Canadian Paediatric Surveillance Program Research Articles

Symptomatic Adrenal Suppression Among Children in Canada

EB Goldbloom, A Mokashi, EA Cummings. Arch Dis Child. 2017;102(4):338–339 To determine the national incidence and presenting features of pediatric glucocorticoid-induced symptomatic adrenal suppression (AS) in Canada by using a national pediatric surveillance program. Canadian pediatricians and pediatric subspecialists in clinical practice participated in a prospective surveillance through the Canadian Pediatric Surveillance Program, surveying for rare conditions. Over 2500 pediatricians and pediatric subspecialists were surveyed monthly for 2 years through the Canadian Pediatric Surveillance Program either by mail or e-mail. A check-off form asked physicians whether they had identified any new cases of symptomatic adrenal suppression (AS). If …

Validation of RSV infections in pediatric transplant recipients reported to a national surveillance program: A PICNIC study

Background: Respiratory syncytial virus (RSV) infections are a common cause of morbidity and mortality in pediatric transplant recipients. From 2010 to 2013, the Canadian Paediatric Surveillance Program (CPSP) performed national active surveillance of RSV infections occurring in the 2 years following hematopoietic stem cell transplant (HSCT) or solid organ transplant (SOT). This study aimed to validate accuracy of reporting of inpatient cases of post-transplant RSV infections to the CPSP. Methods: Transplant recipients <18 years with potential RSV infection were retrospectively identified from 9 tertiary-care pediatric centres, using ICD-10 codes for RSV and transplant from hospital and local laboratory information systems. Cases included after chart review were cross-referenced with the CPSP database. Sensitivity and positive predictive value (PPV) of the CPSP were calculated, and characteristics of reported and non-reported cases compared. Results: Of 27 cases found using this retrospective search of administrative databases, 8 (30%) had been reported to the CPSP; 10 additional cases reported to the CPSP were not detected by the study. Sensitivity of the CPSP was 30% (95% CI 14% to 50%), and PPV was 44% (95% CI 22% to 69%). The proportion of HSCTs was lower among cases reported to CPSP than among those not reported (13% versus 59%; p=0.03). More community-acquired RSV infections were noted in the reported group than in the non-reported group (100% versus 59%; p=0.04). Conclusion: The CPSP showed poor sensitivity and PPV for detecting RSV infections in pediatric transplant recipients. Additional strategies are needed to develop a surveillance program sufficiently sensitive to capture the burden of RSV in this population to inform preventive approaches.

RESULTS OF NATIONAL SURVEILLANCE OF CHILDHOOD TUBERCULOSIS: 2013–2016

Abstract There is little detailed epidemiologic and clinical data about tuberculosis (TB) disease in children in Canada. This study characterizes the epidemiologic, clinical, and treatment data for all cases of TB in children under age 15 in Canada surveyed through the Canadian Pediatric Surveillance Program’s (CPSP) Childhood Tuberculosis Study. Preliminary results from the study from October 2013 to September 2016 are presented here, as data collection from reported cases is still ongoing. New active TB cases were identified through a monthly form sent by the CPSP to approximately 2500 active pediatricians, pediatric subspecialists, and select non-pediatricians who manage childhood TB. For cases meeting inclusion criteria, a detailed questionnaire was sent to the treating physician to collect clinical, epidemiological, and treatment data, followed by 6-month follow-up surveys until 6 months after treatment completion. Of 248 unique incident cases reported, 142 cases both met inclusion criteria and returned a detailed questionnaire. Selected demographic data are shown here:Intrathoracic TB was reported in 129/142 (91%) of cases of which 111 had pulmonary disease. Of 104 patients who underwent investigations for pulmonary disease (sputum in 60, brochoalveolar lavage in 6, and gastric aspirates in 56), one or more positive cultures were obtained in 42 (40%). Within age groups, the proportion of cases who underwent investigation for pulmonary disease and were culture positive was: 3/11 (27%) under 1 year of age, 14/40 (35%) 1-4 years old, 8/23 (35%) 5-9 years old, and 17/30 (57%) 10 years or older. Extrathoracic TB was reported in 35 (25%), including 16 (42%) patients 10+ years old. There was one case of multi-drug resistant TB. Preliminary results from this study suggests a high incidence of TB in Inuit and First Nations children, as well as a higher proportion of extrathoracic TB and greater success in culture positivity in children aged 10+. At completion, this study will provide the most complete picture of childhood TB in Canada and will serve to refine practice in monitoring, detecting, and treating this infection.

