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Objective: Therapeutic hypothermia (TH) is the standard treatment for neonates with hypoxic-ischemic encephalopathy (HIE). Validated cost estimates are required to better evaluate the cost-effectiveness of additional interventions during TH. The goal of this study is to identify clinical factors associated with costs of care and validate the Canadian Neonatal Network (CNN) costing algorithm for neonates with HIE receiving TH. Study design: Single-center retrospective cohort study among neonates with HIE treated with TH in a tertiary neonatal intensive care unit from 2016 to 2018. Actual costs per patient were obtained from the hospital cost accounting system, Coût par Parcours de Soinset de Services, and linked to patient data. Estimated costs per patient were calculated using the CNN case-costing algorithm. Neonates were grouped into cost tertiles to identify characteristics of high resource users. Comparisons of actual costs and estimated costs were performed across 8 cost domains. Results: Among 98 neonates treated with TH, 77 (79%) had mild-moderate HIE and 21 (21%) had severe HIE on admission. Factors associated with higher costs were severity of HIE and other markers of disease severity (seizures, mechanical ventilation, length of stay, and presence of brain injury on magnetic resonance imaging). Total median cost per neonate was $24,692 [IQR: $17,466; $39,234], which highly correlated with the CNN algorithm (median: $28 558 [IQR: $23 644; $40 704]) (R = 0.93, P < .01). The mean difference in total costs between estimates was $5339 (95% CI: $2697, $7981). There was a moderate-to-strong correlation between actual and estimated costs in 5/8 cost domains (R range: 0.68-0.98). Conclusions: Severity of HIE and other markers of disease severity were associated with higher hospital costs. The CNN costing algorithm cost estimates for neonates with HIE treated with TH highly correlate with actual costs but overestimates the costs by approximately 15%.

Objective: To evaluate the association between shift-level organizational data (unit occupancy, nursing overtime ratios [OTRs], and nursing provision ratios [NPRs]) with nosocomial infection (NI) among infants born very preterm in the neonatal intensive care unit (NICU). Study design: This was a multicenter, retrospective cohort study, including 1921 infants 230/7-326/7 weeks of gestation admitted to 3 tertiary-level NICUs in Quebec between 2014 and 2018. Patient characteristics and outcomes (NIs) were obtained from the Canadian Neonatal Network database and linked to administrative data. For each shift, unit occupancy (occupied/total beds), OTR (nursing overtime hours/total nursing hours), and NPR (number of actual/number of recommended nurses) were calculated. Mixed-effect logistic regression models were used to calculate aOR for the association of organizational factors (mean over 3 days) with the risk of NI on the following day for each infant. Results: Rate of NI was 11.5% (220/1921). Overall, median occupancy was 88.7% [IQR 81.0-94.6], OTR 4.4% [IQR 1.5-7.6], and NPR 101.1% [IQR 85.5-125.1]. A greater 3-day mean OTR was associated with greater odds of NI (aOR 1.08, 95% CI 1.02-1.15), a greater 3-day mean NPR was associated lower odds of NI (aOR 0.96, 95% CI 0.95-0.98), and occupancy was not associated with NI (aOR, 0.99, 95% CI 0.96-1.02). These findings were consistent across multiple sensitivity analyses. Conclusions: Nursing overtime and nursing provision are associated with the adjusted odds of NI among infants born very preterm in the NICU. Further interventional research is needed to infer causality.

Abstract Background Immediately after birth, the oxygen saturation is between 30 and 50%, which then increases to 85–95% within the first 10 min. Over the last 10 years, recommendations regarding the ideal level of the initial fraction of inspired oxygen (FiO2) for resuscitation in preterm infants have changed from 1.0, to room air to low levels of oxygen (

Summary: Background: Excessive antimicrobial exposure is associated with an increase in neonatal mortality, morbidities and adverse neurodevelopment. Canadian Neonatal Network has been promoting judicious antimicrobial use through the Evidence-based Practice for Improving Quality processes. Our objective was to evaluate the antimicrobial consumption among neonates in tertiary neonatal intensive care units (NICU) in Canada in the recent decade. Methods: This is a retrospective cohort study including data from very preterm infants (born at

