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To determine if suicide attempts increased during the first year of the pandemic among young adolescents in Quebec, Canada. We analyzed children aged 10–14 years who were hospitalized for a suicide attempt between January 2000 and March 2021. We calculated age-specific and sex-specific suicide attempt rates and the proportion of hospitalizations for suicide attempts before and during the pandemic and compared rates with patients aged 15–19 years. We used interrupted time series regression to measure changes in rates during the first (March 2020 to August 2020) and second (September 2020 to March 2021) waves and difference-in-difference analysis to determine if the pandemic had a greater impact on girls than boys. Suicide attempt rates decreased for children aged 10–14 years during the first wave. However, rates increased sharply during the second wave for girls, without changing for boys. Girls aged 10–14 years had an excess of 5.1 suicide attempts per 10,000 at the start of wave 2, with rates continuing to increase by 0.6 per 10,000 every month thereafter. Compared with the prepandemic period, the increase in the proportion of girls aged 10–14 years hospitalized for a suicide attempt was 2.2% greater than that of boys during wave 2. The pattern seen in girls aged 10–14 years was not present in girls aged 15–19 years. Hospitalizations for suicide attempts among girls aged 10–14 years increased considerably during the second wave of the pandemic, compared with boys and older girls. Young adolescent girls may benefit from screening and targeted interventions to address suicidal behavior. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between assisted reproductive technology (ART) and offspring morbidity in the first decade of life.Design: Longitudinal cohort study.Setting: Provincial health registry in Quebec, Canada.Patient(s): A total of 797,654 singleton children born between 2008 and 2019, followed up to 2020.Intervention(s): Retrospective, noninterventional study of any ART procedure vs. no ART.Main Outcome Measure(s): Childhood morbidity, including hospitalization for infectious, allergic, malignant, and other diseases, assessed using adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association with ART. We controlled for unmeasured family-level confounders that were shared among siblings through stratified Cox regression. To do so, we restricted the analysis to 10,097 siblings with discordant exposure to ART and compared the risk of outcomes in exposed vs. unexposed siblings.Result(s): Compared with no ART, ART was associated with 1.23 times the risk of any hospitalization (95% CI 1.19-1.27), 1.25 times the risk of infectious disease hospitalization (95% CI 1.21-1.29), and 1.25 times the risk of allergy hospitalization (95% CI 1.14-1.38). When we used a sibling design to control for shared genetic and environmental confounders, ART was not associated with a greater risk of childhood hospitalization (HR 0.92, 95% CI 0.78-1.08).Conclusion(s): ART is associated with an elevated risk of hospitalization up to 11 years of age, but discordant sibling analysis suggests that the association may be due to genetic, environmental, or other shared familial confounders. [ABSTRACT FROM AUTHOR]

Background: Intraventricular hemorrhage is a serious neonatal complication associated with neurodevelopmental disorders, but the relationship with other childhood morbidities is unclear. We sought to assess the association of neonatal intraventricular hemorrhage with the risk of morbidity up to 12 years of age.Methods: We analyzed a cohort of 794,384 infants born between 2006 and 2016 in Quebec, Canada, with 4,269,579 person-years of follow-up. The exposure was grade I to IV intraventricular hemorrhage in the neonatal period. The main outcome measure was childhood hospitalization by cause of admission. In adjusted Cox regression models, we estimated hazard ratios and 95% confidence intervals for the association of intraventricular hemorrhage with future childhood hospitalization.Results: Infants with intraventricular hemorrhage had a higher incidence of childhood hospitalization than infants without hemorrhage (23.8 vs. 5.7 per 100 person-years). Compared with those with no hemorrhage, infants with intraventricular hemorrhage had 1.56 times the risk of hospitalization (95% confidence interval, 1.43-1.70). The risk was 2.81 times higher for grade III/IV hemorrhage (95% confidence interval, 2.23-3.53). Intraventricular hemorrhage at term was associated with 3.19 times the risk of hospitalization (95% confidence interval, 2.55-4.00), whereas preterm intraventricular hemorrhage was associated with 2.06 times the risk before 28 weeks (95% confidence interval, 1.75-2.42) and 1.87 times the risk between 28 and 36 weeks (95% confidence interval, 1.68-2.08), compared with no hemorrhage at term. Primary reasons for hospitalizations included central nervous system, ophthalmologic, musculoskeletal, and cardiovascular disorders.Conclusions: Intraventricular hemorrhage, especially of higher grades and in term neonates, is a predictor of future risk of hospitalization in childhood. [ABSTRACT FROM AUTHOR]

