Study treatments will be administered once daily for 3 days. All participants, parents or caregivers, clinicians, and research personnel will remain blinded. The primary outcome is length of stay from chest tube insertion to discharge from hospital. Secondary outcomes include time to meeting discharge criteria, chest tube duration, fever duration, need for additional procedures, adverse events, hospital readmission, cost of hospitalization, and mortality. DISCUSSION This multicenter randomized controlled trial will assess the safety, effectiveness, and cost-effectiveness of combined treatment with dornase alfa and fibrinolytics compared to fibrinolytics alone for the treatment of empyema in children. TRIAL REGISTRATION ClinicalTrials.gov: NCT01717742 . Registered on 8 October 2012.
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Affiliation(s)
- Michael H Livingston
- McMaster Children's Hospital, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sanjay Mahant
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Felix Ratjen
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Bairbre L Connolly
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Muhammad Mamdani
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Ian Maclusky
- Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 5B2, Canada
| | - Sophie Laberge
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Lucy Giglia
- McMaster Children's Hospital, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - J Mark Walton
- McMaster Children's Hospital, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Connie L Yang
- Department of Pediatrics, Division of Respiratory Medicine, British Columbia's Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Ashley Roberts
- Department of Pediatrics, Division of Respiratory Medicine, British Columbia's Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Anna C Shawyer
- Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A9, Canada
| | - Mary Brindle
- Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A9, Canada
| | - Simon J Parsons
- Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A9, Canada
| | - Cristina A Stoian
- Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A9, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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13
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Roychoudhury S, Roy M, Giglia L, Arora S, Braga L. CONSISTENCY TO CONSENSUS: HOW STANDARDIZATION OF POSTNATAL MANAGEMENT OF PRENATAL HYDRONEPHROSIS IMPACTED CARE. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jarde A, Lutsiv O, Park CK, Beyene J, Dodd JM, Barrett J, Shah PS, Cook JL, Saito S, Biringer AB, Sabatino L, Giglia L, Han Z, Staub K, Mundle W, Chamberlain J, McDonald SD. Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis. BJOG 2017; 124:1176-1189. [PMID: 28276151 DOI: 10.1111/1471-0528.14624] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it. OBJECTIVES To compare progesterone, cerclage and pessary, determine their relative effects and rank them. SEARCH STRATEGY We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL and Web of Science (to April 2016), without restrictions, and screened references of previous reviews. SELECTION CRITERIA We included randomised trials of progesterone, cerclage or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study. DATA COLLECTION AND ANALYSIS We extracted data by duplicate using a piloted form and performed Bayesian random-effects network meta-analyses and pairwise meta-analyses. We rated evidence quality using GRADE, ranked interventions using SUCRA and calculated numbers needed to treat (NNT). MAIN RESULTS We included 36 trials (9425 women; 25 low risk of bias trials). Progesterone ranked first or second for most outcomes, reducing PTB < 34 weeks [odds ratio (OR) 0.44; 95% credible interval (CrI) 0.22-0.79; NNT 9; low quality], <37 weeks (OR 0.58; 95% CrI 0.41-0.79; NNT 9; moderate quality), and neonatal death (OR 0.50; 95% CrI 0.28-0.85; NNT 35; high quality), compared with control, in women overall at risk. We found similar results in the subgroup with previous PTB, but only a reduction of PTB < 34 weeks in women with a short cervix. Pessary showed inconsistent benefit and cerclage did not reduce PTB < 37 or <34 weeks. CONCLUSIONS Progesterone was the best intervention for preventing PTB in singleton pregnancies at risk, reducing PTB < 34 weeks, <37 weeks, neonatal demise and other sequelae. TWEETABLE ABSTRACT Progesterone was better than cerclage and pessary to prevent preterm birth, neonatal death and more in network meta-analysis.