AimTo co-create parental presence practice recommendations across Canadian NICUs during pandemics caused by respiratory pathogens such as COVID-19.MethodsRecommendations were developed through evidence, context, Delphi and Values and Preferences methods. For Delphi 1 and 2, participants rated 50 items and 20 items respectively on a scale from 1 (very low importance) to 5 (very high). To determine consensus, evidence and context of benefits and harms were presented and discussed within the Values and Preference framework for the top-ranked items. An agreement of 80% or more was deemed consensus.ResultsAfter two Delphi rounds (n = 59 participants), 13 recommendations with the highest rated importance were identified. Consensus recommendations included 6 strong recommendations (parents as essential caregivers, providing skin-to-skin contact, direct or mothers' own expressed milk feeding, attending medical rounds, mental health and psychosocial services access, and inclusion of parent partners in pandemic response planning) and 7 conditional recommendations (providing hands-on care tasks, providing touch, two parents present at the same time, food and drink access, use of communication devices, and in-person access to medical rounds and mental health and psychosocial services).ConclusionThese recommendations can guide institutions in developing strategies for parental presence during pandemics caused by respiratory pathogens like COVID-19

Abstract The effectiveness of intravenous immunoglobulin (IVIg) for patients with unexplained recurrent implantation failure (uRIF) remains debated. We retrospectively analysed outcomes of uRIF patients treated with IVIg compared to a separate control uRIF cohort within our center (01/2014–12/2021). Primary outcomes included live birth, miscarriage, or transfer failure. We documented IVIg side effects and maternal/fetal outcomes. Logistic regression analysis was used to assess for association of IVIg exposure with outcomes and adjust for confounders. The study included 143 patients, with a 2:1 ratio of controls to patients receiving IVIg treatment. Patient characteristics were similar between groups. There was higher live birth rate (LBR) in patients receiving IVIg (32/49; 65.3%) compared to controls (32/94; 34%); p

Introduction Severe bronchopulmonary dysplasia (BPD) is a well-known factor consistently associated with impaired cognitive outcomes. Regarding reported benefits on long-term neurodevelopmental outcomes, the potential adverse effects of high-dose docosahexaenoic acid (DHA) supplementation on this short-term neonatal morbidity need further investigations in infants born very preterm. This study will determine whether high-dose DHA enteral supplementation during the neonatal period is associated with the risk of severe BPD at 36 weeks’ postmenstrual age (PMA) compared with control, in contemporary cohorts of preterm infants born at less than 29 weeks of gestation.Methods and analysis As part of an Australian–Canadian collaboration, we will conduct an individual participant data (IPD) meta-analysis of randomised controlled trials targeting infants born at less than 29 weeks of gestation and evaluating the effect of high-dose DHA enteral supplementation in the neonatal period compared with a control. Primary outcome will be severe grades of BPD (yes/no) at 36 weeks’ PMA harmonised according to a recent definition that predicts early childhood morbidities. Other outcomes will be survival without severe BPD, death, BPD severity grades, serious brain injury, severe retinopathy of prematurity, patent ductus arteriosus and necrotising enterocolitis requiring surgery, sepsis, combined neonatal morbidities and growth. Severe BPD will be compared between groups using a multivariate generalised estimating equations log-binomial regression model. Subgroup analyses are planned for gestational age, sex, small-for-gestational age, presence of maternal chorioamnionitis and mode of delivery.Ethics and dissemination The conduct of each trial was approved by institutional research ethics boards and written informed consent was obtained from participating parents. A collaboration and data sharing agreement will be signed between participating authors and institutions. This IPD meta-analysis will document the role of DHA in nutritional management of BPD. Findings will be disseminated through conferences, media interviews and publications to peer-reviewed journals.PROSPERO registration number CRD42023431063.Trial registration number NCT05915806.

