Publications by authors named "Ran D Goldman"

269 Publications

Formula choices in infants with cow's milk allergy.

Can Fam Physician 2021 Mar;67(3):180-182

Question: I frequently encounter infants with symptoms suggestive of allergy after being introduced to standard cow's milk formula. Parents are concerned and ask for recommendations regarding formula alternatives. Which formulas are best for children with cow's milk allergy?

Answer: Cow's milk allergy is common, and the criterion standard for diagnosis is elimination, provocation (with a double-blind, placebo-controlled food challenge protocol), and re-elimination. The allergy is treated by eliminating cow's milk protein from the diet. Formula alternatives include hydrolyzed cow's milk formula, rice-based formula, soy-based formula, and amino acid-based formula, which are all nutritionally adequate alternatives to cow's milk formula. Symptom severity, patient preference, cost, and efficacy are factors to be considered when choosing an alternative.
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http://dx.doi.org/10.46747/cfp.6703180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963007PMC
March 2021

Fruit-Induced Anaphylaxis: Clinical Presentation and Management.

J Allergy Clin Immunol Pract 2021 Mar 13. Epub 2021 Mar 13.

Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.

Background: Data are sparse regarding the clinical characteristics and management of fruit-induced anaphylaxis.

Objective: To assess clinical characteristics and management of patients with fruit-induced anaphylaxis and determine factors associated with severe reactions and epinephrine use.

Methods: Over 9 years, children and adults presenting with anaphylaxis to seven emergency departments in four Canadian provinces and patients requiring emergency medical services in Outaouais, Quebec were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting symptoms, triggers, and management was collected. Multivariate logistic regression was used to identify factors associated with severe reactions and epinephrine treatment in the pre-hospital setting.

Results: We recruited 250 patients with fruit-induced anaphylaxis, median age 10.2 years (interquartile range, 3.6-23.4 years); 48.8% were male. The most common fruit triggers were kiwi (15.6%), banana (10.8%), and mango (9.2%). Twenty-three patients reported having eczema (9.3%). Epinephrine use was low in both the pre-hospital setting and the emergency department (28.4% and 40.8%, respectively). Severe reactions to fruit were more likely to occur in spring and among those with eczema (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI], 1.03-1.23; and 1.17, 95% CI, 1.03-1.34, respectively). Patients with moderate and severe reactions (aOR = 1.23; 95% CI, 1.06-1.43) and those with a known food allergy (aOR = 1.38; 95% CI, 1.24-1.54) were more likely to be treated with epinephrine in the pre-hospital setting.

Conclusions: Severe anaphylaxis to fruit is more frequent in spring. Cross-reactivity to pollens is a potential explanation that should be evaluated further.
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http://dx.doi.org/10.1016/j.jaip.2021.02.055DOI Listing
March 2021

Technology in quest of the holy grail.

Authors:
Ran D Goldman

CJEM 2021 Jan 25;23(1):6-7. Epub 2021 Jan 25.

The Innovative VR Pain Lab, Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, and the BC Children's Hospital, 4480 Oak St, Vancouver, BC, Canada.

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http://dx.doi.org/10.1007/s43678-020-00063-xDOI Listing
January 2021

Second-Generation Antipsychotic Use in Pediatric Emergency Medicine.

Pediatr Emerg Care 2021 Mar;37(3):161-164

Professor, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, University of British Columbia; BC Children's Hospital Research Institute, Vancouver, BC, Canada.

Abstract: In recent years, the number of patients presenting to the emergency department with mental health complaints has been growing, alongside an increase in second-generation antipsychotic (SGAs) prescriptions for a variety of mental health conditions. Children treated with SGAs may have abnormalities, such as rapid weight gain and central adiposity, glucose intolerance, dyslipidemia, and hypertension; they may present to the pediatric emergency department with components of metabolic syndrome or type 2 diabetes, and a subsequent significant risk for cardiovascular complications later in life. Pediatric emergency department providers may serve as a safety net for patients to detect SGA-related metabolic complications, especially among vulnerable populations lacking access to primary care or psychiatric services.
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http://dx.doi.org/10.1097/PEC.0000000000002387DOI Listing
March 2021

Les accès de frissonnement: Un phénomène bénin chez l'enfant.