The possibility that child maltreatment was misclassified as unintentional injury during the COVID-19 pandemic has not been evaluated. We assessed if child maltreatment hospitalizations changed during the pandemic, and if the change was accompanied by an increase in unintentional injuries. This study included children aged 0–4 years who were admitted for maltreatment or unintentional injuries between April 2006 and March 2021 in hospitals of Quebec, Canada. We used interrupted time series regression to estimate the effect of the pandemic on hospitalization rates for maltreatment, compared with unintentional transport accidents, falls, and mechanical force injuries. We assessed if the change in maltreatment hospitalization was accompanied by an increase in specific types of unintentional injury. Hospitalizations for child maltreatment decreased from 16.3 per 100,000 (95 % CI 9.1–23.4) the year before the pandemic to 13.2 per 100,000 (95 % CI 6.7–19.7) during the first lockdown. Hospitalizations for most types of unintentional injury also decreased, but injuries due to falls involving another person increased from 9.0 to 16.5 per 100,000. Hospitalization rates for maltreatment and unintentional injury remained low during the second lockdown, but mechanical force injuries involving another person increased from 3.8 to 8.1 per 100,000. Hospitalizations for child maltreatment may have been misclassified as unintentional injuries involving another person during the pandemic. Children admitted for these types of unintentional injuries may benefit from closer assessment to rule out maltreatment. • Hospitalization rates for child maltreatment decreased during the pandemic. • Falls and unintentional mechanical injuries involving another person increased in parallel. • Some cases of maltreatment may have been misclassified as unintentional injury. • Strategies to identify child maltreatment during a pandemic are needed. [ABSTRACT FROM AUTHOR]

The emotional turmoil associated with extremely preterm birth is inescapable parents. How each parent handles the unexpected, makes sense of the unknown and learns to parent their child is uniquely personal. A rigid standardized approach to support families through their journey before and during neonatal intensive care disregards this individuality. This article reviews general concepts and practices that can be learned and applied by clinicians to promote resiliency and help parents cope adaptively. This review will describe how to personalize parenting support during the antenatal consultation and hospitalization for parents of extremely premature infants. To facilitate this, mindsets and care delivery models need to shift from inflexible standardized protocols to flexible guidelines that enable personalized communications, support structures and care delivery models tailored to each person's characteristics, preferences, and values. [ABSTRACT FROM AUTHOR]

The philosophy of care in Neonatal Intensive care Units (NICU) has changed with increasing integration of families. We examined parents' and clinicians' perspective about Family Integrated Care (FiCare) in our quaternary NICU. We found that parents and clinicians reported many benefits for families. They were all enthusiastic about FiCare for non-medical items such as changing diapers and skin-to-skin care; for more medical items, such as presenting at rounds, being present during resuscitation or procedures, most physicians wished for more parental involvement, more than other professionals, even parents. All parents described how FiCare benefited them, had empowered them, helped them feel like parents and become a family; but several parents, who could not participate as much or did not want to assume clinical roles, reported feeling guilty. Having a flexible, yet transparent FiCare philosophy is key, as opposed to having homogeneous goals. For example, an aim to have all parents present at rounds in a quality improvement initiative can cause harm to some families. We suggest how to ethically improve FiCare in the best interest of families while minimizing harms. It is important for FiCare not to be "Family Imposed Care." Optimizing FiCare can only be done when parents' priorities guide our actions, while also keeping in mind clinicians' perspectives and respecting the reality of each NICU. [ABSTRACT FROM AUTHOR]