Abstract Background Chorioamnionitis is a frequent complication of pregnancy and is known to be associated with serious adverse post-natal outcomes including death. However, the assessment of fetal well-being in labor in the context of chorioamnionitis is often challenging because of fetal tachycardia. Identifying specific risk factors for adverse neonatal outcomes in the context of chorioamnionitis could therefore be of paramount importance. This study aimed to determine if maternal and fetal risk factors for increased neonatal mortality and early neonatal mortality are modified in the context of chorioamnionitis in term pregnancies. Methods A retrospective population-based cohort study using the United States birth/infant death public file from 2011 to 2013 was performed, including all live births at 37 weeks gestation and beyond. Interaction between chorioamnionitis and maternal demographic variables as well as labor and delivery potential risk factors were analyzed for association with neonatal death ( 35 kg/m2), late or no prenatal care, diabetes, meconium-stained amniotic fluid, gestational ages other than 39 weeks, neonatal weight

Umbilical hernia (UH) is a common pediatric condition, for which delaying surgical repair for asymptomatic UH until after age 3 is recommended due to a high incidence of spontaneous closure. We aimed to determine the adherence to guidelines, rate of urgent surgical repair, outcomes, cost, and interinstitutional referral patterns of UH repair in the province of Quebec (Canada). This was a population-based retrospective cohort study of children 28 days to 17 years old who underwent UH repair between 2010 and 2020 using health administrative databases. Children who had multiple procedures, or prolonged peri-operative stays were excluded. Early repair was defined as elective surgery at or under age 3. Of the 3215 children, 1744 (54.2%) were female, and 1872 (58.2%) were treated in a tertiary children's hospital. Guidelines were respected for 2853 out of 3215 children (89.7%). Patients living over 75 km from their treating hospitals (OR 2.36, 95% CI 1.33–4.16, P < 0.01), with pre-existing comorbidities (OR, 2.82; 95% CI, 1.96–4.05; P < 0.001), or being treated in a tertiary center (OR 2.10, 95% CI 1.45–3.03, P < 0.001) had a higher risk of early repair. Repair at or under age 3 and urgent surgery were associated with significant cost increases of 411$ (P < 0.001) and 558$ (P < 0.001), respectively. Quebec has a high rate of adherence to age-specific guidelines for UH repair. Future research should explore factors that explain transfers into tertiary centers, and the extent to which these reflect efficient use of resources. level III. Retrospective comparative study. [ABSTRACT FROM AUTHOR]

Enteral feeding is an essential part of the management of infants with gastroschisis. We hypothesized that exclusive breast milk is associated with improved neonatal outcomes. We conducted a retrospective review of infants with uncomplicated gastroschisis through the Canadian Pediatric Surgery Network (CAPSNet) and Canadian Neonatal Network (CNN). The primary outcome was time to full enteral feeds. We identified 411 infants with gastroschisis treated at CAPSNet centres from 2014 to 2022. 144 patients were excluded due to gestational age <32 weeks, birth weight <1500 g, other congenital anomalies, or complicated gastroschisis. Of the remaining 267 participants, 78% (n = 209) received exclusive breast milk diet in the first 28 days of life, whereas 22% (n = 58) received supplemental or exclusive formula. Infants who received exclusive breast milk experienced higher time to reach full enteral feeding (median 24 vs 22 days, p = 0.047) but were more likely to have undergone delayed abdominal closure (32% vs 17%, p = 0.03). After adjustment, there were no significant differences between groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay. Infants who received supplemental or exclusive formula had a similar risk of necrotizing enterocolitis (4% vs 3%) but were less likely to transition to exclusive breast milk at discharge (73% vs 11%, p < 0.001). Early use of exclusive breast milk in infants with uncomplicated gastroschisis is associated with similar outcomes compared to supplemental or exclusive formula. Patients who received supplemental or exclusive formula were unlikely to transition to exclusive breastfeeding by discharge. Level IIb (Individual Cohort Study). • Infants with gastroschisis are thought to benefit from exclusive breast milk. • This national study of infants with uncomplicated gastroschisis showed that exclusive breast milk in the first 28 days of life was associated with similar in-hospital outcomes but an increased rate of breastfeeding at discharge. [ABSTRACT FROM AUTHOR]