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Affiliation(s)
- A Jarde
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - O Lutsiv
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - C K Park
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - J Beyene
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - J M Dodd
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia
| | - J Barrett
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P S Shah
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - J L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada.,Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada
| | - S Saito
- Department of Obstetrics and Gynaecology, University of Toyama, Toyama, Japan
| | - A B Biringer
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - L Sabatino
- Midwifery Education Program, McMaster University, Hamilton, ON, Canada
| | - L Giglia
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Z Han
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - K Staub
- Canadian Premature Babies Foundation, Sherwood Park, AB, Canada
| | - W Mundle
- Maternal Fetal Medicine Clinic, Windsor Regional Hospital, Windsor, ON, Canada
| | - J Chamberlain
- Save the Mothers, Uganda Christian University, Mukono, Uganda
| | - S D McDonald
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
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Jarde A, Lutsiv O, Park CK, Barrett J, Beyene J, Saito S, Dodd JM, Shah PS, Cook JL, Biringer AB, Giglia L, Han Z, Staub K, Mundle W, Vera C, Sabatino L, Liyanage SK, McDonald SD. Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: a systematic review and meta-analysis. BJOG 2017; 124:1163-1173. [DOI: 10.1111/1471-0528.14513] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 12/14/2022]
Affiliation(s)
- A Jarde
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
| | - O Lutsiv
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
| | - CK Park
- Department of Clinical Epidemiology and Biostatistics; McMaster University Hamilton, ON Canada
| | - J Barrett
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - J Beyene
- Department of Clinical Epidemiology and Biostatistics; McMaster University Hamilton, ON Canada
| | - S Saito
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - JM Dodd
- Department of Obstetrics and Gynecology; University of Adelaide; Adelaide Australia
| | - PS Shah
- Department of Paediatrics; University of Toronto; Toronto ON Canada
| | - JL Cook
- The Society of Obstetricians and Gynaecologists of Canada; Ottawa ON Canada
| | - AB Biringer
- Department of Family and Community Medicine; University of Toronto; Toronto ON Canada
| | - L Giglia
- Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - Z Han
- The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an Shaanxi Province China
| | - K Staub
- Canadian Premature Babies Foundation; Sherwood Park AB Canada
| | - W Mundle
- Maternal Fetal Medicine Clinic; Windsor Regional Hospital; Windsor ON Canada
| | - C Vera
- Division of Obstetrics and Gynecology; Escuela de Medicina; Pontificia Universidad Católica de Chile; Santiago Chile
| | - L Sabatino
- Midwifery Education Program; McMaster University; Hamilton ON Canada
| | - SK Liyanage
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
| | - SD McDonald
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
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Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, Beyene J, Wang Y, McDonald SD. Neonatal Outcomes in Women With Untreated Antenatal Depression Compared With Women Without Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2016; 73:826-37. [PMID: 27276520 DOI: 10.1001/jamapsychiatry.2016.0934] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite the prevalence of antenatal depression and the fact that only one-third of pregnant women with depression consider it acceptable to take antidepressants, the effect of untreated depression on neonatal outcomes remains to be addressed thoroughly. OBJECTIVE To undertake a systematic review and meta-analysis to understand the effect of untreated depression on neonatal outcomes. DATA SOURCES We executed our search strategy, with emphasis on its exhaustiveness, in MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials, and Web of Science. The search was conducted in July, 2015. STUDY SELECTION We included randomized and nonrandomized studies that examined neonatal outcomes in women with depression receiving neither pharmacological nor nonpharmacological treatment compared with women without depression. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened titles and abstracts, assessed full-text articles, extracted data, and assessed their quality using a modified version of the Newcastle-Ottawa Scale. We pooled data using random-effects meta-analyses, quantified heterogeneity using the I2 statistic, and explored it with subgroup analyses by type of assessment of depression, severity, reported conflicts of interest, and study quality. MAIN OUTCOMES AND MEASURES Primary outcomes were preterm birth before 37 weeks and before 32 weeks, small and large for gestational age, low birth weight, and neonatal intensive care unit admission. RESULTS Of the 6646 titles initially identified, 23 studies met inclusion criteria, all observational, with a total of 25 663 women. Untreated depression was associated with significantly increased risks of preterm birth (odds ratio [OR], 1.56; 95% CI, 1.25-1.94; 14 studies; I2, 39%) and low birth weight (OR, 1.96; 95% CI, 1.24-3.10; 8 studies; I2, 48%), with a trend toward higher risks for exposure to more severe depression. While the odds of preterm birth more than doubled in studies reporting conflicts of interest (OR, 2.50; 95% CI, 1.70-3.67; 5 studies; I2, 0%), studies not reporting such conflicts showed more moderate results (OR, 1.34; 95% CI, 1.08-1.66; 9 studies; I2, 30%). CONCLUSIONS AND RELEVANCE Our results contrast with what is, to our knowledge, the only previous systematic review that examined the question of untreated depression because we found significant risks of 2 key perinatal outcomes, preterm birth and low birth weight. These are important results for pregnant women and clinicians to take into account in the decision-making process around depression treatment.