Can Fam Physician 2021 Feb;67(2):e56-e58

Question: Un enfant de 2 ans est récemment venu à ma clinique en raison d'épisodes répétés de raidissements du cou et de mouvements de frissons aux épaules et aux bras. Les épisodes durent de 4 à 5 secondes et se produisent plus de 10 fois par jour, sans modèle apparent, outre une fréquence accrue à l'heure des repas. Même s'il n'a pas eu de perte de conscience, les parents s'inquiétaient qu'il ait des convulsions. Un neurologue a diagnostiqué des accès de frissonnement. Devrais-je commencer des médicaments antiépileptiques pour cet enfant? RÉPONSE: Les accès de frissonnement sont des mouvements involontaires de la tête et des extrémités supérieures qui se produisent durant des activités normales et qui n'affectent pas la conscience. Des constatations normales à un examen neurologique et au tracé d'un électroencéphalogramme confirmeront que l'enfant a des accès de frissonnement, un phénomène bénin qui ne requiert pas d'examen plus approfondi ou de traitement médical. La cause de cet état est inconnue, mais il se distingue de l'épilepsie et ne nécessite pas de médicaments antiépileptiques, auxquels il ne répond pas. Les parents peuvent avoir l'assurance que les accès diminueront en fréquence et disparaîtront spontanément avec l'âge.
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http://dx.doi.org/10.46747/cfp.6702e56DOI Listing
February 2021

Shuddering attacks: A benign phenomenon in children.

Can Fam Physician 2021 Feb;67(2):107-108

Question: A 2-year-old child was recently brought into my office for repeated episodes of neck stiffening and shivering movements of the shoulders and arms. The episodes last 4 to 5 seconds and occur more than 10 times per day, with no apparent pattern except increased frequency at mealtime. Although there has never been loss of consciousness, the parent was worried that these were seizures. The child was diagnosed by a neurologist as having shuddering attacks. Should I start antiepileptic medications for this child?

Answer: Shuddering attacks are involuntary movements of the head and upper extremities that occur during normal activities and do not impair consciousness. Normal neurologic examination findings and normal electroencephalogram tracing will confirm that this child has shuddering attacks, a benign phenomenon that requires no further investigation or medical therapy. The condition is of unknown cause but is distinct from epilepsy and neither warrants nor responds to antiepileptic medications. Parents can be reassured that attacks will decrease in frequency and will spontaneously remit with age.
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http://dx.doi.org/10.46747/cfp.6702107DOI Listing
February 2021

Continuous positive airway pressure for obstructive sleep apnea in children.

Can Fam Physician 2021 Jan;67(1):21-23

Question: A 12-year-old child underwent adenotonsillectomy for treatment of obstructive sleep apnea (OSA) but continues to snore at night and struggles with attentiveness at school. The child's parent uses a continuous positive airway pressure (CPAP) machine at night and wonders whether the same therapy could be used in children.

Answer: Unlike in adults, pediatric OSA is commonly related to adenotonsillar hypertrophy and is often amenable to treatment with adenotonsillectomy. As an alternative to surgery or in cases of postsurgical persistence of OSA, CPAP has shown effectiveness in improving both polysomnographic parameters and daytime neurobehavioural symptoms in children with OSA. Adherence to CPAP therapy is a challenge in children and requires parental education and special considerations such as a mask acclimatization period.
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http://dx.doi.org/10.46747/cfp.670121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822622PMC
January 2021

Henoch-Schönlein purpura in children: Use of corticosteroids for prevention and treatment of renal disease.

Can Fam Physician 2020 12;66(12):895-897

Question: A few patients have previously presented to my clinic with palpable purpura, joint inflammation, and severe abdominal pain characteristic of Henoch-Schönlein purpura (HSP). Considering that renal injury is the primary long-term complication of HSP, are corticosteroids effective in preventing or treating renal disease in children with HSP?

Answer: Henoch-Schönlein purpura is self-limiting in 94% of children, but permanent renal injury is reported in one-fifth of children with nephritic or nephrotic features. Corticosteroids have been considered as candidates for preventing and treating renal involvement in HSP. There is a moderate level of evidence to suggest corticosteroids are not effective in preventing renal involvement in HSP. However, based on low-level evidence and similarities with primary immunoglobulin A nephropathy, experts recommend corticosteroids in treating renal involvement in HSP to prevent long-term kidney injury. Dose and duration of therapy should be carefully considered in consultation with a pediatric nephrologist.
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http://dx.doi.org/10.46747/cfp.6612895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745939PMC
December 2020

Pediatric influenza in the emergency department: diagnosis and management.

