Breastfeeding on Injectable Opioid Agonist Therapy: A Case Report.

BACKGROUND: Injectable opioid agonist therapy (iOAT) is the highest-intensity treatment currently available in Canada for individuals with severe opioid use disorder. However, there is limited data on iOAT administration in the perinatal period, with no research, practice guidelines, or known reports of breastfeeding on iOAT. This article presents the first known case of an individual breastfeeding on iOAT. CASE SUMMARY: We present a case of a pregnant 32-year-old woman from Canada with severe opioid use disorder, who stabilized with iOAT and chose to breastfeed her infant. She presented to hospital at 38 + 6 gestation in labor, unstable in her substance use disorder despite multiple interventions and was initiated on iOAT (intravenous hydromorphone) shortly after delivery. Before initiation of breastfeeding the infant was admitted to the neonatal intensive care unit for monitoring. On day 9 of life the infant received breastmilk for the first time, and was discharged from neonatal intensive care unit on day 12 of life with no clinical evidence of sedation or respiratory depression. The infant maintained mixed feeding and at 58 days of life was discharged in the mother and father's care, a healthy infant with stable vitals. DISCUSSION: This case suggests positive infant and maternal health and social outcomes for breastfeeding on iOAT. Further research on perinatal iOAT use and the pharmacokinetics of high-dose hydromorphone in breastmilk is required to inform clinical practice guidelines to safely support individuals and their infants who are impacted by substance use.

Video Diversion Improves Success Rate of Fundoscopic Examination in Children: A Prospective Randomized Controlled Trial.

BACKGROUND: Fundoscopy is an important component of the neurological examination as it can detect pathologies such as high intracranial pressure. However, the examination can be challenging in young children. This study evaluated whether playing a video during eye examination improves the success, duration, and ease of pediatric fundoscopy. MATERIALS AND METHODS: This was a prospective, multipractitioner, multiclinic, randomized controlled trial. Patients aged one to four years were recruited in the emergency department, neurology clinic, spinal cord clinic, and general pediatric clinic. Eye examination was randomized to video or non-video-assisted fundoscopy. Successful examinations were defined as visualizing the fundus within 60 seconds. Time to visualize optic disc was recorded and difficulty of examination was assessed using a 10-point Likert scale. RESULTS: We recruited 101 subjects with a mean age of 2.8 years. Overall, there was a 20% absolute improvement in the success rate of visualizing the optic disc in the video versus non-video group (P < 0.001, 95%CI: 7.8% to 31%). Time to visualize optic disc was also improved (Δ5.3 seconds, P < 0.01, 95%CI: 1.4 to 9.1 seconds). Practitioners and caregivers noticed a 33% (P < 0.01, 95%CI: 21% to 44%) and 42% (P < 0.01, 95%CI: 30% to 56%) relative improvement in the ease of examination with video, respectively. CONCLUSIONS: The use of videos improved the ease, duration, and, most importantly, the success of fundoscopy in younger children. This simple, inexpensive adjunct has great potential to improve the ease and efficacy of this aspect of the neurological examination and allow fundoscopic examination to be effectively performed earlier in the age-appropriate vision screening protocols.

Evaluation of a semi-quantitative CO2 monitor with pulse oximetry for prehospital endotracheal tube placement and management.

OBJECTIVE: To evaluate three prototype versions of semi-quantitative end-tidal CO2 monitors with different alarm features during prehospital or interfacility use. METHODS: Subjects were 43 adult, non-pregnant patients requiring intubation, or who already were intubated and required transport. Teams at one AirEvac and seven Advanced Life Support (ALS) paramedic stations were trained in the use of the monitors. Team members at each station evaluated each model for eight days. Participants completed questionnaires following each use. RESULTS: The monitors performed properly in all cases, but in one case, vomit in the airway adapter tube prevented obtaining a readout. The monitors aided management in 40 of 43 cases (93%); in one, the monitor reading was reported as variable (between 20 and 30 mmHg) although the teams knew the monitors were semi-quantitative; in another, the monitor was not required, but performed properly; and the third was the one in which vomit in the tube prevented a reading. In 26 of 43 cases (60.4%), the monitor was used to confirm endotracheal tube placement (there were no instances of incorrect placement). In all cases, the devices were used to monitor respiration and oxygen saturation. Alarms were audible in the environment, but only preferred in the AirEvac situation. The "breath beep" feature was useful, particularly in patients in whom chest movements during respiration were difficult to observe. CONCLUSIONS: "Breath beeps" were clearly audible and were a useful feature in all prehospital and transport environments, while audible alarms were desired only in the AirEvac situation. Semi-quantitative CO2 detection is valuable in the ALS/AirEvac environment, even for teams with high intubation success rates.