PERINATAL FINDINGS IN A CONGENITAL MYOTONIC DYSTROPHY COHORT

Abstract BACKGROUND: Congenital Myotonic Dystrophy (CDM) is the harshest form of Myotonic Dystrophy type 1 (DM1,OMIM #160900). The mode of inheritance is autosomal dominant, and results from a microsatellite expansion in DMPK with an incidence of 2.1:1000,000 live births in Canada. The principal clinical signs during the neonatal period are myopathic facies, hypotonia and weakness resulting in such features as talipes equinovarus, nutritional, cardiac and respiratory problems. OBJECTIVES: To describe the main findings of CDM in the perinatal period. DESIGN/METHODS: A five year prospective cohort study from 2005 to 2010 of eligible incident cases of CDM was performed via the Canadian Pediatric Surveillance Program (CPSP). Reporting physicians completed a questionnaire with the medical history at birth and during the perinatal period. Our patients met the CDM criteria proposed by Campbell et al. (2013): 1) CDM symptoms with hospitalization greater of 72 hours; and 2) CTGrs above 200. RESULTS: We obtained 43 questionnaires, 22 female and 21 male (F:M ratio of 1.04:1). Average CTG repeat size (CGTrs) was 795.67 (250-2300). The main complication during the prenatal period was polyhydramnios (n=20). The majority of the patients (n=27) had full term pregnancy and with normal birth weight (n=25). Average Apgar was 4 at 1 (range 1-9), and 6 for 5 and 10. Intubation was required in 29/43 of the cases, with an average hospital stay of 43.5 days. Nutritional support (ie ng feeds) was required in 34/43, and it was longer than 14 days in 21 patients. Nine patients died, 6 of them due to respiratory failure. Four deaths were withdrawal of life support. CONCLUSION: The respiratory difficulties are well described as the principal complication in CDM (Ho et al. [2015]), but we found that the necessity of multiple nutritional interventions was the most frequent neonatal complication (79%), respiratory complications remains as the principal cause of death (66.6%). Zaki et al. (2010) describes a cohort with a 100% frequency of polyhydramnios, differing on ours where it is 46.5%.We conclude that CDM is not always evident prenatally by polyhydramnios, IUGR or preterm delivery. Nutritional and respiratory assessments should be prioritized, and nutritional interventions may extend for long periods of time. Despite high respiratory and feeding support needs, the majority of patients improved over time. Hence the importance of prenatal counseling and preparation for the complications in the neonatal period.

Depressive Disorders in Preadolescent Children

Research Article| March 01 2017 Depressive Disorders in Preadolescent Children AAP Grand Rounds (2017) 37 (3): 34. https://doi.org/10.1542/gr.37-3-34 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Depressive Disorders in Preadolescent Children. AAP Grand Rounds March 2017; 37 (3): 34. https://doi.org/10.1542/gr.37-3-34 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: depressive disorders, pre-teen, major depressive disorder Source: Korczak DJ, Ofner M, LeBlanc J, et al. Major depressive disorder among preadolescent Canadian children: rare disorder or rarely detected? In Press. Academic Pediatr. 2016; doi: https://doi.org/10.1016/j.acap.2016.10.011Google Scholar Researchers from multiple institutions in Canada conducted a nationwide, prospective study to identify preadolescent children who were newly diagnosed with major depressive disorder (MDD). For the study, 2,500 pediatricians in the Canadian Pediatric Surveillance Program (CPSP) were surveyed monthly over 3 years to report new cases of MDD, as defined by DSM-IV, among children aged 5–12 years. To meet diagnostic criteria for MDD, children had to have depressive symptoms or markedly diminished interest or pleasure in most activities almost daily and for most of the day, and impairment in at least 4 of 7 functional domains (ie, significant weight change, insomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness or excessive guilt, diminished ability to concentrate, and recurrent thoughts of death). Children whose symptoms were related to substance use, were due to acute bereavement, or who had a previous diagnosis of a bipolar disorder were excluded. For each child with MDD identified, the physician was asked to complete a case report that included the patient’s demographic data, clinical characteristics and treatment, presence of medical or psychiatric comorbidities, and family history of mental illness in a first-degree relative. During the study period, 29 children met study criteria for having newly identified MDD. Among the 29 participants with confirmed MDD, median age was 11.1 years (range, 7.3–12.9), 55% were boys, and 23 (79%) had been experiencing depressive symptoms for >6 months. Eighteen children (62%) were globally impaired in all functional domains at the time of presentation. Comorbid medical conditions were present in 5 children (17%): 2 children had asthma, while 1 child each had a seizure disorder, migraine headaches, and type 1 diabetes. Among comorbid psychiatric disorders, attention-deficit/hyperactivity disorder and anxiety were the most common, each occurring in 13 children (45%) with MDD; 8 (28%) had all 3 disorders. Twenty-three children (79%) had a history of a psychiatric disorder in a first-degree relative, with parental depression or anxiety present in 21 (72%). Additionally, 22 children (76%) reported suicide ideation, and 6 (21%) had attempted suicide. Most study children with MDD were treated with medication (n=23; 79%), and 13 (45%) were treated with ≥2 medications. The researchers conclude that preadolescent children with physician-identified MDD often have long-standing symptoms present and high levels of functional impairment before presentation. Psychiatric comorbidity is common in these patients. Dr. Phillipi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Screening for depression in adolescents and adults, including pregnant and postpartum women, is recommended by the US Preventive Services Task Force (USPSTF) (Grade B).1,2 Screening recommendations are based on “high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.” The USPSTF goes... You do not currently have access to this content.

