Designing a national pediatric critical care database: a Delphi consensus study.

PURPOSE: We sought to describe the processes undertaken for the systematic selection and consensus determination of the common data elements for inclusion in a national pediatric critical care database in Canada. METHODS: We conducted a multicentre Delphi consensus study of Canadian pediatric intensive care units (PICUs) participating in the creation of a national database. Participants were PICU health care professionals, allied health professionals, caregivers, and other stakeholders. A dedicated panel group created a baseline survey of data elements based on literature, current PICU databases, and expertise in the field. The survey was then used for a Delphi iterative consensus process over three rounds, conducted from March to June 2021. RESULTS: Of 86 invited participants, 68 (79%) engaged and agreed to participate as part of an expert panel. Panel participants were sent three rounds of the survey with response rates of 62 (91%), 61 (90%) and 55 (81%), respectively. After three rounds, 72 data elements were included from six domains, mostly reflecting clinical status and complex medical interventions received in the PICU. While race, gender, and home region were included by consensus, variables such as minority status, indigenous status, primary language, and ethnicity were not. CONCLUSION: We present the methodological framework used to select data elements by consensus for a national pediatric critical care database, with participation from a diverse stakeholder group of experts and caregivers from all PICUs in Canada. The selected core data elements will provide standardized and synthesized data for research, benchmarking, and quality improvement initiatives of critically ill children.

RéSUMé: OBJECTIF: Nous avons cherché à décrire les processus entrepris pour la sélection systématique et la détermination consensuelle des éléments de données communs à inclure dans une base de données nationale sur les soins intensifs pédiatriques au Canada. MéTHODE: Nous avons mené une étude multicentrique de consensus selon la méthode Delphi sur les unités de soins intensifs pédiatriques (USIP) canadiennes participant à la création d'une base de données nationale. Les personnes participant à l'étude étaient des professionnel·les de la santé de l'USIP, du personnel paramédical, des soignant·es et d'autres intervenant·es. Un groupe de travail spécialisé a créé une enquête de base des éléments de données sur la littérature, les bases de données actuelles portant sur les USIP et l'expertise dans le domaine. L'enquête a ensuite été utilisée pour créer un processus de consensus itératif Delphi sur trois cycles, mené de mars à juin 2021. RéSULTATS: Sur les 86 personnes invitées à participer, 68 (79 %) se sont engagées et ont accepté de participer à un groupe d'experts. Les membres du panel ont reçu trois rondes du sondage, avec des taux de réponse de 62 (91 %), 61 (90 %) et 55 (81 %), respectivement. Après trois cycles, 72 éléments de données provenant de six domaines ont été inclus, reflétant principalement l'état clinique et les interventions médicales complexes reçues à l'USIP. Alors que la race, le genre et la région d'origine ont été inclus par consensus, des variables telles que le statut de minorité, le statut d'autochtone, la langue principale parlée et l'origine ethnique ne l'ont pas été. CONCLUSION: Nous présentons le cadre méthodologique utilisé pour sélectionner des éléments de données consensuels destinés à une base de données nationale sur les soins intensifs pédiatriques, avec la participation d'un groupe diversifié d'expert·es et de soignant·es de toutes les USIP au Canada. Les éléments de données de base sélectionnés fourniront des données normalisées et synthétisées pour la recherche, l'analyse comparative et les initiatives d'amélioration de la qualité pour les enfants gravement malades.

The curious incident of the dog in the nighttime: The effects of pet-human co-sleeping and bedsharing on sleep dimensions of children and adolescents.

BACKGROUND: Pets are often thought to be detrimental to sleep. Up to 75% of households with children have a pet, and 30-50% of adults and children regularly share their bed with their pets. Despite these high rates, few studies have examined the effect of pet-human co-sleeping on pediatric sleep. This study compared subjective and objective sleep in youth who never, sometimes, or frequently co-slept with pets. METHODS: Children (N = 188; aged 11-17 years; M = 13.25 years) and their parents answered standardized sleep questionnaires assessing timing, duration, onset latency, awakenings, and sleep quality. Children completed a home polysomnography (PSG) sleep study for one night and wore an actigraph for two weeks accompanied with daily sleep diary. Based on reported frequency of bedsharing with pets, children were stratified into three co-sleeping groups: never (65.4%), sometimes (16.5%), frequently (18.1%). RESULTS: Overall, 34.6% of children reported co-sleeping with their pet sometimes or frequently. Results revealed largely identical sleep profiles across co-sleeping groups; findings were congruent across sleep measurement (subjective: child, parent report; objective: PSG, actigraphy). Effect sizes indicated that frequent co-sleepers had the highest overall subjective sleep quality, but longest PSG onset-latency compared to the sometimes group. CONCLUSIONS: Co-sleeping with pets was prevalent in one third of children. Sleep dimensions were similar regardless of how frequently children reported sharing their bed with their pet. Future research should examine dyadic measurement of co-sleepers to derive causal evidence to better inform sleep recommendations.

Parental Expectations Are Associated with Children's Sleep Duration and Sleep Hygiene Habits.

OBJECTIVE: Although parents recognize the importance of sleep, most have a limited understanding of children's sleep needs. This study examined whether parental expectations about sleep were linked to children and adolescent's sleep duration and sleep hygiene. METHOD: Participants included 376 unique parent-child dyads. Parents (mean age = 47.0 years, SD = 6.7) estimated the number of hours of sleep their children (mean age = 13.0 years, SD = 2.2; 9-17 years) needed. These estimates were age-matched with recommended pediatric guidelines of the American Academy of Sleep Medicine and the National Sleep Foundation to yield 3 groups: expect less (8%-11%), expect appropriate (85%-89%), and expect more (3%-4%). Sleep duration for school nights and weekends were reported by children and parents. Sleep hygiene included sleep-promoting practices (quiet, dark bedroom, regular bed/wake times, consistent routine) and sleep-interfering practices (physiological arousal, presleep worry, alcohol/smoking intake, daytime napping, screen time). RESULTS: Most parents (68.7%) endorsed that children do not get enough sleep. Linear and logistic regressions were used to assess the impact of parental expectations. For every additional hour of sleep expected, children slept between 15.5 (parent-report 95% confidence interval [CI], 9.0-22.0) and 17.9 minutes (child-report 95% CI, 9.7-26.2) longer on school nights, adjusted for age, sex, puberty, and parental education. For parents who expected less sleep than recommended, their children had the shortest sleep duration, least favorable sleeping environments, and greater presleep worry. CONCLUSION: Parental sleep expectations were directly linked to children's sleep duration. Pediatricians and primary care providers can mobilize knowledge to optimally convey accurate information about developmental sleep needs and recommended hours to parents to promote longer sleep.