Authors:
Ran D Goldman

Pediatr Emerg Med Pract 2021 Jan 2;18(1):1-20. Epub 2021 Jan 2.

Professor, University of British Columbia, Pediatric Emergency Physician, BC Children's Hospital, Vancouver, BC, Canada.

Influenza in children is a significant cause of morbidity and mortality. Presenting symptoms of influenza vary greatly among children; clinical presentation should be assessed for severity of illness and potential complications. Available clinical and laboratory findings should be used to guide treatment for young children with fever. Clinicians should be aware of up-to-date recommendations to diagnose and treat children with influenza and to ensure public health engagement to prevent and manage influenza epidemics. This issue reviews common complications of influenza infection, offers guidance for infection control measures, and provides evidence-based recommendations for the management of pediatric patients with influenza in the emergency department.
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January 2021

Reply.

J Pediatr 2021 04 30;231:299-300. Epub 2020 Nov 30.

Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington.

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http://dx.doi.org/10.1016/j.jpeds.2020.11.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703517PMC
April 2021

Finding the Needle in the Hay Stack: Population-based Study of Prediagnostic Symptomatic Interval in Children With CNS Tumors.

J Pediatr Hematol Oncol 2020 Nov 23. Epub 2020 Nov 23.

Pediatrics, Division of Hematology/Oncology/BMT, University of British Columbia, BC Children's Research Institute, Vancouver, BC, Canada.

Central nervous system (CNS) tumors in children are a devastating diagnosis and delay in diagnosis is well documented in the literature. The aim of this study was to document and characterize time to diagnosis of CNS tumors among children 0 to 17 years of age in a pediatric center. A retrospective chart review was conducted of medical records of children with CNS tumors from 2000 to 2016 in British Columbia, Canada and 148 reports were available for review. Average age at diagnosis was 87.8 months (SD=59.7; median=72). One third (30%) were diagnosed after a single visit to a health care provider and 11 (7.7%) after more than 4 visits. Median time to diagnosis (prediagnostic symptomatic interval [PSI]) was 62 days (average 197±341 d; range, 0 to 2047 d). Longest period was time from first symptom to first health care provider visit (PSI1, median 37 d). Tumors in the posterior fossa and symptoms of ataxia or paresis were associated with a significantly shorter PSI. CNS tumors in children continue to pose a diagnostic challenge with variability in time to diagnosis. Our population-based study suggests variability in time to diagnosis with a need for education of families to identify symptoms associated with CNS tumors.
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http://dx.doi.org/10.1097/MPH.0000000000002012DOI Listing
November 2020

Factors associated with parents' willingness to enroll their children in trials for COVID-19 vaccination.

Hum Vaccin Immunother 2020 Nov 23:1-5. Epub 2020 Nov 23.

Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine , Seattle, WA, USA.

The coronavirus disease 2019 (COVID-19) pandemic has taken an unprecedented global toll and vaccination is needed to restore healthy living. Timely inclusion of children in vaccination trials is critical. We surveyed caregivers of children seeking care in 17 Emergency Departments (ED) across 6 countries during the peak of the pandemic to identify factors associated with intent to participate in COVID-19 vaccine trials. Questions about child and parent characteristics, COVID-19 expressed concerns and parental attitudes toward participation in a trial were asked. Of 2768 completed surveys, 18.4% parents stated they would enroll their child in a clinical trial for a COVID-19 vaccine and 14.4% would agree to a randomized placebo-controlled study. Factors associated with willingness to participate were parents agreeing to enroll in a COVID-19 vaccine trial themselves (Odds Ratio (OR) 32.9, 95% Confidence Interval (CI) (21.9-51.2)) having an older child (OR 1.0 (1.0-1.01)), having children who received all vaccinations based on their country schedule (OR 2.67 (1.35-5.71)) and parents with high school education or lower (OR 1.79 (1.18-2.74)). Mothers were less likely to enroll their child in a trial (OR 0.68 (0.47-0.97)). Only one fifth of families surveyed will consider enrolling their child in a vaccine trial. Parental interest in participation, history of vaccinating their child, and the child being older all are associated with parents allowing their child to participate in a COVID vaccine trial. This information may help decision-makers and researchers shape their strategies for trial design and participation engagement in upcoming COVID19 vaccination trials.
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http://dx.doi.org/10.1080/21645515.2020.1834325DOI Listing
November 2020

Fluid management in children with diabetic ketoacidosis.