Classification of childhood onset eating disorders: A latent class analysis.

This study tested the hypothesis that latent class analysis (LCA) would successfully classify eating disorder (ED) symptoms in children into categories that mapped onto DSM-5 diagnoses and that these categories would be consistent across countries. Childhood onset ED cases were ascertained through prospective active surveillance by the Australian Paediatric Surveillance Unit, the Canadian Paediatric Surveillance Program, and the British Paediatric Surveillance Unit for 36, 24, and 14 months, respectively. Pediatricians and child psychiatrists reported symptoms of any child aged ≤ 12 years with a newly diagnosed restrictive ED. Descriptive analyses and LCA were performed separately for all three countries and compared. Four hundred and thirty-six children were included in the analysis (Australia n = 70; Canada n = 160; United Kingdom n = 206). In each country, LCA revealed two distinct clusters, both of which presented with food avoidance. Cluster 1 (75%, 71%, 66% of the Australian, Canadian, and United Kingdom populations, respectively) presented with symptoms of greater weight preoccupation, fear of being fat, body image distortion, and over exercising, while Cluster 2 did not (all p < .05). Cluster 1 was older, had greater mean weight loss and was more likely to have been admitted to an inpatient unit and have unstable vital signs (all p < .01). Cluster 2 was more likely to present with a comorbid psychiatric disorder (p < .01). Clusters 1 and 2 closely resembled the DSM-5 criteria for anorexia nervosa and avoidant/restrictive food intake disorder, respectively. Symptomatology and distribution were remarkably similar among countries, which lends support to two separate and distinct restrictive ED diagnoses.

Symptomatic adrenal suppression among children in Canada

BackgroundAdrenal suppression (AS) is an under-recognised side effect of glucocorticoid (GC) use. AS may go undetected until a physiological stress precipitates an adrenal crisis. The incidence of AS has not...

Developmental Milestones and Quality of Life Assessment in a Congenital Myotonic Dystrophy Cohort.

Congenital myotonic dystrophy (CDM) is a neuromuscular disorder caused by a CTG triplet repeat expansion in the DMPK gene. In addition to the expected motor delay, affected children often have significant developmental disability in language and cognitive realms, which ultimately impacts on quality of life. In a prospective cohort of children with CDM to 1) present the profile of language and motor developmental milestones, and 2) describe their early childhood health related quality of life (HRQOL). A five year cohort study of eligible incident cases of CDM was performed via the Canadian Pediatric Surveillance Program (CPSP). Consenting subjects were then followed from infancy in a prospective cohort study. Caregivers were contacted every 3 months for the first year of life, and then twice yearly in order to obtain data concerning language skills, motor development and parent proxy HRQOL from the PedsQL and Infant and Toddler Quality of life (ITQOL) questionnaires. Milestones were achieved at later ages in patients when compared to healthy children. Girls appeared to be more delayed than boys in both language and motor skills. HRQOL scores remained stable in this cohort, for both the PedsQL and ITQOL. Understanding developmental milestones and quality of life are important parameters when judging a child's overall health. For CDM patients delineating developmental milestones and QOL have important clinical care and research implications.