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Affiliation(s)
- Alexander Jarde
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Morais
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Dawn Kingston
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Giallo
- Healthy Mothers Healthy Families Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Glenda M MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Yi Wang
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
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Jarde A, Morais M, Kingston D, Giallo R, Giglia L, MacQueen G, Wang Y, Beyene J, McDonald SD. Does non-pharmacological therapy for antenatal depression reduce risks for the infant? Arch Womens Ment Health 2016; 19:549-52. [PMID: 26395260 DOI: 10.1007/s00737-015-0577-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
Depression during pregnancy has been associated with an increased risk of adverse outcomes for the infant such as preterm birth. These risks are not reduced with pharmacological treatment, but the effect of non-pharmacological therapies is unknown. We performed a systematic review to assess the risk of adverse perinatal outcomes in non-pharmacologically treated depressed women compared to non-depressed women. We found no studies that met our inclusion criteria, highlighting a critical need for research on this topic.
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Affiliation(s)
- A Jarde
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - M Morais
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - D Kingston
- Faculty of Nursing, University of Alberta, 11405-87th Avenue, Edmonton, AB, T6G 1C9, Canada
| | - R Giallo
- Healthy Mothers Healthy Families Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, 3052, VIC, Australia
| | - L Giglia
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - G MacQueen
- Department of Psychiatry, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Y Wang
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - J Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - S D McDonald
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Jarde A, Lutsiv O, Park C, Shah P, Biringer A, Saito S, Cook J, Vera C, Barret J, Chamberlain J, Dodd J, Giglia L, Lopez-Yarto M, Mundle W, Sabatino L, Staub K, Han Z, Wang Y, Yu J. P-OBS-JM-077 What is the Best Intervention for Preventing Preterm Birth: Progesterone, Cerclage or Pessary? A Systematic Review and Network Meta-analysis. Journal of Obstetrics and Gynaecology Canada 2016. [DOI: 10.1016/j.jogc.2016.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jarde A, Morais M, Kingston D, Giallo R, Giglia L, MacQueen G, Wang Y, Beyene J, McDonald SD. P-OBS-JM-078 Do Women with Untreated Antenatal Depression Have Worse Neonatal Outcomes than Women Without depression? A systematic Review and Meta-analysis. Journal of Obstetrics and Gynaecology Canada 2016. [DOI: 10.1016/j.jogc.2016.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Livingston MH, Cohen E, Giglia L, Pirrello D, Mistry N, Mahant S, Weinstein M, Connolly B, Himidan S, Bütter A, Walton JM. Are some children with empyema at risk for treatment failure with fibrinolytics? A multicenter cohort study. J Pediatr Surg 2016; 51:832-7. [PMID: 26964704 DOI: 10.1016/j.jpedsurg.2016.02.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines recommend that children with empyema be treated initially with chest tube insertion and intrapleural fibrinolytics. Some patients have poor outcomes with this approach, and it is unclear which factors are associated with treatment failure. METHODS Possible risk factors were identified through a review of the literature. Treatment failure was defined as need for repeat pleural drainage and/or total length of stay greater than 2weeks. RESULTS We retrospectively identified 314 children with empyema treated with fibrinolytics at The Hospital for Sick Children (2000-2013, n=195), Children's Hospital, London Health Sciences Centre (2009-2013, n=39), and McMaster Children's Hospital (2007-2014, n=80). Median length of stay was 11days (range 5-69days). Thirteen percent of children required repeat drainage procedures, and 34% experienced treatment failure. There were no deaths. White blood cell count, erythrocyte sedimentation rate, C-reactive protein, albumin, urea to creatinine ratio, and signs of necrosis on initial chest x-ray were not associated with treatment failure. Multivariable logistic regression demonstrated increased risk with positive blood culture (odds ratio=2.7), immediate admission to intensive care (odds ratio=2.6), and absence of complex septations on baseline ultrasound (odds ratio=2.1). Male gender and platelet count were associated with treatment failure in the univariate analysis but not in the multivariable model. CONCLUSIONS Predicting which children with empyema are at risk for treatment failure with fibrinolytics remains challenging. Risk factors include positive blood culture, immediate admission to intensive care, and absence of complex septations on ultrasound. Routine blood work and inflammatory markers have little prognostic value.
