Social media use to improve communication on children and adolescent’s health: the role of the Italian Paediatric Society influencers

Background Fake news on children’s and adolescent health are spreading. Internet availability and decreasing costs of media devices are contributing to an easy access to technology by families. Public health organizations are working to contrast misinformation and promote scientific communication. In this context, a new form of communication is emerging social media influencers. Aim of this study is to evaluate the role of paediatric influencers (PI) in communicating information about children and adolescents’ health. Materials and methods A group of PI was enrolled from December 2019 to January 2020 by a scientific commission nominated by the Italian Paediatric Society (SIP). PI were asked to share Facebook messages from the official page of the SIP to their own network. Social media tools have been evaluated across 12 months, from July 28, 2019, to July 11, 2020. For the purposes of clarity, we schematically divided the study period as follows: the period of PIs activity (January 6, 2020, to July 11, 2020) and the period when PIs were not yet active (July 28, 2019, to January 4, 2020). Information on Facebook page (lifetime total likes, daily new likes, daily page engaged, daily total reach) and on published post (lifetime post total reach, lifetime post organic reach, lifetime engaged users) were evaluated. Results A significant increase in Facebook daily new likes, page engagement and total reach, as well as in lifetime post total and organic reach was evidenced. As for PI, they reported a positive experience in most cases. Discussion In the digital era, communication strategies are becoming more important, so that the scientific community has to be actively involved in social media communication. Our pilot study demonstrated that the recruitment of paediatric influencers has increased communication and interaction of the SIP Facebook page. Conclusion Our study shows the potential role of influencers: spreading health messages via PI seems to be a successful strategy to promote correct communication about children’s and adolescents’ health.

Sustainable Neonatal CLABSI Surveillance: Consensus Toward New Criteria in the Netherlands

Group Name: Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric SocietyBackground: Central-line–associated bloodstream infections (CLABSIs) are a main focus of infection prevention and control initiatives in neonatal care. Standardized surveillance of neonatal CLABSI enables intra- and interfacility comparisons, which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands. Across neonatal intensive care units (NICUs), several different sets of CLABSI criteria and surveillance methods are used for local monitoring of CLABSI incidence rates. To achieve standardized CLABSI surveillance, we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria. Method: A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI surveillance criteria was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of 3 expert panel rounds. Figure 1 shows a detailed description of the consensus procedure. Result: The expert panel achieved consensus on Dutch neonatal CLABSI surveillance criteria, which are summarized in Figure 2. Neonatal CLABSI is defined as a bloodstream infection occurring >72 hours after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by 1 or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: (1) a bacterial or fungal pathogen is identified from 1 or more blood cultures; (2) the patient has clinical symptoms of sepsis and (2A) a common commensal is identified in 2 separate blood cultures or (2B) a common commensal is identified by 1 blood culture and C-reactive protein (CRP) level is >10 mg/L in the first 36 hours following blood culture collection. Conclusion: The newly developed Dutch neonatal CLABSI surveillance criteria are concise, are specific to the neonatal population, and comply with a single blood-culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI surveillance criteria is needed to identify best practices for infection prevention and control.Funding: NoDisclosures: None

Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal

Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal. Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources. Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources. Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.

The 2020 Rourke Baby Record release: A time for reflection and looking forward

The Rourke Baby Record (RBR) is a health supervision guide for providing care and anticipatory guidance to children aged 0 to 5 years in Canada. First developed in 1979, it has been revised regularly to ensure that it remains current and evidence-informed. The RBR has a longstanding relationship with the Canadian Paediatric Society (CPS), and relies on this organization for its expertise to inform the RBR guide’s content. The 2020 edition of the RBR includes many recommendations based on evidence provided in current CPS position statements. The RBR Working Group is planning to develop app-based resources and an adapted RBR for clinical care provision in this challenging pandemic time to ensure that Canadian infants and children continue to receive high-quality care.