Surveillance of Periodic Fever Syndromes in Canada

Abstract BACKGROUND: Periodic fever syndromes (PFS) represent a group of rare, inflammatory disorders, which have their onset in childhood, and are associated with significant lifelong morbidity, and at times, increased mortality. The majority of affected children have recurrent, self-limited inflammatory episodes with unprovoked fever. The severe inflammatory state during an attack causes signs and symptoms in one or more organ systems. The Canadian Pediatric Surveillance Program (CPSP) studies relevant conditions of public health importance that are of such low incidence or prevalence that national ascertainment of cases are needed. Conditions that are studied share a high disability, morbidity and economic costs to society, despite the low frequency. More than 2400 pediatricians including relevant subspecialists, have been enrolled as CPSP participants. This program provides an ideal mechanism for surveillance of PFS in Canada. OBJECTIVES: To estimate the incidence of periodic fever syndromes in the Canadian paediatric population, to describe the patterns of presentation, and to raise awareness in the medical community. DESIGN/METHODS: This study was initiated through the Canadian Paediatric Surveillance Program (CPSP), and was carried out over a three year period ending in September 2014. The case definition included patients less than 18 years of age presenting with a newly diagnosed periodic fever syndrome (PFS). Conditions under surveillance included Familial Mediterranean fever (FMF), Tumor necrosis factor receptor-associated periodic syndrome (TRAPS), Hyperimmunoglobulin D syndrome (HIDS), cryopyrin-associated periodic syndromes (CAPS), Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA), and Undefined periodic fever syndromes. The study protocol outlined established clinical and/or genetic criteria for diagnosis. Participating pediatricians and pediat-ric subspecialists across the country were sent monthly reporting forms. Detailed questionnaires were completed by physicians who report a recent diagnosis. Submissions were screened for accuracy and confirmed cases then entered into a database. RESULTS: Between September 2011 and August 2014 a total of 221 cases of PFS were reported. Detailed questionnaires were completed on 194 (88%), from which 13 were excluded. Of the 181 confirmed cases, 85 (47%) were PFAPA, 72 (40%) were undefined PFS, 17 (10%) were FMF, and the remaining 6 cases were CAPS, TRAPS, and HIDS. The mean age at diagnosis was 5.5 years (range 12 months – 16 years). On average symptom onset occurred 2.5 years before diagnosis (range 1-4 years). The majority of reporting physicians were rheumatologists (58%), and paediatricians (36%). Cases were identified in all provinces across Canada with the majority (103, 57%) from Ontario. For the 72 undefined PFS cases the reporting physicians described 36% as PFAPA-like, 10% FMF-like, 5% HIDS-like, 3% CAPS-like, and 1% TRAPS-like. Such cases had features of the specified PFS but either did not meet the full criteria, or confirmatory tests were not available at the time of reporting. Among all cases reported in the study, 58% had genetic testing completed as part of their diagnosis. The majority of cases without any genetic testing had been diagnosed as PFAPA. CONCLUSION: Periodic fever syndromes represent rare forms of autoin-flammatory disease, which affect many Canadian children. This CPSP study identified that the most common PFS diagnosed was PFAPA followed by undefined PFS and FMF. CAPS, HIDS, and TRAPS were rarely diagnosed. Children with PFS were seen by multiple physicians over an average of two to three years before a diagnosis was made. It is hoped that increased awareness of these rare conditions will facilitate earlier diagnosis and the initiation of effective treatments for these children.

