The Impact of Parental Presence Restrictions on Canadian Parents in the NICU During COVID-19: A National Survey.

The purpose of this research was to explore parental perspectives on the impact of parent restrictions imposed in response to the COVID-19 pandemic across Canadian Neonatal Intensive Care Units (NICUs). A co-designed online survey was conducted targeting parents (n = 235) of infants admitted to a Canadian NICU from March 1, 2020, until March 5, 2021. Parents completed the survey from 38 Canadian NICUs. Large variation in the severity of policies regarding parental presence was reported. Most respondents (68.9%) were classified as experiencing high restrictions, with one or no support people allowed in the NICU, and felt that policies were less easy to understand, felt less valued and respected, and found it more challenging to access medicine or health care. Parents reported gaps in care related to self-care, accessibility, and mental health outcomes. There is significant variation in parental restrictions implemented across Canadian NICUs. National guidelines are needed to support consistent and equitable care practices.

Neurodevelopmental outcomes of very preterm infants who received cord milking at birth: a randomized controlled trial.

Umbilical cord milking improves postnatal adaptation and short-term outcomes of very preterm infants compared to early cord clamping. Little is known about the impact of umbilical cord milking on long-term neurodevelopmental outcomes. The objective of this study is to compare the effects of intact umbilical cord milking (UCM) vs. early cord clamping (ECC) at birth on neurodevelopmental outcomes at 36 months' corrected age. Preterm infants < 31 weeks' gestation who were randomized at birth to receive three time milking of their attached cord or ECC (< 10 s) were evaluated at 36 months' corrected age. Neurodevelopmental outcomes were assessed by blinded examiners using Bayley Scales of Infant and Toddler Development (version III). Analysis was by intention to treat. Out of the 73 infants included in the original trial, 2 died and 65 (92%) infants were evaluated at 36 months' corrected age. Patient characteristics and short-term outcomes were similar in both study groups. There were no significant differences in the median cognitive, motor or language scores or in the rates of cerebral palsy, developmental impairment, deafness, or blindness between study groups. CONCLUSION: Neurodevelopmental outcomes at 36 months' corrected age of very preterm infants who received UCM were not shown to be significantly different from those who received ECC at birth. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01487187 What is Known: • Compared to early cord clamping, umbilical cord milking improves postnatal adaptation and short-term outcomes of very preterm infants compared to early cord clamping. • Little is known about the impact of umbilical cord milking on neurodevelopmental outcomes. WHAT IS NEW: • Neurodevelopmental outcomes at 3 years of age were not significantly different in very preterm infants who received cord milking vs. those who received early cord clamping at birth.

EPIQ Review.

BACKGROUND: A checklist that promotes compliance with aseptic technique during line insertion is a component of many care bundles aimed at reducing nosocomial infections among intensive care unit patients. OBJECTIVE: To determine whether the use of bundled interventions that include a checklist during central-line insertions reduces catheter-related bloodstream infections in intensive care unit patients. METHODS: A literature review was performed using methodology adapted from the American Heart Association's International Liaison Committee on Resuscitation. RESULTS: Seventeen cohort studies were included. Thirteen studies were supportive of the intervention, while four were neutral. Infection rates ranged from 1.6 to 10.8 per 1000 central-line days in control groups, and from 0.0 to 3.8 per 1000 central-line days in the intervention groups. CONCLUSION: There is fair evidence to recommend the use of care bundles that include a checklist during central-line insertion in intensive care unit patients to reduce the incidence of catheter-related bloodstream infections.

HISTORIQUE: Une liste de vérification qui favorise le respect d'une technique aseptique pendant l'insertion d'un cathéter fait partie de nombreux « soins regroupés ¼ pour réduire les infections nosocomiales chez les patients à l'unité de soins intensifs. OBJECTIF: Déterminer si le recours à des interventions regroupées qui incluent une liste de vérification pendant l'insertion d'un cathéter central réduit les infections sanguines liées aux cathéters chez les patients à l'unité de soins intensifs. MÉTHODOLOGIE: Analyse bibliographique au moyen de la méthodologie adaptée du comité de liaison internationale sur la réanimation de l'American Heart Association. RÉSULTATS: Dix-sept études de cohorte ont été incluses. Treize étaient favorables à l'intervention et quatre étaient neutres. Le taux d'infection variait entre 1,6 et 10,8 cas sur 1 000 jours-cathéters centraux dans les groupes témoins, et entre 0,0 et 3,8 cas sur 1 000 jours-cathéters centraux dans les groupes d'intervention. CONCLUSION: Les preuves sont acceptables pour recommander l'utilisation de groupes de soins qui incluent une liste de vérification pendant l'insertion d'un cathéter central chez les patients de l'unité de soins intensifs pour réduire l'incidence d'infections sanguines liées aux cathéters.