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Affiliation(s)
- Michael H Livingston
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Clinician Investigator Program, McMaster University, Hamilton, Ontario, Canada
| | - Eyal Cohen
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - David Pirrello
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada
| | - Niraj Mistry
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael Weinstein
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bairbre Connolly
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharifa Himidan
- Division of General & Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andreana Bütter
- Division of Pediatric Surgery, Western University, London, Ontario, Canada
| | - J Mark Walton
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada.
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Lutsiv O, Hulman A, Woolcott C, Beyene J, Giglia L, Armson BA, Dodds L, Neupane B, McDonald SD. 288: Is gestational weight gain above the guidelines associated with less SGA in twins? Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kapadia MZ, Park CK, Beyene J, Giglia L, Maxwell C, McDonald SD. Weight Loss Instead of Weight Gain within the Guidelines in Obese Women during Pregnancy: A Systematic Review and Meta-Analyses of Maternal and Infant Outcomes. PLoS One 2015. [PMID: 26196130 PMCID: PMC4509670 DOI: 10.1371/journal.pone.0132650] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Controversy exists about how much, if any, weight obese pregnant women should gain. While the revised Institute of Medicine guidelines on gestational weight gain (GWG) in 2009 recommended a weight gain of 5–9 kg for obese pregnant women, many studies suggested even gestational weight loss (GWL) for obese women. Objectives A systematic review was conducted to summarize pregnancy outcomes in obese women with GWL compared to GWG within the 2009 Institute of Medicine guidelines (5–9 kg). Design Five databases were searched from 1 January 2009 to 31 July 2014. The Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement were followed. A modified version of the Newcastle-Ottawa scale was used to assess individual study quality. Small for gestational age (SGA), large for gestational age (LGA) and preterm birth were our primary outcomes. Results Six cohort studies were included, none of which assessed preterm birth. Compared to GWG within the guidelines, women with GWL had higher odds of SGA <10th percentile (adjusted odds ratio [AOR] 1.76; 95% confidence interval [CI] 1.45–2.14) and SGA <3rd percentile (AOR 1.62; 95% CI 1.19–2.20) but lower odds of LGA >90th percentile (AOR 0.57; 95% CI 0.52–0.62). There was a trend towards a graded relationship between SGA <10th percentile and each of three obesity classes (I: AOR 1.73; 95% CI 1.53–1.97; II: AOR 1.63; 95% CI 1.44–1.85 and III: AOR 1.39; 95% CI 1.17–1.66, respectively). Conclusion Despite decreased odds of LGA, increased odds of SGA and a lack of information on preterm birth indicate that GWL should not be advocated in general for obese women.
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Affiliation(s)
- Mufiza Zia Kapadia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Christina K. Park
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lucy Giglia
- Department of Pediatrics, Division of General Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Cindy Maxwell
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D. McDonald
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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23
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DeMatteo C, Stazyk K, Giglia L, Mahoney W, Singh SK, Hollenberg R, Harper JA, Missiuna C, Law M, McCauley D, Randall S. A Balanced Protocol for Return to School for Children and Youth Following Concussive Injury. Clin Pediatr (Phila) 2015; 54:783-92. [PMID: 25601958 DOI: 10.1177/0009922814567305] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Few protocols exist for returning children/youth to school after concussion. Childhood concussion can significantly affect school performance, which is vital to social development, academic learning, and preparation for future roles. The goal of this knowledge translation research was to develop evidence based materials to inform physicians about pediatric concussion. METHODS The Return to School (RTS) concussion protocol was developed following the National Institute for Health and Care Excellence procedures. RESULTS Based on a scoping review, and stakeholder opinions, an RTS protocol was developed for children/youth. This unique protocol focuses on school adaptation in 4 main areas: (a) timetable/attendance, (b) curriculum, (c) environmental modifications, and (d) activity modifications. CONCLUSION A balance of cognitive rest and timely return to school need to be considered for returning any student to school after a concussion. Implementation of these new recommendations may be an important tool in prevention of prolonged absence from school and academic failure while supporting brain recovery.