Can Fam Physician 2020 11;66(11):817-819

Question: Previous research has indicated that rapid rehydration in children with type 1 diabetes who present with diabetic ketoacidosis could result in cerebral edema. I have been treating patients with diabetic ketoacidosis with gradual fluid replacement. With the risk of cerebral injury in these patients, should I continue management with slow fluid rehydration?

Answer: Recent research has shown that neither fluid infusion rate nor sodium chloride concentration increases risk of cerebral injury. However, it is possible for subtle brain injury to occur during treatment, regardless of the fluid administration strategy. The 2018 International Society for Pediatric and Adolescent Diabetes guidelines have been updated in light of this research.
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November 2020

Paediatric patients seen in 18 emergency departments during the COVID-19 pandemic.

Emerg Med J 2020 Dec 29;37(12):773-777. Epub 2020 Oct 29.

BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.

Background: Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians' offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year.

Methods: We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0-16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year.

Results: A reduction of 57% and 70% in overall visits was recorded in the children's hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of 'fever' and 'gastrointestinal' symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively).

Conclusion: Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.
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http://dx.doi.org/10.1136/emermed-2020-210273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604790PMC
December 2020

Current Approach to the Evaluation and Management of Incomplete Kawasaki Disease in the Emergency Department.

Pediatr Emerg Care 2020 Nov;36(11):537-541

Chair, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division Head, Clinical Pharmacology, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, BC, Canada.

Kawasaki disease (KD) is one of the most common vasculitides of childhood and frequently presents to the emergency department. Although the diagnosis of KD is based on clinical criteria, children who do not fulfill the criteria but have sufficient supportive features of KD are diagnosed as having incomplete KD and warrant the same course of therapy as children with classic KD. The diagnosis of incomplete KD is challenging and requires a high index of suspicion. The purpose of this article is to review presenting features of incomplete KD and the diagnostic approach and management of children in the emergency department.
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http://dx.doi.org/10.1097/PEC.0000000000002259DOI Listing
November 2020

Pneumothorax spontané chez l’enfant.

Authors:
Ran D Goldman

Can Fam Physician 2020 10;66(10):e261-e263

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571644PMC
October 2020

Spontaneous pneumothorax in children.

Authors:
Ran D Goldman

Can Fam Physician 2020 10;66(10):737-738

A 15-year-old boy in my practice returned for follow-up after having a spontaneous pneumothorax. He spent 6 hours in the emergency department and received oxygen. How common is this condition, and what needs to be considered regarding management and recurrence? Primary spontaneous pneumothorax-penetration of air in the pleural space between the lung and the chest wall-in children is common, and the incidence seems to be on the rise. Emphysematous bleb, asthma, and tobacco use were the most common findings associated with the condition, and in young children pneumothorax might be associated with underlying congenital anomalies. Auscultation and observation of the chest with imaging are used to diagnose the condition, and recurrence in adolescents is common. Treatment includes supportive therapy (mostly rest and oxygen) for small pneumothorax or placing a chest tube or definitive surgical treatment for larger pneumothorax.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571650PMC
October 2020

Caregiver willingness to vaccinate their children against COVID-19: Cross sectional survey.

Vaccine 2020 11 10;38(48):7668-7673. Epub 2020 Oct 10.

Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland.

Background: More than 100 COVID-19 vaccine candidates are in development since the SARS-CoV-2 genetic sequence was published in January 2020. The uptake of a COVID-19 vaccine among children will be instrumental in limiting the spread of the disease as herd immunity may require vaccine coverage of up to 80% of the population. Prior history of pandemic vaccine coverage was as low as 40% among children in the United States during the 2009 H1N1 influenza pandemic.

Purpose: To investigate predictors associated with global caregivers' intent to vaccinate their children against COVID-19, when the vaccine becomes available.