Abstract Background Late-onset sepsis in very low birth weight (VLBW) infants is a diagnostic challenge. We aimed to evaluate the diagnostic utility of the C-Reactive protein (CRP) and the complete blood count (CBC) for late-onset sepsis in VLBW infants. Methods In a 5-year retrospective cohort of 416 VLBW infants born at less than 1500 g, there were 590 separate late-onset sepsis evaluations. CRP and CBC were drawn at time of initial blood culture (T0), at 16–24 h (T24) and 40–48 h (T48) after. The positive cut-off values for abnormal values were the following: CRP ≥10 mg/L and CBC with at least one anomaly, including white blood cell count 0.10, or platelet count

The Covid-19 virus has triggered a worldwide pandemic and therefore many employees were required to work from home which caused numerous challenges. With the Covid-19 pandemic now in its third year, there are already several studies available on the subject of home offices. To investigate the impact of remote work on employee satisfaction and trust, this quantitative study aims to review existing results and formulate hypotheses based on a conceptual model created through a qualitative study and extensive literature review. The research question is as follows: Does home office during Covid-19 affect employee satisfaction and trust? To test the hypotheses, a structural equation model was constructed and analyzed. The culture of trust and flexibility are identified as the biggest influencing factors in this study. [ABSTRACT FROM AUTHOR]

Sulfuric acid is a colourless, odorless liquid, which causes typical injury patterns such as cutaneous and ocular burns, respiratory complications from inhalation, and ingestion injuries (coagulative necrosis of the mucosa, gastric and intestinal perforations) with significant dermal and mucosal injury because of its corrosive action. Most injuries caused by sulfuric acid ingestion are accidental, especially in the paediatric population. Intentional cases of ingestion have rarely been reported in adults as a method of suicide following a major depressive disorder. In this paper, we report the case of a 44-year-old woman who was found dead outside her home with a retained fillet knife embedded in her left chest wall and cutaneous chemical burns extending from her mouth down her chin and anterior torso. During the crime scene investigation, a half empty bottle of chemical drain cleaner containing concentrated sulfuric acid was found next to her body. An autopsy revealed chemical burns to the tongue, trachea, larynx, pharynx and oesophagus along with a blackish fluid in the peritoneal cavity. Histological analyses showed extensive corrosive changes in the gastrointestinal tract. Toxicological screening of blood and urine samples was negative; gastric contents contained a high quantity of concentrated (≈ 96%) sulfuric acid with a pH value of < 1.0. Death was attributed to shock following sulfuric acid ingestion. Circumstantial evidence and autopsy findings proved that the manner of death was suicidal. Complex suicides can be challenging for the forensic pathologist because of the plurality of methods used. The authors highlight the importance of systematical exhaustive postmortem investigation in order to ascertain the cause and manner of death in cases of planned complex suicide.

The Maremmana breed is characterised by rusticity, resistance to harsh environments and good growth ability and it could be considered as one of the most suited breeds for extensive rearing in Italy. Moreover, Maremmana presents high fertility and good fostering ability but, on the other hand, the age at first calving appears quite high. This could probably be due to reduced feed availability to which animals are frequently subjected. The aim of this paper was to determine the age at puberty in Maremmana heifers, the repeatability of the reproductive cycles along the seasons and to verify the possibility to anticipate the age at first service. Haematic levels of progesterone and 17-β-estradiol were determined weekly in 6 heifers raised in pens and fed with 0.70 Milk FU/kg DM and 121 g of gross protein/kg d.m, starting from 9 up to 25 months of age. Metabolic profile was determined monthly to highlight possible metabolic unbalances that could affect reproductive activity. Plasma was submitted to RIA analysis in order to measure steroidal hormones. Puberty was considered reached when two subsequent measures of progesterone resulted higher than 1 ng/ml of plasma. This happened in 5 out of 6 heifers at an average age of 17 months. The fluctuation of the hormonal levels throughout the year seems to exclude the seasonality of the oestrous cycle. The results showed that the level of the most important metabolites is within the normal range and it does not seem to interfere with the choice to anticipate the first service by one year. Possible periods of anoestrus noticed in some herds could be linked to the reduced availability of pastures in a few months of the year.

Examines ramifications of special class placement on the self-concept of learning-disabled children. Results reveal a strong link between learning disabilities and low self-concept. Three kinds of effects of special class placement on self-concept and certain sex differences are indicated. (Author/BB)