Early Onset Neonatal Sepsis in Canada: 2011-2012

Abstract BACKGROUND: Canadian and US studies suggest that the organisms responsible for early-onset neonatal sepsis (EONS) are changing, with an increase in Escherichia coli (EC) as well as antibiotic-resistant organisms. Current Canadian guidelines for prevention and treatment of EONS are based on Group B streptococcus (GBS) as the likely organism. Population-level data may inform updates to these national strategies. OBJECTIVES: To determine the incidence, types of organisms and corresponding resistance patterns involved in EONS in Canada. To identify how the organisms are affected by maternal antibiotic prophylaxis and other factors. DESIGN/METHODS: Cases of EONS (defined as positive blood and/or cerebrospinal fluid (CSF) culture at &amp;lt;7 days of age) between January 2011 and December 2012 were identified through the Canadian Paediatric Surveillance Program (CPSP). Neonates were excluded if they were asymptomatic with a positive culture likely to be a contaminant, or if the CSF culture was positive as a result of an intracranial procedure. RESULTS: Over the 2-year period, 127 cases meeting our criteria were identified, and there were 754,849 total Canadian live births. The incidence for EONS was 0.17/1000 live births. 79.5% of cases presented within the first 24 hours of life, while 15% presented between 72 h-7 days. GBS accounted for 41.7% of cases, while EC accounted for 35.4%. Resistance was noted in 33.9% of cases overall. 55.6% of EC were resistant, with ampicillin resistance being the most common. The species of infecting organism was significantly associated with gestational age, very low birth weight, age at presentation, the mother having received GBS prophylaxis, and rupture of membranes lasting more than 18 h. GBS was most common in term and EC in preterm neonates. The overall EONS case fatality rate was 11%, with most of these being deaths from EC. CONCLUSION: Our study suggests a lower rate of EONS than historically suggested, with differing dominant organisms based on gestational ages of the neonates. Later ages at presentation and high rates of resistance especially among EC cases further complicate the picture. We recommend a review of the Canadian prevention and treatment guidelines based on our findings.

Severe Alcohol Intoxication in Canadian Adolescents: 2 Year Surveillance Data

Abstract BACKGROUND: Alcohol is the most commonly used drug by Canadian adolescents, and can lead to a host of negative short and long-term outcomes. Understanding more about youth drinking can help develop more effective strategies for treatment and prevention. This study, gathering data through the Canadian Pediatric Surveillance Program (CPSP), was completed to fill in knowledge gaps and provide epidemiologic data about severe alcohol intoxication among Canadian adolescents. OBJECTIVES: The objectives of the surveillance study included: 1) To obtain national epidemiological data outlining the incidence of severe alcohol intoxication among adolescents. 2) To describe the demographics, presentation to hospital, co-ingestions, co-morbidities, management and short-term outcomes. 3) To use the data to increase awareness and education. 4) To facilitate harm reduction strategies. DESIGN/METHODS: Through the established methodology of the CPSP, paediatric physicians have been actively surveyed on a monthly basis for identified cases of severe alcohol intoxication. A detailed questionnaire was then completed for each new case. The case definition includes any adolescent meeting the following criteria: 1) Between 11-15 years of age 2) Blood alcohol level &amp;gt; 0 g/L (if drawn) 3) Presenting with severe intoxication with impaired consciousness requiring prolonged ER observation (≥ 6 hours) or hospital admission. RESULTS: In the two years of surveillance, 40 cases were confirmed, including 21 male and 19 female adolescents, with a median age of 14. The youngest case reported was 11 years old. There were no significant differences between sex and blood alcohol level or age at presentation and blood alcohol level. Additional descriptive data of the confirmed cases will be reported and discussed. CONCLUSION: After two years of surveillance, 40 cases of severe intoxication in adolescents have been identified. This is likely only the ‘tip of the iceberg’ and represents the more severe cases that required prolonged ER observation or hospital admission. The young age of presentation (youngest 11 years of age) and severity of intoxication requiring observation/admission are concerning. These data regarding Canadian adolescents presenting to the ED with severe intoxication will help inform strategies for education, prevention and harm reduction. It is noteworthy that the majority of adolescents with severe intoxication consumed spirits, suggesting that more education for adolescents around the higher potency of spirits relative to other alcoholic beverages and the dangers of consumption even in small amounts could reduce the incidence of severe alcohol intoxication in children and adolescents. Consideration of more stringent controls on spirits to help decrease adolescents’ access would assist with harm reduction.

Awareness of Sentinel Injuries Among Canadian Paediatricians: A Cpsp One-Time Survey

