Abstract Aim To examine whether adding clonidine to the morphine regimen for treatment of neonatal abstinence syndrome (NAS) is associated with a shorter length of treatment compared with morphine alone. Methods Using a retrospective cohort design, infants with NAS resulting from opioid exposure delivered between 2006 and 2015 (n = 174) were identified using the Nova Scotia Atlee Perinatal Database (NSAPD). Maternal and infant characteristics were collected from the NSAPD. The database was augmented with chart review for treatment information. Results The incidence of NAS in the study population increased fivefold from 1.48/1000 live births in 2007 to 7.50/1000 live births in 2015. Of the 174 infants, 22 were treated with morphine and 100 were treated with morphine + clonidine. Longer length of treatment (p = 0.004) and higher peak morphine dose (p = 0.045) were observed in the combination group. Conclusion The increase in the incidence of NAS is consistent with recent published reports. The increase in length of treatment and peak morphine dose in the morphine + clonidine group is in marked contrast to previous work on this treatment combination. Further study on the impact of clinical characteristics such as methadone and antidepressant exposure on the association is warranted.
Background: There is no cardiovascular disease (CVD) risk factor profile in a representative sample of Canadian children and adolescents according to weight status. The 2007-2009 Canadian Health Measures Survey, launched by Statistics Canada in partnership with Health Canada and the Public Health Agency of Canada, provides an opportunity to address this gap. Methods: The Canadian Health Measures Survey collected information at 15 sites across Canada from March 2007 to March 2009 from Canadians aged 6 to 79 years living in private households. The survey consisted of a household interview and a visit to a mobile examination centre to perform physical measurements, including anthropometry, blood pressure, and biospecimen collection. The present analysis is based on data from 2087 children and adolescents aged 6 to 19 years. Results: Childrenandadolescentswhowereoverweightorobesehadon average higher mean concentrations and higher prevalence of adverse levels of CVD risk factors (systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein B, C-reactive protein, homocysteine, and insulin levels) than did normal-weight children and adolescents. Adjustment for covariates (gender, age, household education,household income adequacy, and provinceof residence) and
Health-promoting schools (HPS) is an effective approach to enhance the health and well-being of children and youth, but its measurement remains a challenge considering contextual differences across school environments. The purpose of this study was to qualitatively explore the physical features of the school environment through photographs of schools that had implemented an HPS approach compared with schools that had not. This study used a descriptive approach, wherein physical features of the school environment were distilled through visual images and qualitatively analyzed. School environment data were collected from 18 elementary schools (10 HPS, 8 comparison schools) from a school board in rural Nova Scotia (Canada). Evaluation assistants captured photographs of the physical school environment as part of a broader environment audit. Overarching themes included the promotion, access and availability of opportunities for healthy eating and physical activity, healthy school climate and safety and accessibility of the school. The photographs characterized diverse aspects of the school environment and revealed differences between schools that had implemented an HPS approach compared with schools that had not. There were increased visual cues to support healthy eating, physical activity and mental well-being, and indications of a holistic approach to health among schools that implemented an HPS approach. This research adds to understanding the environmental elements of HPS. The use of photographic data to understand school environments provided an innovative method to explore the physical features of schools that had implemented an HPS approach.
We analysed the data of pregnancies with twin-twin transfusion syndrome (TTTS) in order to identify clinical factors present at the time of diagnosis which can be used to predict the outcome of the pregnancy.We report prenatal sonographic findings, interventions and outcomes of 28 TTTS pregnancies over a three-year period. Patients were classified into stages of TTTS as follows: Stage I: bladder of donor visible, normal Doppler studies; Stage II: bladder of donor not visible, normal Doppler studies; Stage III: abnormal Doppler studies; Stage IV: hydrops.In nine pregnancies the infants did not survive the perinatal period (the first 28 days after delivery): the median gestational age at delivery was 24 (range 21 - 29) weeks; six of these nine pregnancies (66 %) were classified as stages III or IV. In five pregnancies one infant survived the perinatal period: the median gestational age at delivery was 28 (range 27 - 32) weeks; four of these five pregnancies (80 %) were classified as stages III or IV. In 14 pregnancies both infants survived the perinatal period: the median gestational age at delivery was 30.5 (range 28 - 39) weeks; two of these 14 pregnancies (14 %) were classified as stages III or IV.In pregnancies complicated by TTTS, the results of Doppler studies at the time of diagnosis represent the most important clinical factor predicting the outcome of the pregnancy. At the time of delivery, however, the predicted outcome is most directly linked to the gestational age.
The activated partial thromboplastin time (aPTT) and anti-Xa activity are used for monitoring unfractionated heparin (UFH) therapy in children and may not be optimal.Determine correlations of aPTT, anti-Xa and UFH dose in children. Single centre prospective cohort study in children receiving UFH. The aPTT and anti-Xa results from routine coagulation monitoring were collected. Thirty-nine children (median age 18 days) were enrolled. There was no relationship between aPTT and UFH dose (r2=0.12) or anti-Xa and UFH dose (r2=0.03) or aPTT and anti-Xa (r2=0.22). aPTT and anti-Xa do not accurately monitor UFH therapy in children.
Fetal growth restriction and maternal smoking during pregnancy are independently implicated in lowering intellectual attainment in children. We hypothesized that only reduction of fetal growth that is attributable to extrinsic causes (e.g., maternal smoking) affects intellectual development of a child. Cross-sectional survey of 3,739 students in Nova Scotia (Canada) in 2003 was linked with the perinatal database, parental interviews on socio-demographic factors and the performance on standardized tests when primarily 11–12 years of age, thereby forming a retrospective cohort. Data was analyzed using hierarchical logistic regression with correction for clustering of children within schools. The risk of poor test result among children born small-for-gestational-age (SGA) to mothers who smoked was 29.4%, higher than in any other strata of maternal smoking and fetal growth. The adjusted odds ratio among SGA children born to mothers who smoked was the only one elevated compared to children who were not growth restricted and born to mothers who did not smoke (17.0%, OR = 1.46, 95% CI 1.02, 2.09). Other perinatal, maternal and socio-demographic factors did not alter this pattern of effect modification. Heterogeneity of etiology of fetal growth restriction should be consider in studies that address examine its impact on health over life course.
Objective To model the development of the tri-ponderal mass index (TMI, kg/m 3 ) throughout childhood and adolescence and to compare the utility of the TMI with that of the body mass index (BMI, kg/m 2 ) to predict cardiometabolic risk in a population-based sample of Canadian children and youth. Methods We used data from the Canadian Health Measures Survey to model TMI from 6 to 19 years of age. Percentile curves were developed using the LMS method. Logistic regression was used to predict abnormal levels of cardiometabolic markers; predictive accuracy was assessed using the area under the ROC curve (AUC). Results Mean TMI was relatively stable from ages 6 to 19 years for both sexes, but variability increased with age. There was no notable difference in AUC values for prediction models based on BMI z-score compared with TMI for any of the outcomes. For both BMI z-score and TMI, prediction accuracy was good for homeostasis model assessment insulin resistance and having ≥3 abnormal tests (AUC>0.80), fair for C-reactive protein and poor for the remainder of the outcomes. Conclusions The use of a single sex-specific TMI cut-off for overweight or obesity is hampered by the increasing variability of the measure with age. Weight-for-height indices likely have only limited ability to predict cardiometabolic marker levels, and changing the scaling power of height is unlikely to improve predictive accuracy.
