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Abstract Background For paediatrics residents, much of newborn care is learned during Neonatal Intensive Care Unit (NICU) rotations. However, the NICU is a high-stress and specialized learning environment. Today’s residents often have less NICU exposure during their training than in the past, leading to concerns from trainees that they are inadequately prepared for neonatal care and resuscitation upon graduation. Objectives We aimed to develop, implement and evaluate a paediatric residency NICU curriculum aimed to augment and improve learning on rotation. Design/Methods We utilized Kern’s Six Step Approach for Curriculum Development. Step 1: We identified that our paediatric residents consistently expressed dissatisfaction with the quality and quantity of learning opportunities on their NICU rotations. Step 2: A collaborative working group of residents, paediatricians, and neonatologists identified learning needs. Step 3: Needs were mapped to specific general paediatrics educational objectives within the Royal College Competency Based Medical Education (CBME) curriculum. Step 4: Suitable learning strategies were selected including simulation, procedural skill training, embedded time with the neonatal resuscitation team, and lunch and learn seminars. Steps 5 and 6: The curriculum was piloted during the 2021-2022 academic year and resident reactions evaluated. Results The detailed curriculum is shown in Table 1. At the start of each NICU rotation, all paediatrics residents on rotation attended a half-day simulation based “boot-camp” consisting of a didactic Neonatal Resuscitation Program (NRP) refresher course, relevant procedural skills stations (intubation, UVC placement, needle thoracocentesis), and simulated neonatal resuscitation scenarios. Junior residents were scheduled for protected time to attend deliveries with a dedicated multidisciplinary resuscitation team to ensure familiarity and begin to solidify skills. Learning was further augmented by weekly, resident-led lunch and learn sessions on topics mapped to level of training. To evaluate this curriculum, resident satisfaction was assessed using surveys post bootcamp and at the end of their rotation. Overall, the curriculum was well received. Bootcamp was the highest rated element; 96% of residents agreed or strongly agreed that the session was useful for their education (Figure 1). Post curriculum implementation, there was significant improvement in resident NICU rotation feedback; residents expressed that the NICU learning environment and resident experience has improved. Conclusion We successfully implemented a NICU curriculum for paediatrics residents, with high satisfaction ratings and improved overall rotation feedback. This program shows promise in addressing a long standing educational gap. More research is needed to investigate whether it leads to improved competency in practice.

Abstract Background Neonatal intensive care units (NICUs) often experience acute clinical events. Post-event team debriefs can reinforce success, identify areas for improvement, and improve healthcare providers’ (HCP) psychological coping. However, barriers exist to successful debriefs, and poor debriefs can increase HCP stress. Objectives To implement and evaluate structured post-event clinical debriefs for NICUs within a regional neonatal program. Design/Methods We assembled a multi-disciplinary implementation team, adapted an existing tool (INFO Clinical Debriefing Tool), and identified champions for each site (2 level 2 NICUs, 1 level 3 perinatal NICU, and 1 level 4 surgical NICU). A REDCap database, debrief triggers, feedback process for recommendations to quality improvement leads and frontline HCPs were developed. We chose charge nurses as facilitators as they were consistently present but were not team leads. Facilitators were trained in 2-hour Zoom sessions with a didactic presentation followed by simulated debriefing practice. Debriefs were then started and tracked. A post-implementation survey was conducted at 6 months. Results Eighty-one HCPs responded to the pre survey, identifying time stress and skill / availability of facilitators as main barriers. Most nurses (75%) were comfortable participating in debriefs; this approached 100% in other disciplines. However, there were negative experiences reported. (Table 1) Ninety-five debriefs were conducted in 6 months; 50% were delivery room resuscitations, 14% were in-unit events. Median 7 (IQR 5-8) HCPs attended; 85% had 3 or more disciplines attending. Most (81%) were led by trained facilitators, with 80% led by nurses or respiratory therapists. Debriefs took a median 12 minutes (IQR 8-17), and generated recommendations for improvements to equipment, team communication, and processes. Two sites had more success with uptake, facilitated by consistent presence of champions. Barriers to implementation included: availability of trained facilitators, time constraints, competing unit priorities. The post survey (85 responses) showed a positive view of INFO debriefs. Most respondents (88%) had participated in at least 1 debrief; of these 76% report positive / very positive experience, 76% thought team members always had the chance to speak up, and 78% felt the INFO process provided an effective mechanism for communicating concerns. Participants still listed time pressure as the main barrier.(Table 2) Conclusion Nurse-led, structured post-event clinical debriefs can be implemented in NICUs and are positively viewed by participants. NICUs experience implementation barriers that need to be considered.

Argininosuccinate lyase (ASL) deficiency is a rare autosomal recessive urea cycle disorder. The severe neonatal-onset form is characterised by hyperammonaemia in the first days of life and manifests with a variety of severe symptoms. However, an index of suspicion for additional or alternative diagnoses must be maintained when the patient’s presentation is out of keeping with expected manifestations and course. We present a case of a neonate with ASL deficiency and concomitant hypotonia, severe respiratory distress, pulmonary hypertension, systemic hypotension and congenital hypothyroidism. The patient was investigated and subsequently diagnosed with brain-lung-thyroid syndrome, caused by a mutation in the NKX2-1 gene.