Abstract BACKGROUND: A sentinel injury is a visible or detectable minor injury in a pre-cruising infant that is poorly explained and therefore suspicious for physical abuse. Examples include bruises and intra-oral bleeding, which may be “warning injuries” for possible abuse. Timely recognition and management of a sentinel injury can potentially alter a pattern of escalating child abuse, but studies have demonstrated that in up to a third of cases, physicians miss early signs of abuse. OBJECTIVES: Our purpose was to assess paediatrician awareness of sentinel injuries in pre-cruising children as precursors to more serious physical abuse. DESIGN/METHODS: A Canadian Paediatric Surveillance Program (CPSP) one-time survey of Canadian paediatricians was conducted in March of 2015 to evaluate awareness of sentinel injuries and their significance. Respondents were provided with clinical vignettes describing infants with sentinel injuries and were asked questions about their differential diagnosis and management plan. Respondents were then classified as either “aware” or “not aware” based on their responses, and a multivariable logistic regression analysis was used to identify variables most strongly correlated with awareness. RESULTS: The survey achieved a response rate of 23.4%. Of the 582 respondents, 65% were aware that bruises and intra-oral injuries in pre-cruising children are red flags for possible physical abuse. Respondents were more likely to be aware of bruises as sentinel injuries (91.9%) than they were of intra-oral injuries (67.2%). Paediatric subspecialists were significantly less likely than general paediatricians to be aware of sentinel injuries as red flags for later serious abuse (adjusted OR=0.57, 95% CI 0.37–0.88, p=0.01). Other important trends included higher awareness with more recent completion of residency, and also with additional training in the area of child abuse and neglect. CONCLUSION: Over one-third of Canadian paediatricians are unaware that unexplained bruising and intra-oral bleeding in a pre-cruising child should prompt assessment for possible abuse. Further physician education is warranted to ensure that paediatricians understand the importance of sentinel injuries and the indications for initiating investigations to detect occult injuries of child abuse. Future directions include the development of physician training opportunities in the area of identifying and managing sentinel injuries, as well as extending the study population to include family physicians who provide primary care to children.

Midpoint Results of National Surveillance of Childhood Tuberculosis

Abstract BACKGROUND: There is little detailed epidemiologic and clinical data about tuberculosis (TB) disease in children in Canada. OBJECTIVES: To characterize the epidemiologic, clinical, and treatment data for all cases of TB in children under age 15 in Canada through the Canadian Pediatric Surveillance Program’s (CPSP) Childhood Tuberculosis Study. The initial results of the 3 year study presented here includes cases from September 2013 to October 2015. DESIGN/METHODS: TB cases were identified through a monthly form sent by the CPSP to approximately 2500 active pediatricians, pediatric subspecialists, and select non-pediatricians who manage childhood TB. For cases meeting inclusion criteria, a detailed questionnaire was sent to collect clinical, epidemiological, and treatment data, followed by 6-month follow-up surveys until 6 months after treatment completion. RESULTS: Of 164 unique incident cases reported, 84 met inclusion criteria and returned a detailed questionnaire. Selected demographic data is shown here: Intrathoracic TB was reported in 78/84 (93%) of cases including 66 with pulmonary disease. One or more positive cultures were obtained in 32/68 (47%) of cases attempting pulmonary culture using sputum (n=17), bron-choalveolar lavage (n=2), and/or gastric aspirates (n=16). Of these, 4/9 (44%) were positive in children 12 months or younger, 8/23 (35%) between ages 1-4, 5/14 (36%) between ages 5-9, and 15/22 (68%) in children 10+ years. In two culture-negative cases, a positive AFB was found in the sputum. Extrathoracic TB was reported in 30% (n=25), with rates in children 10+ years being significantly higher than expected given the current literature. One case was MDR-TB. CONCLUSION: Detailed clinical, epidemiological, and treatment data has been obtained for many cases of childhood TB in Canada through the CPSP Childhood Tuberculosis Study. This study will provide the most complete picture of childhood TB in Canada and will serve to refine practice in monitoring, detecting, and treating this infection.

Severe Neonatal Hyperbilirubinemia Decreased after the 2007 Canadian Guidelines

To estimate the incidence of severe neonatal hyperbilirubinemia in Canada from 2011-2013 following the implementation of the Canadian Pediatric Society's published guidelines on the management of hyperbilirubinemia in 2007. Our previously reported incidence of hyperbilirubinemia in Canada was 1 in 2480. Term infants ≤ 60 days of age, with a peak serum total bilirubin level > 425 μmol/L or who had an exchange transfusion were followed prospectively through the Canadian Pediatric Surveillance Program from 2011-2013. Infants with rhesus isoimmunization or born < 35 weeks gestation were excluded. Ninety-one cases of severe neonatal hyperbilirubinemia were confirmed. Sixty-nine infants (76%) were readmitted to hospital, 47 (52%) of them within 6 days of age. The remaining 22 infants (24%) were identified with severe neonatal hyperbilirubinemia before they were discharged from the hospital. The mean reported peak bilirubin level was 484 μmol/L (range 181-788; SD ± 92). An etiology was identified in 57 (63%) cases, with ABO incompatibility (n = 35) and glucose-6-phosphate dehydrogenase deficiency (n = 11) being the most common. An infant was 3.5 times more likely to be diagnosed with severe neonatal hyperbilirubinemia from 2002-2004 compared with 2011-2013 (95% CI 2.72-4.47). The minimum estimated incidence of severe neonatal hyperbilirubinemia in Canada is 1 in 8352 live births. Introduction of the Canadian Pediatric Society guidelines and improved physician awareness of severe neonatal hyperbilirubinemia in the last 10 years likely made positive contributions to this trend.