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Affiliation(s)
| | | | - Lucy Giglia
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, ON, Canada
| | - William Mahoney
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, ON, Canada
| | - Sheila K Singh
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, ON, Canada
| | - Robert Hollenberg
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, ON, Canada
| | | | | | - Mary Law
- McMaster University, Hamilton, Ontario, Canada
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Selvakumar S, Babic B, Chitayat S, Fitzpatrick K, Latchman A, Seigel S, Giglia L. 9: Comparison of Neonatal Abstinence Syndrome Outcomes Before and After Implementation of Revised Management Guidelines. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Kapadia MZ, Park CK, Beyene J, Giglia L, Maxwell C, McDonald SD. Can we safely recommend gestational weight gain below the 2009 guidelines in obese women? A systematic review and meta-analysis. Obes Rev 2015; 16:189-206. [PMID: 25598037 DOI: 10.1111/obr.12238] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 12/24/2022]
Abstract
A systematic review was conducted to determine the risk of adverse pregnancy outcomes with gestational weight gain (GWG) below the 2009 Institute of Medicine guidelines compared with within the guidelines in obese women. MEDLINE, Embase, Cochrane Register, CINHAL and Web of Science were searched from 1 January 2009 to 31 July 2014. Quality was assessed using a modified Newcastle-Ottawa scale. Three primary outcomes were included: preterm birth, small for gestational age (SGA) and large for gestational age (LGA). Eighteen cohort studies were included. GWG below the guidelines had higher odds of preterm birth (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.07-2.00) and SGA (AOR 1.24; 95% CI 1.13-1.36) and lower odds of LGA (AOR 0.77; 95% CI 0.73-0.81) than GWG within the guidelines. Across the three obesity classes, the odds of SGA and LGA did not show any notable gradient and remained unexplored for preterm birth. Decreased odds were noted for macrosomia (AOR 0.64; 95% CI 0.54-0.77), gestational hypertension (AOR, 0.70; 95% CI 0.53-0.93), pre-eclampsia (AOR 0.90; 95% CI 0.82-0.99) and caesarean (AOR 0.87; 95% CI 0.82-0.92). GWG below the guidelines cannot be routinely recommended but might occasionally be individualized for certain women, with caution, taking into account other known risk factors.
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Affiliation(s)
- M Z Kapadia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
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26
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DeMatteo C, Stazyk K, Singh SK, Giglia L, Hollenberg R, Malcolmson CH, Mahoney W, Harper JA, Missiuna C, Law M, McCauley D. Development of a conservative protocol to return children and youth to activity following concussive injury. Clin Pediatr (Phila) 2015; 54:152-63. [PMID: 25422524 DOI: 10.1177/0009922814558256] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Consensus-based guidelines exist for adult athletes returning to play after concussion, but there are no protocols developed specifically for children. The goal of this knowledge translation research was to develop evidence-based materials to inform physicians about pediatric concussion. METHODS A pediatric concussion protocol was developed based on the National Institute for Health and Care Excellence procedures. RESULTS This return to activity protocol was developed to guide management when children/youth sustain a concussion. The protocol incorporated 3 main themes: (a) a protocol must include return to all activity, including sport and school; (b) existing consensus-based adult protocols are not appropriate for children; and (c) a more conservative protocol is needed. After pilot testing, the developed protocol is being used across Ontario. CONCLUSION Implementation of these new pediatric recommendations is an important addition to prevention of subsequent concussions during vulnerable recovery periods, with potential to facilitate recovery by preventing prolonged symptomatology, and secondary sequelae.