Method: An international cross sectional survey of 1541 caregivers arriving with their children to 16 pediatric Emergency Departments (ED) across six countries from March 26 to May 31, 2020.

Results: 65% (n = 1005) of caregivers reported that they intend to vaccinate their child against COVID-19, once a vaccine is available. A univariate and subsequent multivariate analysis found that increased intended uptake was associated with children that were older, children with no chronic illness, when fathers completed the survey, children up-to-date on their vaccination schedule, recent history of vaccination against influenza, and caregivers concerned their child had COVID-19 at the time of survey completion in the ED. The most common reason reported by caregivers intending to vaccinate was to protect their child (62%), and the most common reason reported by caregivers refusing vaccination was the vaccine's novelty (52%).

Conclusions: The majority of caregivers intend to vaccinate their children against COVID-19, though uptake will likely be associated with specific factors such as child and caregiver demographics and vaccination history. Public health strategies need to address barriers to uptake by providing evidence about an upcoming COVID-19 vaccine's safety and efficacy, highlighting the risks and consequences of infection in children, and educating caregivers on the role of vaccination.
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http://dx.doi.org/10.1016/j.vaccine.2020.09.084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547568PMC
November 2020

Caregivers' Willingness to Accept Expedited Vaccine Research During the COVID-19 Pandemic: A Cross-sectional Survey.

Clin Ther 2020 11 3;42(11):2124-2133. Epub 2020 Oct 3.

Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan.

Purpose: This study determined the predictors of caregivers' willingness to accept an accelerated regulatory process for the development of vaccines against coronavirus disease 2019 (COVID-19).

Methods: An international cross-sectional survey was administered to 2557 caregivers of children in 17 pediatric emergency departments (EDs) across 6 countries from March 26, 2020, to June 30, 2020. Caregivers were asked to select 1 of 4 choices with which they most agreed regarding a proposed COVID-19 vaccine-approval process, in addition to questions regarding demographic characteristics, the ED visit, and attitudes about COVID-19. Univariate analyses were conducted using the Mann-Whitney U test for comparing non-normally distributed continuous variables, an independent t test for comparing normally distributed continuous variables, and a χ or Fisher exact test for categorical variables. Multivariate logistic regression analysis was used for determining independent factors associated with caregivers' willingness to accept abridged development of a COVID-19 vaccine. A P value of <0.05 was considered significant.

Findings: Almost half (1101/2557; 43%) of caregivers reported that they were willing to accept less rigorous testing and postresearch approval of a new COVID-19 vaccine. Independent factors associated with caregivers' willingness to accept expedited COVID-19 vaccine research included having children who were up to date on the vaccination schedule (odds ratio [OR] = 1.72; 95% CI, 1.29-2.31), caregivers' concern about having had COVID-19 themselves at the time of survey completion in the ED (OR = 1.1; 95% CI, 1.05-1.16), and caregivers' intent to have their children vaccinated against COVID-19 if a vaccine were to become available (OR = 1.84; 95% CI, 1.54-2.21). Compared with fathers, mothers completing the survey were less likely to approve of changes in the vaccine-development process (OR = 0.641; 95% CI, 0.529-0.775).

Implications: Less than half of caregivers in this worldwide sample were willing to accept abbreviated COVID-19 vaccine testing. As a part of an effort to increase acceptance and uptake of a new vaccine, especially in order to protect children, public health strategies and individual providers should understand caregivers' attitudes toward the approval of a vaccine and consult them appropriately.
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http://dx.doi.org/10.1016/j.clinthera.2020.09.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532744PMC
November 2020

Risk of peanut- and tree-nut-induced anaphylaxis during Halloween, Easter and other cultural holidays in Canadian children.