Neonatal follow-up studies traditionally report on long-term neurodevelopmental outcomes as a metric of success of neonatal intensive care. Research endpoints are also typically deficit-based, assessing whether disabilities, such as cerebral palsy, cognitive impairment, deafness or blindness, are present or not. These historical approaches have resulted in neonatal follow-up programs that narrowly focus on the early identification of neurodevelopmental problems, possibly to the detriment of other outcomes that matter to parents. This focus on neurodevelopmental disability may also contribute to the negative stereotypes associated with extreme preterm birth. In this article, we discuss parental perspectives regarding important long-term outcomes. We examine limitations with current definitions of outcomes and propose a strength-based approach to generate meaningful findings both for clinicians and families. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between cesarean delivery and childhood infections up to 13 years of age.Study Design: We conducted a longitudinal cohort study of 731 803 children born between 2006 and 2016 at all hospitals in the province of Quebec, Canada. We followed children born by cesarean, operative vaginal, and nonoperative vaginal delivery up to 13 years of age. Outcomes included hospitalization for otitis media, respiratory, infectious enteritis, and other infections. We estimated hazard ratios with 95% CIs for the association between mode of delivery and childhood infections, adjusted for patient characteristics.Results: At age 3-4 years, cesarean delivery was associated with a 1.07-fold greater risk of otitis media (95% CI, 1.03-1.11), a 1.15-fold greater risk of respiratory infection (95% CI, 1.09-1.22), and a 1.13-fold greater risk of infectious enteritis (95% CI, 1.03-1.25) compared with nonoperative vaginal delivery. However, operative vaginal delivery was associated with these same outcomes. Both cesarean and operative vaginal delivery were more strongly associated with infection hospitalization before age 1 year, but associations disappeared after 5 years.Conclusions: Cesarean delivery is associated with infection hospitalization before but not after age 5 years. However, associations were also present for operative vaginal delivery, which suggests that mechanisms other than exposure to maternal vaginal flora explain the relationship. [ABSTRACT FROM AUTHOR]

Objectives: To explore parental perspectives regarding their preterm child at 18 months corrected age and to investigate whether reported answers correlate with level of neurodevelopmental impairment (NDI) as defined by clinicians. We hypothesized that parents would report more negative concerns with increasing level of NDI.Study Design: This study included 190 infants born <29 weeks of gestational age in 2009-2012 at 1 tertiary university health center. Infants underwent detailed developmental assessment at 18 months corrected age, and were classified into either absence or presence of mild to moderate or severe NDI. Parents were asked 2 open-ended questions: "What concerns you most about your child?" and "Please describe the best things about your child." Open-ended questions were analyzed using qualitative methodology.Results: In this cohort, 49%, 43%, and 8% of participants had no, mild to moderate, and severe NDI. The majority of parents (72.8%) had both positive and negative aspects to report; 26.8% only had positive ones. The main positive themes invoked by parents included their child's personality (61%), happiness (40%), developmental outcome/progress (40%), and physical health (11%). The main themes regarding parental concerns included neurodevelopment (56%), notably language and behavior, and physical health (24%), particularly growth/nutrition and physical fragility. There was no association between positive themes and categories of NDI, but parents of children with mild to moderate NDI reported more concerns about development.Conclusions: Neonatal outcome research would benefit from incorporating parental perspectives regarding their child, including negative and positive aspects, enabling physicians to provide complete and balanced information to parents of all preterm infants. [ABSTRACT FROM AUTHOR]

Background: Extremely preterm infants are at high-risk for neurodevelopmental disabilities. The Movement Assessment of Infants (MAI) and the Alberta Infant Motor Scale (AIMS) have been designed to predict outcome with modest accuracy with the Bayley-I or Bayley-II.Aims: To examine and compare the predictive validity of the MAI and AIMS in determining neurodevelopmental outcome with the Bayley-III.Design: Retrospective cohort study of 160 infants born at ≤ 28 weeks gestation.Method: At their corrected age, infants underwent the MAI at 4 months, the AIMS at 4 and 10-12 months, and the Bayley-III and neurological examination at 18 months. Sensitivity and specificity were calculated.Results: Infants had a mean gestation of 26.3 ± 1.4 weeks and birth weight of 906 ± 207 g. A high-risk score (≥ 14) for adverse outcome was obtained by 57% of infants on the MAI. On the AIMS, a high-risk score (<5th percentile) was obtained by 56% at 4 months and 30% at 10-12 months. At 18 months, infants with low-risk scores on either the MAI or AIMS had higher cognitive, language, and motor Bayley-III scores than those with high-risk scores. They were less likely to have severe neurodevelopmental impairment. To predict Bayley-III scores <70, sensitivity and specificity were 91% and 49%, respectively, for the MAI and 78% and 48%, respectively, for the AIMS.Conclusions: Extremely preterm infants with low-risk MAI at 4 months or AIMS scores at 4 or 10-12 months had better outcomes than those with high-risk scores. However, both tests lack specificity to predict individual neurodevelopmental status at 18 months. [ABSTRACT FROM AUTHOR]