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Affiliation(s)
| | | | - Sheila K Singh
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lucy Giglia
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Robert Hollenberg
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Charles H Malcolmson
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - William Mahoney
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | | | - Mary Law
- McMaster University, Hamilton, Ontario, Canada
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Morais M, Mehta C, Murphy K, Shah PS, Giglia L, Smith PA, Bassil K, McDonald SD. How often are late preterm births the result of non-evidence based practices: analysis from a retrospective cohort study at two tertiary referral centres in a nationalised healthcare system. BJOG 2013; 120:1508-14. [DOI: 10.1111/1471-0528.12401] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
- M Morais
- Department of Obstetrics & Gynecology; Division of Maternal Fetal Medicine; McMaster University; Hamilton ON Canada
| | - C Mehta
- Department of Obstetrics & Gynecology; University of Toronto; Toronto ON Canada
| | - K Murphy
- Department of Obstetrics & Gynecology; University of Toronto; Toronto ON Canada
| | - PS Shah
- Department of Pediatrics; Division of Neonatology; Department of Health Policy, Management and Evaluation; University of Toronto; Toronto ON Canada
| | - L Giglia
- Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - PA Smith
- Department of Obstetrics & Gynecology; Division of Maternal Fetal Medicine; McMaster University; Hamilton ON Canada
| | - K Bassil
- Department of Epidemiology; Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - SD McDonald
- Department of Obstetrics & Gynecology; Division of Maternal Fetal Medicine; McMaster University; Hamilton ON Canada
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
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28
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Lutsiv O, Pullenayegum E, Foster G, Vera C, Giglia L, Chapman B, Fusch C, McDonald SD. Women's intentions to breastfeed: a population-based cohort study. BJOG 2013; 120:1490-8. [DOI: 10.1111/1471-0528.12376] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 11/28/2022]
Affiliation(s)
- O Lutsiv
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - E Pullenayegum
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Centre for Evaluation of Medicines; St Joseph's Healthcare; Hamilton ON Canada
| | - G Foster
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Biostatistics Unit; Father Sean O'Sullivan Research Centre; St Joseph's Healthcare; Hamilton ON Canada
| | - C Vera
- Departmento de Obstetricia y Ginecologia; Escuela de Medicina; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - L Giglia
- Division of General Pediatrics; Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - B Chapman
- Better Outcomes Registry and Network (BORN) Ontario (formerly OPSS); Ottawa ON Canada
| | - C Fusch
- Division of Neonatology; Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - SD McDonald
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Division of Maternal-Fetal Medicine; Departments of Obstetrics & Gynecology and Diagnostic Imaging; McMaster University; Hamilton ON Canada
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Abstract
The number of children undergoing successful renal transplantations has been increasing steadily and as a result; general pediatricians are now more likely to encounter children with a kidney allograft in their practice. Although the medical care immediately after transplantation is mostly provided by transplant teams, more and more outpatient care will eventually be performed at the patient's local community. Medical care from general pediatricians is particularly important, especially for children who are residing far from transplant centers. As these children require prolong immunosuppressive therapies and are susceptible to various specific clinical problems, it is imperative for their primary care providers and pediatricians to be knowledgeable about their specific needs and be competent in providing care. This article highlights the roles and common practice related issues that pertain to general pediatricians in the care of pediatric renal allograft recipients.
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Affiliation(s)
- Keith K Lau
- 1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lucy Giglia
- 1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Howard Chan
- 1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anthony K Chan
- 1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
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Lau KK, Giglia L, Chan H, Chan AK. [Management of children after renal transplantation: highlights for general pediatricians]. Zhongguo Dang Dai Er Ke Za Zhi 2012; 14:81-88. [PMID: 22357461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The number of children undergoing successful renal transplantations has been increasing steadily and as a result, general pediatricians are now more likely to encounter children with a kidney allograft in their practice. Although the medical care immediately after transplantation is mostly provided by transplant teams, more and more outpatient care will eventually be performed at the patient's local community. Medical care from general pediatricians is particularly important, especially for children who are residing far from transplant centers. As these children require prolong immunosuppressive therapies and are susceptible to various specific clinical problems, it is imperative for their primary care providers and pediatricians to be knowledgeable about their specific needs and be competent in providing care. This article highlights the roles and common practice related issues that pertain to general pediatricians in the care of pediatric renal allograft recipients.