Children and Adolescent’s Perception of Media Device Use Consequences

Media device (MD) use is increasing worldwide among children. Adolescents and young children spend a lot of time using MD, Internet, and social networks. The age of initial use is getting lower to 12 years old. The aim of this research is to study children’s use and perception of MD. The Italian Paediatric Society (SIP) conducted a Survey on Italian children in collaboration with Skuola.net using an online questionnaire. A total of 10,000 questionnaires were completed. Children admitted they spend more than 3 h (41%), more than 2 h (29%), more than 1 h (21%) and less than 1 h (9%) daily. Problematic MD use has been found with children using MD before sleeping (38%), during school (24%), and at wake up in the morning (21%). Addiction was documented in 14% of adolescents. Among the reported consequences, low academic outcomes, and reduced concentration (24%), neck and back pain (12%), insomnia (10%), and mood disturbances (7%) were referred. Adolescents may have a low perception of the risks related to excessive MD. The duration of time spent using media devices is a main risk factor. In this context, parents should strongly discourage excessive MD use, mainly during school, at bedtime, and wake-up. Additionally, parents should be informed and start conversations with their children on the potential negative effects of prolonged MD use.

105 Actually, it is easy being green: Ten years of the Canadian PAediatric Society Annual General Meeting viewed through a sustainability lens

Introduction/Background The Canadian Paediatric Society (CPS) recently released the “Global climate change and health of Canadian Children” statement. As climate rapidly evolves from “change” to “crisis” there is an increasing pressure toward sustainable conferencing. Knowing the value of attending meetings, the growing body of literature evaluating travel-related carbon cost and convention sustainability can inform environmental harm minimization. Conferences can pressure venues to increase sustainability by choosing sites and venues wisely and communicating their requirements to rejected venues. They can also offer carbon offset purchase through credible companies (e.g. Gold Standard). Over the last 10 years the CPS has conducted its Annual General Meeting (AGM) at host cities that reflect Canada’s large geographic footprint. Venues included both hotel and standalone conference centers. There is no published evaluation of sustainable practices for CPS meetings. Objectives Evaluate the past 10 CPS Annual General Meetings (AGMs) for: Design/Methods Travel-related carbon cost was estimated with a round-trip calculator for economy seating the most direct available flights (https://co2.myclimate.org/en/offset_further_emissions). Cities of origin for attendee were the 11 CaRMS-matched pediatric residency training programs (https://www.carms.ca/match/psm/program-descriptions/). Venues were evaluated based on current publicly available self-reported information using conference sustainability criteria suggested through a literature review and public rating tools (Green Key, Quality Standards of the International Association of Convention Centres). Ground transportation from the airport was scored /3 by: public transport from airport (1), formal shared transport (1), fee deterrence for parking (1). Venue type was split by hotel-associated (H) and standalone convention centre (CC) meeting facilities. Sustainability of meeting facilities was divided into supports /2 (rentable supports, links to local vendors, catering and personnel) for exhibitors (1) and event planners (1), policies /3 by: sustainability, promotion of a green community (1), and waste management (1), and walkability from accommodation /1. Results The last 10 CPS AGMs were held in western (3; Vancouver 2010, Edmonton 2013, Vancouver 2017), eastern (1; Charlottetown 2016) and central (6; Quebec City 2011, London 2012, Montreal 2014, Toronto 2015, Quebec City 2018, Toronto 2019) provinces; in 2020 it is in Vancouver. Central Canada sites had the lowest air travel carbon cost per attendee. Average air travel-related carbon cost per attendee for different host cities ranged from 0.479 (London) to 0.919 (Vancouver) tonnes, with Ontario and Quebec sites averaging 0.518, Charlottetown 0.654 and Edmonton 0.756 tonnes. Ground transportation scores differed by city from Montreal (3/3 with public transit, formal transportation share and parking fees to dissuade driving) to London (0/3), with more favorable public transit options in larger cities. Venues differed when divided by hotel with meeting facilities (H) vs standalone conference center (CC), with CC outranking H for clearly posted sustainability plans (1.6 vs 1.2/2; 2=venue-specific, 1=company chain policy, 0=no plan), green and sustainable community building plans (1.6 vs 1.2/2; 2=greening local communities, 1=company chain policy, 0=no plan) and green waste management policies (1.2 vs 0/2; 2=venue-specific, 1=company chain policy, 0=no plan). Walkable accommodation was equal and present for all venues, with attached accommodation for all but one CC (Montreal), which had immediately adjacent hotels available. Conclusion As expected, the carbon cost of air transportation per attendee was lower in central provinces. Ground transportation from the airport was better in larger host cities. Standalone conference centres had more sustainable event support and locally focused policies regarding sustainability, environmentally friendly community building initiatives and waste management solutions, three major components of “greening” conferences. Based on the available resources across Canada, we recommend that the CPS considers these sustainability criteria in planning future events.