Acute flaccid paralysis surveillance: The need for ruling out polio infection

Afive-year-old, previously well male was admitted to hospital with severe headache after a three-day history of fever, cough and breathing difficulty. The child had not travelled outside of Canada and had received all recommended immunizations. The following day, he developed leg weakness, right-sided calf pain, limited lower extremity movement and decreased lower extremity reflexes bilaterally. Although given a presumptive diagnosis of Guillain-Barre syndrome (GBS) and started on intravenous immunoglobulin, his leg weakness continued to progress. To determine the etiology of his acute flaccid paralysis (AFP), brain and spine magnetic resonance imaging and lumbar puncture were conducted. Because viral culture from stool is the most sensitive test for identifying poliovirus, a stool sample was sent to the National Microbiology Laboratory (NML, Winnipeg, Manitoba) to rule out poliomyelitis. Samples from other sources (eg, nasopharyngeal swab) may be useful for detecting other viruses but stool culture is still recommended for detecting polio. The stool sample was obtained early within the recommended 14 days to ensure the highest probability of poliovirus detection. Results returned after 10 days were negative for poliovirus and further investigations were undertaken. The present case was reported to the local public health unit and the Canadian Paediatric Surveillance Program (CPSP). A 60-day follow-up with the attending physician was scheduled through neurology.

Respiratory syncytial virus infections in pediatric transplant recipients: A Canadian Paediatric Surveillance Program study.

The incidence and spectrum of severity of RSV infections in SOT or HSCT recipients is not known. From September 2010 through August 2013, pediatricians were surveyed monthly by the CPSP for SOT or HSCT recipients with RSV infection within two yr post-transplant. There were 24 completed case report forms that fit the inclusion criteria (10 HSCT and 14 SOT recipients). Six of 24 cases (25%) remained outpatients, and 11 (46%) were managed on an inpatient ward, while seven (29%) required intensive care of which five required mechanical ventilation and two died of RSV infection. Ten of 23 cases (43%) were nosocomial with these data not recorded for one case. Many transplant recipients recover uneventfully from RSV infection in the first two yr post-transplant. However, severe disease and death also occur. Larger studies are required to establish risk factors for poor outcomes. Prevention of nosocomial RSV should be a priority in transplant recipients.

120: Injuries Associated with Liquid Detergent Packets

Since the introduction of convenient new laundry packets to North American in 2012 there have been more frequent reports of child injuries related to liquid detergent packets. A recent study reported 17,000 cases gathered by poison control centres across the United States including several hundred serious injuries and at least one death. In Canada there have been more than 100 cases seen in paediatric emergency departments. To obtain more information on Canadian children injured in such incidents the Canadian Paediatric Surveillance Program (CPSP) conducted a one-time survey of paediatricians across Canada. To obtain more information on Canadian children injured in such incidents the Canadian Paediatric Surveillance Program (CPSP) conducted a one-time survey of paediatricians across Canada. The survey gathered information on number of cases seen, age groups most affected, types of exposures and injuries sustained point of access, treatment and disposition of the children. In August 2014, the CPSP sent a one-time survey to approximately 2,500 active practicing paediatricians and subspecialists enrolled in the Program. CPSP gathered information on 54 children with injuries following exposure to single-load liquid detergent packets treated by paediatricians within the past year (2014). Half (56%) were less than 2 years of age and 43% were aged 2–4 years. All except 2 of the children were treated by reporting physicians in emergency departments (69%) and in-patient settings (28%). Three quarters of the incidents involved exposure to liquid detergent packets for laundry and the remainder were for dishwashers. Among cases where the point of access was known, two thirds of the children accessed detergent packets directly from the manufacturer's original package or container and another 20% found a packet on the floor or lying around. Almost all the children (47 or 88%) were treated following ingestion or had exposure to the gastrointestinal tract, six sustained ocular injuries, four had dermal exposure and three suffered pulmonary exposure. The injuries and symptoms reported in order of frequency include: nausea and vomiting, chemical burns (mouth, esophagus or skin), pulmonary toxicity, conjunctivitis, respiratory distress, corneal ulcer or keratitis, and central nervous system depression. Twenty-five patients (46%) were admitted to hospital and of these, at least six were treated in intensive care units. Another six patients (11%) were treated and released with referral for medical follow up. Twenty-one patients (39%) were not seriously injured and released without need for medical follow up. Liquid detergent packets pose a hazard for young children and exposures resulted in serious injuries. Prevention may be enhanced by greater parent and caregiver awareness of the hazard combined with vigilance in safe storage of household chemicals, including detergent packets.