CMAJ 2020 Sep;192(38):E1084-E1092

Division of Allergy and Clinical Immunology (Leung, Gabrielli, Ben-Shoshan), Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Que.; Division of Rheumatology (Clarke, Shand), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Morris), Hôpital Sacré-Coeur; Division of Pediatric Emergency Medicine (Gravel), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Division of Pediatric Emergency Medicine (Lim), Department of Pediatrics, Children's Hospital at London Health Sciences Centre, London, Ont.; Divisions of Allergy and Immunology (Chan) and Emergency Medicine (Goldman, Enarson), Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC; Department of Pediatrics (O'Keefe), Faculty of Medicine, Memorial University, St. John's, NL; Food Allergy Canada (Gerdts), Toronto, Ont.; Division of Clinical Immunology & Allergy (Chu), Department of Medicine, and Department of Health Research Methods, Evidence, and Impact (Chu), McMaster University, Hamilton, Ont.; Division of Immunology and Allergy (Upton), Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Centre for Outcomes Research and Evaluation (Zhang), Research Institute of McGill University Health Centre, Montréal, Que.

Background: It is not established whether the risk of anaphylaxis induced by peanuts or tree nuts in children increases at specific times of the year. We aimed to evaluate the risk of peanut-and tree-nut-induced anaphylaxis during certain cultural holidays in Canadian children.

Methods: We collected data on confirmed pediatric cases of anaphylaxis presenting to emergency departments in 4 Canadian provinces as part of the Cross-Canada Anaphylaxis Registry. We assessed the mean number of cases per day and incidence rate ratio (IRR) of anaphylaxis induced by unknown nuts, peanuts and tree nuts presenting during each of 6 holidays (Halloween, Christmas, Easter, Diwali, Chinese New Year and Eid al-Adha) versus the rest of the year. We estimated IRRs and 95% confidence intervals (CIs) using Poisson regression.

Results: Data were collected for 1390 pediatric cases of anaphylaxis between 2011 and 2020. Their median age was 5.4 years, and 864 (62.2%) of the children were boys. During Halloween and Easter, there were higher rates of anaphylaxis to unknown nuts (IRR 1.66, 95% CI 1.13-2.43 and IRR 1.71, 95% CI 1.21-2.42, respectively) and peanuts (IRR 1.86, 95% CI 1.12-3.11 and IRR 1.57, 95% CI 0.94-2.63, respectively) compared to the rest of the year. No increased risk of peanut- or tree-nut-induced anaphylaxis was observed during Christmas, Diwali, Chinese New Year or Eid al-Adha. Anaphylaxis induced by unknown nuts, peanuts and tree nuts was more likely in children aged 6 years or older than in younger children.

Interpretation: We found an increased risk of anaphylaxis induced by unknown nuts and peanuts during Halloween and Easter among Canadian children. Educational tools are needed to increase awareness and vigilance in order to decrease the risk of anaphylaxis induced by peanuts and tree nuts in children during these holidays.
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http://dx.doi.org/10.1503/cmaj.200034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532006PMC
September 2020

Antibiotic exposure in early life and development of childhood asthma.

Can Fam Physician 2020 09;66(9):661-663

I understand that antibiotic use in children younger than 2 years of age has been associated with the development of asthma. With so many children in early life suffering from middle ear and throat infections, are those children who are treated with antibiotics at higher risk of developing asthma or exacerbating their asthma? Is there a relationship between number of antibiotic courses and risk of asthma? Administration of antibiotics in the first 2 years of life has been shown to be associated with asthma later in life in retrospective and prospective studies. However, study limitations such as protopathic bias, poor data collection methods, and small cohort size prevent clear determination of causality between antibiotics and asthma. The use of antibiotics in young children warrants careful consideration due to antibiotic resistance, adverse effects, and potential association with asthma.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491674PMC
September 2020

Kawasaki disease recognition and treatment.

Can Fam Physician 2020 08;66(8):577-579

If a child presents to my office with several days of fever and a few features of Kawasaki disease (KD) but does not meet the diagnostic criteria, could they still have KD and is treatment needed? Presentations of KD have a range of clinical signs and symptoms. With the lack of a criterion standard test, the diagnosis of KD relies on syndrome recognition and a high index of suspicion in cases where KD does not present classically. It is still possible to have KD even if not all of the criteria are met, and these children are referred to as having incomplete forms of KD. The diagnosis of incomplete KD is usually made in a child or infant who presents with a history of prolonged fever, a few clinical criteria for KD, and other supportive features such as positive laboratory or echocardiographic findings. It is important to recognize children with incomplete forms of KD to avoid poor outcomes such as coronary artery aneurysms.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430790PMC
August 2020

Virtual reality for intravenous placement in the emergency department-a randomized controlled trial.

