Background Nutritional iron deficiency anemia (IDA) peaks in prevalence at 6to 36 months of age. Children with severe IDA often present to emergency departments and may be hospitalized. Currently, little is known about the management and use of packed red blood cell transfusion in hospitalized children with severe IDA. The current Canadian Paediatric Society (CPS) Practice Point on iron requirements in the first 2 years of life (February 2021) provides guidance on prevention of iron deficiency and iron therapy; however, there is no guidance on the use of blood transfusion in children with severe IDA. Choosing Wisely Canada provides guidance on blood transfusions for adults; however, there are no recommendations on transfusion in children. In contrast, the joint American Society of Hematology and American Society of Pediatric Hematology/Oncology Choosing Wisely Task Force recently published (January 2022) recommendations, including avoiding packed red blood cell transfusion for asymptomatic children with IDA and no active bleeding. Objectives To describe the rate of blood transfusion and characteristics of young children hospitalized with IDA. Design/Methods Data from children, 6 to 36 months, hospitalized with IDA (2001-2020) was abstracted from health records using a standardized data collection form. Eligibility criteria were discharge diagnosis of IDA according to International Classification of Diseases codes, and laboratory evidence of IDA (hemoglobin < 110 g/L and at least two abnormal markers such as MCV, ferritin, transferrin, iron). Descriptive statistics were used. Results Of 79 children hospitalized with nutritional IDA (mean age 18.5 months), 34 (43%) received a blood transfusion. Of those receiving a transfusion, the initial mean hemoglobin was 32g/L (range 17-56g/L). Volume of blood given was: 5mL/kg (n=23, 68%), 10mL/kg (n=8, 23%), and >10mL/kg (n=3, 9%). Two children experienced adverse reactions: allergic reaction; non-hemolytic transfusion reaction. Characteristics of the entire cohort (n=79) were: female (n=51, 65%); previously healthy (n=69, 87%); received iron therapy prior to hospitalization (n=6, 8%); tachycardia on presentation (n=47, 59%); daily milk intake (mean 1638mL, range 236-9000mL). Initial laboratory results (mean) were: hemoglobin 40g/L (range 15-85g/L); MCV 51fL; platelet count 574x109/L; ferritin 3ug/L. Management included dietitian consultation with recommendation to reduce milk intake (n=69, 87%) and all patients received oral iron therapy on discharge (n=79, 100%). No child received intravenous iron therapy during their admission. Conclusion Our findings suggest high rates of blood transfusion among young children hospitalized with iron deficiency anemia. Future research includes examining factors associated with transfusion and practices at other Canadian centres. Our overall aim is to help inform future CPS and Choosing Wisely Canada recommendations.
BACKGROUND Across all demographics, families without consistent access to adequate food place children at health risk. Consequences may persist beyond early life into adulthood. Public policy positions breastfeeding, the ideal nutrition for infants, as an important solution to reducing family food insecurity (FFI). However, few studies have investigated the association between breastfeeding duration and FFI. OBJECTIVES To evaluate the association between total breastfeeding duration and FFI in Canadian urban children. DESIGN/METHODS A cross-sectional study was conducted of children aged 0–2 years, from a practice-based child research network. Total breastfeeding duration was collected from parent-reported questionnaires. FFI was measured using 2-item food insecurity and validated 1-item NutriSTEP screens. Multivariable regression analysis was performed adjusting for pre-specified covariates. RESULTS Among 3838 children, the mean total breastfeeding duration was 10.6 months (SD=6.7). Families with food insecurity (14.7%) had increased odds of younger mothers, more males and older and more children. In adjusted model, breastfeeding duration was not associated with FFI (OR 0.99; 95% CI 0.98, 1.01). Low-income families were 9 times more likely to be family food insecure than high-income families (p=0.00). CONCLUSION Contrary to public policy, our study found no association between breastfeeding and family food insecurity (FFI). However, other factors may predominate, in particular family income and structure. Given the detrimental impact of FFI, further research is needed to understand the role of infant feeding practices within the larger political, policy and cultural framework.
Background: This study aimed to assess the responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire after corticosteroid injections and operative management for trapeziometacarpal osteoarthritis (TMC-OA). Methods: This longitudinal cohort study included patients with TMC-OA who underwent treatment (corticosteroid injection or surgery). Measurements occurred at baseline and follow-up time points: 6 weeks, 3 months, 6 months, and 1 year. Patient measures were collected electronically using a data repository platform. The TASD is a validated psychometric patient-administered scale. We examined responsiveness by correlating the TASD scores with another known effective indicator of change (shortened Disabilities of the Arm, Shoulder, and Hand [QuickDASH]). Repeated score measurements over time were analyzed using analysis of variance, and correlations between questionnaires were reported with repeated measures correlation and Pearson correlation coefficients. Results: The nonsurgical cohort undergoing corticosteroid injections included 31 (66%) women and 16 (34%) men, and the surgical cohort included 29 (71%) women and 12 (29%) men. Both the QuickDASH and the TASD captured a statistically significant improvement in symptom burden postoperatively ( P < .0001 for both questionnaires), whereas no statistical significance was noted after corticosteroid injections ( P = .45 and P = .34, respectively). There was a strong correlation between QuickDASH and TASD questionnaires ( r = 0.87, P < .0001). Conclusions: The TASD is a promising TMC-OA–specific questionnaire to capture responsiveness following treatment, particularly following surgery. The responsiveness of TASD was demonstrated in the TMC-OA cohort. Further research is needed to define a minimal clinically important difference.
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