123: Surveillance for Childhood Lyme Disease by the Canadian Pediatric Surveillance Program (CPSP): Initial Findings

123: Surveillance for Childhood Lyme Disease by the Canadian Pediatric Surveillance Program (CPSP): Initial Findings

147: Early Results of National Surveillance of Childhood Tuberculosis in Canada

There is little detailed epidemiologic and clinical data about tuberculosis (TB) disease in children in Canada. To characterize the epidemiologic, clinical, and treatment data for all cases of TB in children under age 15 in Canada through the Canadian Pediatric Surveillance Program's (CPSP) Childhood Tuberculosis Study. The initial results of the three year study presented here includes cases from September 2013 to October 2014. TB cases were identified through a monthly form sent by the CPSP to approximately 2500 active pediatricians, pediatric subspecialists, and select non-pediatricians who manage childhood TB. For cases meeting inclusion criteria, a detailed questionnaire was sent to collect clinical, epidemiological, and treatment data, followed by 6-month follow-up surveys until six months after treatment completion. Of 70 unique incident cases reported, 34 cases both met inclusion criteria and returned a detailed questionnaire. Selected demographic data is shown in Table 1. Intrathoracic TB was reported in 32/34 (94%) of cases including 26 with pulmonary infection. One or more positive cultures were obtained in 13/27 (48%) of cases attempting pulmonary culture using sputum (n=7), bronchoalveolar lavage (n=1), and/or gastric aspirates (n=6). Of these, 4/12 (33%) were positive in patients younger than 5 years, 2/6 (33%) between ages 5–9, and 7/9 (78%) children 10+ years. No culture-negative specimen had a positive AFB, PCR, or AMTD. Extrathoracic TB was reported in 27% (n=9). Of these, seven cases had central nervous system involvement. One case had confirmed drug resistance to Isoniazid and Rifampicin. Numerous cases of childhood TB in Canada have been identified through early results from the CPSP Childhood Tuberculosis Study and detailed clinical, epidemiological, and treatment data have been obtained on these cases. This study will provide the most complete picture of childhood TB in Canada and will serve to refine practice in monitoring, detecting, and treating this infection.

An innovative web based system for reporting rare diseases in paediatrics.

BackgroundSurveillance of rare diseases in children is an important aspect of public health. Rare diseases affect thousands of children worldwide. The Canadian Paediatric Surveillance Program (CPSP) has been in existence since 1996, and provides an innovative means to undertake paediatric surveillance and increase awareness of childhood disorders that are high in disability, morbidity, mortality, and economic costs to society, despite their low frequency. Traditionally, CPSP used manual paper-based reporting on a monthly basis, which although had an impressive response rate, it had inherent longer processing times and costs associated with it.ObjectivesTo provide an overview and evaluate an innovative web-based system that enables seamless reporting from participants across the country providing a quick, reliable and simple mechanism for the participants to submit data while yielding better data quality, timeliness and increased efficiencies.MethodsIn 2011, a proprietary electronic CPSP (eCPSP) system was developed to provide a simple, quick and reliable reporting environment for participants. It supports both the electronic and hardcopy reporting. The analysis presented in this paper was conducted based on usage data of this system.ResultsThe response rates of the new eCPSP were found to be very favorable with adjusted rate of 80%, which equals the baseline. Approximately 50% of online participants report the first day they receive the notification e-mail. The response time was also reduced considerably. Furthermore, there has been significant reduction in data handling related activities (by almost 70%) from estimated 690 hours per year. Finally, the number of cases reported that do not fit the study case criteria has fallen, likely because participants can now immediately access the case definition and protocol via the online system. This has reduced both staff and investigator time for case processing.ConclusionThe eCPSP has modernized the CPSP program from paper-based reporting to efficient online technology while maintaining the core principles of the program. This simple and intuitive approach has proven to be an efficient approach cutting response times significantly while maintaining the desired response rates.