Eur J Pediatr 2021 Mar 10;180(3):725-731. Epub 2020 Aug 10.

Emergency Medicine, Peace Arch Hospital, White Rock, BC, Canada.

This study sought to determine whether adding virtual reality (VR) was superior to standard of care alone in facilitating reduction in pain and anxiety among children who underwent intravenous catheterization in the emergency department (ED). Sixty-six children aged 6-16 years who needed intravenous placement received VR, or standard of care in the ED (videos, television, iPad, child life specialist). Outcome measures included change in pain score, level of anxiety, patient and parent satisfaction (pain and anxiety), number of trials, and procedure time. Compared with controls, the intervention group had similar age, sex, number of trials, and anesthetic use. Time of procedure was shorter in the VR group (median 5 min) but this was not statistically significant compared with 7 min for the control group. Pain in the intervention group was lower, even before the procedure. Difference in pain (before and after) and anxiety (after the procedure) were similar in both groups. Satisfaction from anxiety management was higher for the VR group (p < 0.007) and children rated VR significantly more "fun" (p < 0.024).Conclusion: VR was an effective distraction tool and increased satisfaction from anxiety management for this common pediatric procedure, and should be incorporated in management of anxiety in children in the ED setting.Trial registration: clinicaltrials.gov ID NCT03681730, https://clinicaltrials.gov/ct2/show/NCT03681730 What is Known: • Virtual reality is an evolving computer technology that shows some promise in the areas of acute and chronic pain management due to its ability to create effective distraction. What is New: • We report that among children in the emergency setting with intravenous catheterization, satisfaction from the use of VR for anxiety management should support implementation of VR systems for this procedure.
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http://dx.doi.org/10.1007/s00431-020-03771-9DOI Listing
March 2021

Willingness to Vaccinate Children against Influenza after the Coronavirus Disease 2019 Pandemic.

J Pediatr 2021 Jan 7;228:87-93.e2. Epub 2020 Aug 7.

Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA.

Objectives: To determine factors associated with parents who plan to vaccinate their children against influenza next year, especially those who did not vaccinate against influenza last year using a global survey.

Study Design: A survey of caregivers accompanying their children aged 1-19 years old in 17 pediatric emergency departments in 6 countries at the peak of the coronavirus disease 2019 (COVID-19) pandemic. Anonymous online survey included caregiver and child demographic information, vaccination history and future intentions, and concern about the child and caregiver having COVID-19 at the time of emergency department visit.

Results: Of 2422 surveys, 1314 (54.2%) caregivers stated they plan to vaccinate their child against influenza next year, an increase of 15.8% from the previous year. Of 1459 caregivers who did not vaccinate their children last year, 418 (28.6%) plan to do so next year. Factors predicting willingness to change and vaccinate included child's up-to-date vaccination status (aOR 2.03, 95% CI 1.29-3.32, P = .003); caregivers' influenza vaccine history (aOR 3.26, 95% CI 2.41-4.40, P < .010), and level of concern their child had COVID-19 (aOR 1.09, 95% CI 1.01-1.17, P = .022).

Conclusions: Changes in risk perception due to COVID-19, and previous vaccination, may serve to influence decision-making among caregivers regarding influenza vaccination in the coming season. To promote influenza vaccination among children, public health programs can leverage this information.
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http://dx.doi.org/10.1016/j.jpeds.2020.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410815PMC
January 2021

Corticosteroids for alopecia areata in children.

Can Fam Physician 2020 07;66(7):499-501

In my family practice, several children have presented with alopecia areata. Families are worried about the ongoing hair loss and have been trying several natural health products. I understand that corticosteroids are also considered to treat this condition. Which corticosteroid treatments can I consider and how beneficial are they? Alopecia areata is a source of considerable distress to those affected, and although there are many treatment options available, none have been clinically proven to be consistently effective. Steroids are commonly prescribed and can result in hair regrowth. Topical steroids are most commonly used in children, but intralesional, oral, and even intravenous steroids are available, with varying levels of efficacy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365156PMC
July 2020

Organic facial foreign body in a ski accident: Case report and review of the literature.

J Paediatr Child Health 2020 Jun 25. Epub 2020 Jun 25.

BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.

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http://dx.doi.org/10.1111/jpc.14966DOI Listing
June 2020