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Affiliation(s)
- Keith K Lau
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Ammons B, Griffith L, Giglia L, Mahony J, Chong S, Luinstra K, Smieja M. P288 Estimating the disruptive effects of respiratory viruses on a child's family. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ruggieri RM, Settipani N, Viviano L, Attanasio M, Giglia L, Almasio P, La Bella V, Piccoli F. Long-term interferon-β treatment for multiple sclerosis. Neurol Sci 2003; 24:361-4. [PMID: 14716534 DOI: 10.1007/s10072-003-0190-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2002] [Accepted: 09/26/2003] [Indexed: 10/26/2022]
Abstract
The aim of our study was to analyze the dropout rate in patients with relapsing-remitting multiple sclerosis (RRMS) under long-term treatment with the three commercially available interferon beta (IFNbeta) preparations. According to the drug taken, we divided 122 RRMS patients into 4 groups: Betaferon group, 56 patients taking INFbeta-1b (24 MIU weekly, subcutaneous injections); Avonex group, 38 patients taking IFNbeta-1a (6 MIU weekly, intramuscularly); Rebif group, 18 patients taking INFbeta-1b (18 MIU subcutaneously). Ten patients who shifted from Betaferon to Avonex were included in a fourth group. Dropouts were registered every trimester with the related cause. Data were evaluated using Kaplan-Meier survival analysis and log-rank test. During the observation period of five years, 48 patients (39.9%) dropped out: 48% of the patients in Betaferon group withdrew at a median of 758 days, 26% of the Avonex group at 356 days; 38% of the Rebif group at 421 days, and 40% of those who shifted from Betaferon to Avonex at 259 days. The differences between groups were not significant on survival analysis. Patients receiving higher dose treatment (Betaferon and Rebif groups) dropped out mainly for clinical adverse events; conversely, patients receiving lower dose therapy (Avonex group) dropped out most often for inefficacy. Patients who shifted to a lower dose treatment (fourth group) had a dropout rate similar to that of the initial treatment. Our data showed that one-third of the patients stopped the therapy, mostly for adverse events and then for inefficacy, while the remaining two-thirds were still on treatment without problems up to 5 years of follow-up. Compliance seems related to the dose of the drug, but further analysis is needed to confirm our data.
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Affiliation(s)
- R M Ruggieri
- University of Palermo, Via G. La Loggia 1, I-90129 Palermo, Italy
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Gillies A, Jevremovic A, Giglia L, McMillan H. Emergency Management of Paediatric DKA: Practice vs Proposed Guidelines. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.54a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tam R, Macdonald N, Feder S, Giglia L, Peeling R, Gully P, Toye B, Doherty J. Chlamydia infection in street youth: Need for more aggressive screening programs. Can J Infect Dis 1996; 7:49-52. [PMID: 22514416 PMCID: PMC3327372 DOI: 10.1155/1996/475132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/1995] [Accepted: 06/20/1995] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine, first, the sexual practices among street youth in the Ottawa-Carleton, Ontario region; second, the percentage of street youth who report previous sexually transmitted disease (STD) screening; and third, the rate of previous infection with Chlamydia trachomatis in this population. METHODS This prospective street youth pilot study was cross-sectional in design. Street youth aged 15 to 20 years were recruited through a drop-in centre or shelter in Ottawa, Ontario between August and October 1993. Information on demographics, substance use, current sexual practices and STD screening and infection history were obtained through a structured face to face interview and a 75-item questionnaire. Past C trachomatis infection was determined by microimmunofluorescence assay with purified antigens of C trachomatis (serovars A to K), Chlamydia psittaci (avian strain 6BC) and Chlamydia pneumoniae (TW-183 strain). RESULTS Ninety-eight per cent of the youth approached participated. Of the 100 street youth (61 males, mean age 17.8 years; 39 females, mean age 17.1 years), 94% were sexually active, with 21% of males and 26% of females having had four or more different sexual partners in the previous year. Only 27% of males and 8% of females reported consistent condom use with all partners all of the time. Thirty per cent of males and 50% of females reported previous STD testing. Of the 100 street youth, 22 (16 males and six females) had had previous C trachomatis infection by serotesting, but only three of 16 (19%) of these males and three of six (50%) of these females reported previous STD testing. None of the 22 recalled previous diagnosis or treatment for any STD. CONCLUSIONS These street youth reported a high prevalence of risky sexual behaviour, and this supports the national STD guidelines for targeted screening in this population. The current screening guidelines for C trachomatis in this population do not reach the majority of street youth.
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Affiliation(s)
- R Tam
- Departments of Pediatrics and Medicine, University of Ottawa, and Laboratory Centre for Disease Control, Ottawa, Ontario
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Giglia L, Gully PR. Syphilis trends in Canada 1981-1992. Can Commun Dis Rep 1994; 20:113-20. [PMID: 7920362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- L Giglia
- Division of Sexually Transmitted Diseases, Bureau of Communicable Disease Epidemiology, LCDC, Ottawa
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