ObjectiveInvestigate neurodevelopmental outcomes at 3 years corrected age in infants with a birth weight ≤1250 g born to single parents.Study DesignInfants born between 1995 and 2010 with a birth weight ≤1250 g were considered eligible. Primary outcome was neurodevelopmental impairment; considered present if a child had any of the following: cerebral palsy, cognitive delay, visual impairment, or deafness/neurosensory hearing impairment. Univariate and multivariate analyses were performed.ResultA total of 1900 infants were eligible for inclusion. Follow-up data were available for 1395; 88 were born to a single parent. Infants in the single-parent group had higher mortality (18% vs. 11%, p = 0.009), IQ ≥1 SD below the mean (40% vs. 21%, p = 0.001) and any neurodevelopmental impairment (47% vs. 29%, p = 0.003). Single-parent family status, maternal education, bronchopulmonary dysplasia and severe neurological injury were significant predictors of intellectual impairment at 3 years corrected age.ConclusionPreterm infants with a birth weight ≤1250 g born to single parents at birth have poorer intellectual functioning at 3 years corrected age.

Abstract Introduction Evidence is lacking regarding the benefit of caesarean section (CS) for long-term neurodevelopmental outcomes in singleton preterm neonates. Therefore, uncertainty remains regarding obstetrical best practice in the delivery of premature neonates. Objective Our objective was to determine the association between the mode of delivery and neurodevelopmental outcomes in preterm singleton neonates who were delivered by vaginal route (VR), CS with labour (CS-L), or CS without labour (CS-NL). Methods Singleton neonates of less than 29 weeks’ gestation born January 1995 through December 2010 and admitted to our NICU and then assessed at neonatal follow-up clinic were studied. The primary outcome was neurodevelopmental impairment (NDI) defined as cerebral palsy, cognitive delay, major or minor visual impairment, or hearing impairment or deafness at 36 months’ corrected age. Results In this retrospective cohort study of 1,452 neonates, 1,000 were eligible for the study and 881 (88.1%) were available for follow-up. There was no significant difference in mortality between VR group, CS-L group, and CS-NL group. At 3 years, there was no significant difference between the three groups in terms of NDI. The odds of composite outcome of mortality or NDI for neonates born via CS-NL versus VR, and CS–L versus VR were 0.90 (95% confidence interval [CI]: 0.59 to 1.37) and 1.08 (95% CI: 0.72 to 1.61), respectively. Propensity score-based matched-pair analyses did not show a significant association between the composite outcome and CS with or without labour. Conclusions CS was not associated with increased survival or decreased risk of NDI in premature singleton neonates born at less than 29 weeks’ gestation.

Fetal alcohol spectrum disorders (FASDs) are the most common form of nongenetic birth defect in North America with devastating, long-term consequences. Physicians are the primary providers of medical care for pregnant women and they play an important role in the prevention and diagnosis of FASD. We sought to determine whether differences exist between rural and urban health care providers in knowledge of, attitudes about and awareness of FASD and preconception counselling. Surveys were mailed to a national, random sample of Canadian health care providers (n = 5361) between October 2001 and May 2002. Bivariate data analysis was completed using SPSS 14.0. Compared with their urban counterparts, rural providers were more likely to report being prepared to access resources related to alcohol use and dependency, yet they were less likely to agree that it was the physician's role to manage these issues (78.4% v. 82.8%, p < 0.05). Rural providers were more likely than urban providers to use a standardized tool to screen patients for alcohol use, to ask all pregnant women if they were drinking, to have cared for a patient with an FASD (56.7% v. 48.8%), to agree that providers do not make a diagnosis because of lack of time and training, and to recognize legal issues and inappropriate behaviour as secondary outcomes of FASD. Rural and urban providers were similar in their diagnostic knowledge of FASD. Few differences between rural and urban providers exist with regard to knowledge and diagnosis of FASD; however, rural providers are more prepared to access resources for women with addiction issues and are more likely to care for patients with an FASD.

ObjectiveTo compare neurodevelopmental outcomes of preterm infants at 18–21 months corrected age (CA) whose mothers smoked during pregnancy to those whose mothers did not smoke.Study designPreterm infants born at <29 weeks of gestation and evaluated at 18–21 months CA were included. Primary outcome was a composite outcome of death or neurodevelopmental impairment (NDI).ResultsOf a total of 2760 infants, 699 met exclusion criteria. Of the remaining 2061 infants, 280 (13.6%) were exposed to maternal smoking and 1781 (86.4%) were not. The odds of the composite outcome of death or NDI (aOR 1.40; 95% CI: 1.03–1.91), NDI alone (aOR 1.43; 95% CI: 1.01–2.03), and Bayley-III motor score <85 (aOR 1.91; 95% CI: 1.31–2.81) were higher in exposed infants.ConclusionsExposure to maternal smoking was associated with adverse composite outcome of death or NDI, NDI alone and lower motor scores at 18–21 months CA.