Noninvasive ventilation of air transported infants with respiratory distress in the Canadian Arctic.

Objectives: Since 2016, use of nasal continuous positive airway pressure (nCPAP) in Nunavut for air transport in select patients has become common practice. This study examines the outcomes of patients transferred by air from the Qikiqtaaluk Region during air transport. We examined intubation rates, adverse events during transfer, and respiratory parameters at departure and upon arrival. Methods: This was a retrospective review from September 2016 to December 2019 including patients under 2 years of age transferred by air on nCPAP from the Qikiqtaaluk Region of Nunavut. Results: Data were collected for 40 transfers involving 34 unique patients. Six transfers were from remote communities in Nunavut to Iqaluit, and 33 transfers were from Iqaluit to CHEO. The primary outcome measure was whether the patient required intubation during transport, or urgent intubation upon arrival to CHEO. The median nCPAP setting during transport was 6 cm H2O (5-7 cm H2O) and at arrival to CHEO was 6 cm H2O (6-7 cm H2O). Six of the 33 (18.2%) patients required intubation during their hospital stay and five (15.2%) in a controlled ICU setting. There were no discernible adverse events that occurred during transport for 28 patients (84.5%). Four patients (12.1%) required a brief period of bag-mask ventilation and one patient had an episode of bradycardia. Conclusions: nCPAP on air transport is a safe and useful method for providing ventilatory support to infants and young children with respiratory distress.

Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review.

BACKGROUND AND OBJECTIVE: To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children. METHODS: We searched MEDLINE, EMBASE, PubMed, conference proceedings, and reference lists to identify relevant studies. Two reviewers independently selected studies that compared clinical and/or radiographic characteristics including historical features, physical exam and imaging findings, and presenting signs or symptoms in hospitalized children ≤ 6 years old with AHT and nAHT. RESULTS: Twenty-four studies were included. Meta-analysis was complicated by inconsistencies in the reporting of characteristics and high statistical heterogeneity. Notwithstanding these limitations, there were 19 clinical and radiographic variables that could be meta-analyzed and odds ratios were determined for each variable. In examining only studies deemed to be high quality, we found that subdural hemorrhage(s), cerebral ischemia, retinal hemorrhage(s), skull fracture(s) plus intracranial injury, metaphyseal fracture(s), long bone fracture(s), rib fracture(s), seizure(s), apnea, and no adequate history given were significantly associated with AHT. Epidural hemorrhage(s), scalp swelling, and isolated skull fracture(s) were significantly associated with nAHT. Subarachnoid hemorrhage(s), diffuse axonal injury, cerebral edema, head and neck bruising, any bruising, and vomiting were not significantly associated with either type of trauma. CONCLUSIONS: Clinical and radiographic characteristics associated with AHT and nAHT were identified, despite limitations in the literature. This systematic review also highlights the need for consistent criteria in identifying and reporting clinical and radiographic characteristics associated with AHT and nAHT.

Prevalence of nocturnal hypoglycemia in pediatric type 1 diabetes: a pilot study using continuous glucose monitoring.

OBJECTIVES: To determine the prevalence of nocturnal hypoglycemia (NH) in pediatric type 1 diabetes, to compare the prevalence of NH detected by continuous glucose monitoring (CGM) and self-monitored blood glucose (SMBG), and to compare the prevalence of NH using different thresholds. STUDY DESIGN: Twenty-five patients wore a continuous glucose monitor for 3 nights and also conducted SMBG. NH was defined with three thresholds: (1) <3.9 mmol/L; (2) <3.3 mmol/L; and (3) <2.9 mmol/L. RESULTS: The prevalence of NH with CGM was 68%, 52%, and 48% with the different thresholds. Of the 35 episodes of NH detected by CGM, 25 were not symptomatic and therefore not detected by SMBG. The mean difference in blood glucose between CGM and SMBG was -0.18 mmol/L (P = .35). CONCLUSIONS: This pilot study suggests that the prevalence of NH in pediatric patients with type 1 diabetes with conventional treatment may be as high as 68%, although this varied according to the method of detection and threshold used. Patients may benefit from CGM to detect asymptomatic NH.

Intra- and inter-observer reliability using a noninvasive ultrasound cardiac output monitor in healthy anesthetized children.

BACKGROUND: Accurate and reliable evaluation of cardiac index (CI) in critically ill pediatric patients can optimize their management. Although validated, noninvasive ultrasound measurement techniques have been previously shown to be unreliable because of observer variability. OBJECTIVE: To confirm intra- and inter-observer reliability when using the noninvasive USCOM(®) in healthy anesthetized children. METHODS: Prospective observational study at the Children's Hospital of Eastern Ontario, Ottawa, included newborns to 12 years of age undergoing elective surgery or magnetic resonance imaging. The USCOM(®) was used to assess CI via aortic flow with a trans-sternal approach. Two trained observers were responsible for taking two measurements of CI each at steady state in randomized succession after stable depth of anesthesia was achieved. RESULTS: Fifty-nine patients were included. Forty-seven (80%) were between 3 and 7 years old, with 57% male. The mean difference ± sd for repeat CI measurements by each of two observers was 0.11 ± 0.47 and 0.05 ± 0.65 l·min(-1) ·m(-2) , respectively. Intra-observer reliability for these repeat measurements by each observer determined by Lin's concordance correlation coefficient was 0.92 and 0.85, respectively. The mean difference ± sd between observers was 0.16 ± 0.59 l·min(-1) ·m(-2) , and Lin's concordance correlation coefficient was 0.87. The two observers subjectively rated measurements as 'Difficult' or 'Very difficult' only 14% (16/118) and 3% (4/118) of the time, respectively. No adverse events were reported. CONCLUSION: This study confirms that the USCOM(®) is relatively easy to use and reliable in healthy children when operated by trained users.