Introduction: Risk factors for accidental drug poisonings in children are poorly understood, including the association with maternal substance use. This study seeks to determine whether maternal substance use disorders before birth are associated with the future risk of accidental drug poisonings in young children.Methods: This study was a longitudinal cohort analysis of 1,032,209 children aged <5 years between 2006 and 2020 in Quebec, Canada. The main exposure included maternal substance use disorders before or during pregnancy. The outcome was hospitalization for drug poisonings before age 5 years, including opioids, cannabis, sedatives/hypnotics, stimulants, and other drugs. Adjusted Cox proportional hazards regression was used to compute hazard ratios and 95% CIs for the association of substance use disorders with child drug poisonings during 4,523,003 person-years of follow-up. Analyses were conducted in 2020.Results: Hospitalization rates for drug poisoning before age 5 years were greater for children of mothers with substance use disorders versus no substance use disorder (84.8 vs 20.7 per 100,000 person-years). Maternal substance use disorders before birth were associated with 2.28 times the risk of future drug poisonings in children (95% CI=1.63, 3.20). The association was stronger for maternal opioid use disorders (hazard ratio=4.16, 95% CI=2.38, 7.27) than other drug use disorders. Associations with child poisonings were stronger between age 1 and 2 years (hazard ratio=3.26, 95% CI=2.09, 5.10) and for poisonings involving opioids, cannabis, and sedative/hypnotic drugs.Conclusions: Maternal substance use disorders before childbirth may be markers of future risk of drug poisonings in young children. [ABSTRACT FROM AUTHOR]

Background: Preterm infants are at greater risk of language delay. Early identification of language delay is essential to improve functional outcome in these children.Aim: To examine the concurrent validity of Rescorla's Language Development Survey and the Bayley Scales of Infant and Toddler Development (Bayley-III) at 18months corrected age in preterm infants.Study Design: Test accuracy study.Participants: 189 preterm infants born <29weeks were assessed at 18months.Outcome Measures: The Language Development Survey, a parent-reported screening instrument, was administered in French concurrently with the Language Scales of the Bayley-III. Receiver-Operating-Characteristics curves were used to determine optimal cut-off score on the Language Development Survey to identify Bayley-III score <85. Sensitivity, specificity, positive and negative predictive values, and κ coefficient were calculated.Results: Using Rescorla's original cut-off scores of ≤10 words for boys and ≤24 for girls, sensitivity was 76% and 88% for boys and girls, respectively, and specificity was 73% and 52% for boys and girls, respectively, in identifying language delay as per the Bayley-III. The optimal threshold was ≤10 words for both boys and girls. In girls, lowering the cut-off score decreased sensitivity (79%), but improved specificity (82%), thus lowering the number of false-positives.Conclusion: Our findings support using the Language Development Survey as an expressive language screener in preterm infants. [ABSTRACT FROM AUTHOR]

• Very preterm children are at greater risk of mild to moderate motor impairments. • Early identification of these impairments is essential to improve functional outcome. • The ASQ-3 and LDCDQ are not sufficient on their own to detect motor impairments. [ABSTRACT FROM AUTHOR]

Maternal stress and anxiety are associated with adverse pregnancy outcomes, but the association with future childhood injuries is unclear, especially risk of orthopedic fractures. We conducted a longitudinal study of 773,339 newborns in Quebec, Canada between 2006 and 2018. We identified women with stress or anxiety disorders before or after delivery, and computed the incidence of future operative fractures in offspring. We estimated hazard ratios (HR) with 95% confidence intervals (CI) for the association of maternal stress and anxiety disorders with the risk of pediatric fractures, adjusted for maternal and infant characteristics. Incidence of any fracture was higher for maternal stress (20.5 per 10,000 person-years) and anxiety (19.8 per 10,000 person-years) than no disorder (15.3 per 10,000 person-years). Maternal stress was associated with 1.17 times the risk of pediatric fractures (95% CI 1.00–1.38), and anxiety was associated with 1.26 times the risk (95% CI 1.07–1.47), compared with no disorder. Stress was predominantly linked with fall-related fractures (HR 1.26, 95% CI 1.06–1.50), and anxiety with assault-related fractures (HR 2.97, 95% CI 1.50–5.89). The association of stress with fall-related fractures was more prominent after 36 months of age, whereas anxiety was linked with assault-related fractures before 6 months. Stress and anxiety disorders before or after delivery are associated with the future risk of fractures in children. Women with a history of stress or anxiety disorders may benefit from counselling and social support for child fracture prevention. • The possibility of an association of maternal history of stress and anxiety with childhood bone fractures has not been evaluated. • We followed a longitudinal cohort of 773,339 newborns over time for risk of fractures up to 12 years of age. • Maternal stress or anxiety disorders before, during, and after pregnancy were associated with the future risk of fractures in children. • Associations were stronger for fractures due to falls and assault. [ABSTRACT FROM AUTHOR]