Use of bundled interventions, including a checklist to promote compliance with aseptic technique, to reduce catheter-related bloodstream infections in the intensive care unit.

BACKGROUND: A checklist that promotes compliance with aseptic technique during line insertion is a component of many care bundles aimed at reducing nosocomial infections among intensive care unit patients. OBJECTIVE: To determine whether the use of bundled interventions that include a checklist during central-line insertions reduces catheter-related bloodstream infections in intensive care unit patients. METHODS: A literature review was performed using methodology adapted from the American Heart Association's International Liaison Committee on Resuscitation. RESULTS: Seventeen cohort studies were included. Thirteen studies were supportive of the intervention, while four were neutral. Infection rates ranged from 1.6 to 10.8 per 1000 central-line days in control groups, and from 0.0 to 3.8 per 1000 central-line days in the intervention groups. CONCLUSION: There is fair evidence to recommend the use of care bundles that include a checklist during central-line insertion in intensive care unit patients to reduce the incidence of catheter-related bloodstream infections.

HISTORIQUE: Une liste de vérification qui favorise le respect d'une technique aseptique pendant l'insertion d'un cathéter fait partie de nombreux « soins regroupés ¼ pour réduire les infections nosocomiales chez les patients à l'unité de soins intensifs. OBJECTIF: Déterminer si le recours à des interventions regroupées, qui incluent une liste de vérification pendant l'insertion d'un cathéter central, réduit les infections sanguines liées aux cathéters chez les patients à l'unité de soins intensifs. MÉTHODOLOGIE: Analyse bibliographique au moyen de la méthodologie adaptée du comité de liaison internationale sur la réanimation de l'American Heart Association. RÉSULTATS: Dix-sept études de cohorte ont été incluses. Treize étaient favorables à l'intervention et quatre étaient neutres. Le taux d'infection variait entre 1,6 et 10,8 cas sur 1 000 jours-cathéters centraux dans les groupes témoins, et entre 0,0 et 3,8 cas sur 1 000 jourscathéters centraux dans les groupes d'intervention. CONCLUSION: Les preuves sont acceptables pour recommander l'utilisation de groupes de soins qui incluent une liste de vérification pendant l'insertion d'un cathéter central chez les patients de l'unité de soins intensifs pour réduire l'incidence d'infections sanguines liées aux cathéters.

Probiotics for preterm infants: A National Retrospective Cohort Study.

OBJECTIVE: To evaluate the effect of prophylactic probiotic (PP) administration on rates of necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and mortality in preterm infants. STUDY DESIGN: We conducted a retrospective cohort study of infants < 29 weeks' gestation, admitted to neonatal intensive care units participating in the Canadian Neonatal Network between 1 January 2014 and 31 December 2015. Infants in the exposure group received PP. A multiple logistic regression model with generalized estimation equation was used. RESULTS: A total of 3093 infants were included, 652 infants (21%) received PP. The adjusted odds ratios (aOR) of NEC (aOR 0.64, 95% confidence interval [CI] 0.410, 0.996), mortality (aOR 0.41, 95% CI 0.26, 0.63), and a composite of NEC or mortality were significantly lower in the PP group. There was no significant difference in the aOR of LOS. CONCLUSION: Prophylactic probiotic administration is associated with a reduction in NEC and mortality in preterm infants.

Routine bone marrow examination in the initial evaluation of paediatric Hodgkin lymphoma: the Canadian perspective.

Bone marrow examination (BME) in paediatric Hodgkin lymphoma (HL) was evaluated, as evidence from adult HL suggests it may be unnecessary. An internet-based survey was used to examine the practice of Canadian paediatric oncologists regarding BME in children and the impact of routine BME was evaluated in patients with HL treated at our institution. Sixteen of 17 paediatric oncology centres were represented. Forty-three percent of eligible doctors completed the survey. Routine BME for stages III and IV disease was consistent nationally. By contrast, 54% and 70% of respondents reported performing routine BME for stages I and II HL respectively. Respondents were more likely to report performing routine BME in low-stage HL if trained outside Canada (P = 0.04, stage I; P = 0.07, stage II) or practicing at smaller centres (P = 0.05, stage I; P = 0.03, stage II). At our institution, 62 patients were eligible for analysis. Only four patients (6.5%) had a positive BME. Anaemia was the only significant risk factor (P = 0.006). No patient with otherwise low stage was found to have marrow involvement. Comparison of staging with and without BME demonstrated no significant difference to final risk classification. BME in paediatric patients with low-stage HL has extremely low yield and may be unnecessary.