34 Newborn Jaundice Screening Nomogram for Universal Screening in Saskatchewan

Background Transcutaneous (TcB) meters support clinical decision making at point-of-care, reduces nurses’ time to screen, decreases the frequency of painful blood draws and minimizes health care costs. Best practice for TcB screening is unknown and international guidelines vary. Meter bias may result in over- or underestimation of TSB in a Canadian population. The Canadian Paediatric Society suggests screening between 24 and by 72 hours of age and reducing total serum bilirubin (TSB) action thresholds by the 95th confidence interval of the meter. To support point-of-care decision making, a tertiary center and community follow-up program uses universal screening and follow-up protocols. ​ Objectives The aim of this analysis is to develop a locally validated TcB nomogram with action thresholds based on age and risk for clinical use at point-of-care. ​ Design/Methods This prospective cross-sectional study includes newborns ≥35 weeks gestation <14 days old requiring TSB sampling in hospital or community and 13 JM-105 meters. Participants are included if TcB reading ranges from 1-340µmol/L (0.1-20.0 mg/dL) and TSB is collected within 1 hour of TcB measurement. TSB samples are analyzed using Roche™ Bilirubin Total Gen.3. To measure how close the TcB reading is to TSB, the difference is found by subtracting TSB from mean TcB. Lin’s Concordance statistics are calculated for each meter. Using a 2-dimentional 95th Confidence Interval ellipse, we select 13 JM-105 meters with similar accuracy and precision for use by the universal screening program. Using a quadratic model we fit a line based on the lower 95th predictive interval of the grouped meter data collected from 13 meters to Canadian Paediatric Society low, medium and high risk TSB thresholds for intensive phototherapy. ​ Results The study population includes 498 newborns that received 620 visits and 705 meter readings with thirteen JM-105 with mean birth weight 3.38 kilograms (SD=0.51) with thirteen JM-105. Along with the clinical screening protocol, nomograms for newborns 35-37 weeks gestation (high and medium risk thresholds) and 38+ weeks gestation medium and low risk thresholds) are presented. Newborns with TcB that plots in a potential treatment range will receive a TSB to determine if intensive phototherapy is required. Conclusion To support point-of-care decision making, a tertiary center and community follow-up program uses universal screening and follow-up protocols. TcB nomograms with action thresholds based on age and risk support point-of-care decision making.

Evaluation of compliance with the 2017 Canadian Paediatric Society Position Statement for the management of newborns at risk for early-onset sepsis: A retrospective cohort study

Introduction Due to the nonspecific clinical presentation, clinicians often empirically treat newborns at risk of early-onset sepsis (EOS). Recently, the Canadian Paediatric Society (CPS) published updated recommendations that promote a more judicious approach to EOS management. Objective To examine the compliance with the CPS statement at a tertiary perinatal site and characterize the types of deviations. Methods A retrospective chart review was conducted for all term and late pre-term newborns at risk for sepsis, between January 1 and June 30, 2018. The prevalence of newborns with EOS risk factors was measured during the first month. Management strategies for eligible newborns during the 6-month period were compared to the CPS recommendations to establish the rate of noncompliance. The type of noncompliance, readmission rate, and rate of culture-positive EOS were examined. Results In the first month, 29% (66 of 228) of newborns had EOS risk factors. Among the 100 newborns born in the 6-month period for whom the CPS recommendations apply, 47 (47%) received noncompliant management. Of those, 51% (N=24) had inappropriately initiated investigations, 17% (N=8) had inappropriate antibiotics, and 32% (N=15) had both. The rate of readmission for a septic workup was 1.6% (N= 2). None had culture-positive sepsis while admitted. Conclusion A large proportion of term and late preterm newborns (29%) had EOS risk factors, but none had culture-confirmed EOS. The rate of noncompliance with the CPS recommendations was high (47%), mainly due to overzealous management. Future initiatives should aim at increasing compliance, particularly in newborns at lower EOS risk.