William J. Montelpare

The impact of infant feeding method on neonatal abstinence scores of methadone-exposed infants

PURPOSE:To determine whether neonatal abstinence scores of infants exposed to methadone in utero differed by infant feeding method. DESIGN:A retrospective chart review. SUBJECTS:Twenty-eight term infants that were exposed to methadone in utero and exhibited symptoms of neonatal abstinence syndrome (NAS) prior to hospital discharge were included into the study. The sample was further divided by self-selected infant feeding method including (1) predominately breastfed (n = 8), combination fed (n = 11) or predominately formula fed (n = 9). METHODS:Data were extracted by two independent researchers from both the mothers and infants chart. This included variables such as NAS scores, NAS treatment, infant feeding method and baseline demographic information. MAIN OUTCOME MEASURES:NAS scores were assessed by Registered Nurses according to hospital protocol using a Modified Finnegan Scoring Tool. PRINCIPAL RESULTS:A non-parametric Kruskal-Wallis one way analysis of variance based on ranks revealed statistically significant differences in the number of NAS scores recorded (P = 0.001), magnitude (P < 0.0001) and area score (P = 0.04) by infant feeding method. In particular, infants who were predominantly breastfed had significantly fewer NAS scores done and lower mean scores suggesting decreased severity and duration of NAS symptoms when compared to infants who were combination fed or predominately formula fed. CONCLUSION:Breastfeeding may offer enhanced benefits for infants who have been exposed to methadone in utero. As such, in the absence of contraindications, mothers in methadone maintenance programs should be encouraged and supported to breastfeed their infants.

The experiences of NICU nurses in caring for infants with neonatal abstinence syndrome.

Purpose: This study explored the experiences of NICU nurses in caring for infants with neonatal abstinence syndrome (NAS). Design: A qualitative research approach was used with open-ended questions employing computer-assisted personal interviews. Sample: Fourteen NICU nurses employed in a regional hospital provided responses. Results: The nurses reflected a personal struggle between a desire to employ their technical and critical nursing skills and the need to provide expected maternal care to NAS infants. Other themes included frustration and burnout, challenges to values about parenting, and increased awareness of drug use in the community and at home. Discussion: The results suggest that nurses underrate the skill required to care for infants with NAS. The level of knowledge, patience, and commitment to these newborns should be reframed to increase job satisfaction, and education should be offered to nurses about women struggling with addictions.

Validation of the FAST skating protocol to predict aerobic power in ice hockey players

Few studies have reported a sport-specific protocol to measure the aerobic power of ice hockey players using a predictive process. The purpose of our study was to validate an ice hockey aerobic field test on players of varying ages, abilities, and levels. The Faught Aerobic Skating Test (FAST) uses an on-ice continuous skating protocol on a course measuring 160 feet (48.8 m) using a CD to pace the skater with a beep signal to cross the starting line at each end of the course. The FAST incorporates the principle of increasing workload at measured time intervals during a continuous skating exercise. Step-wise multiple regression modelling was used to determine the estimate of aerobic power. Participants completed a maximal aerobic power test using a modified Bruce incremental treadmill protocol, as well as the on-ice FAST. Normative data were collected on 406 ice hockey players (291 males, 115 females) ranging in age from 9 to 25 y. A regression to predict maximum aerobic power was developed using body mass (kg), height (m), age (y), and maximum completed lengths of the FAST as the significant predictors of skating aerobic power (adjusted R2 = 0.387, SEE = 7.25 mL.kg-1.min-1, p < 0.0001). These results support the application of the FAST in estimating aerobic power among male and female competitive ice hockey players between the ages of 9 and 25 years.

Variability within individuals of plasma ionic magnesium concentrations

BackgroundWith the invention of the ion-selective electrode (ISE), ionic magnesium (iMg) is a common blood assay. This could be advantageous, as iMg is the biologically active form of Mg. There is some evidence that iMg has considerable within subject variability.ResultsIndividual ranges averaged .08 mmol/L (range .05 to .14). Coefficients of variation (CV) ranged from 3% to 7% (mean 4%) while analytical variation was determined to be 2.3%. Biological variability thus accounts for almost half of the variability, which is clinically significant, as 9 of the 13 subjects recorded at least one value below a reference range of .46 – .60 mmol/L. A significant within-day variation (p < .001) was noted, with differences between 7:00 and 10:00 as well as 10:00 and 22:00. Between day variations were not significant (p = .56).ConclusionsA plausible explanation of this data is that iMg has a circadian rhythm. Thus, cautious interpretation of single iMg values is warranted until future research determines the nature of iMg variability.

Identifying Infants at Risk for Neonatal Abstinence Syndrome A Retrospective Cohort Comparison Study of 3 Screening Approaches

Objective: The main objective of this study was to analyze the consistency in using a standardized newborn toxicology screening protocol to identify infants at risk of developing neonatal abstinence syndrome (NAS). Design: A retrospective cohort comparison design was approved by the institutional review board at the regional hospital and used to gather data from the infants’ medical records during the study period. Setting: The data were collected for a period of 1 year from a regional hospital serving 100 000 patients per annum. Patients/Participants: Data were based on expectant mothers who delivered between March 2006 and March 2007. Method: Data of maternal self-reported substance use, and urine toxicology results and meconium results were obtained through retrospective chart review of infants exhibiting signs of NAS as noted by nurses on the Finnegan Scoring Tool. Results: In the absence of accurate prenatal screening, this study lends positively to support the use of toxicology screening protocols at birth to adequately assess and treat infants exposed to illicit substances. Toxicology screening in not intrusive and despite emotional discomfort experienced by mothers of the infants tested, the benefits of attaining accurate information regarding substance exposure is critical for the well-being of the infant. Conclusion: The use of a toxicology screening protocol at birth appears beneficial in determining the need for identifying infants with NAS. Early detection of substance exposure in newborns leads to timely assessment for NAS and subsequent treatment to reduce symptoms in newborns.

Constituent year: a new consideration for injury risk in Canadian youth ice hockey

Objective: To examine if chronological age within Canadian youth ice hockeys 2-year age bands influences the proportion of injury. Design: Retrospective secondary data analyses. Participants: Information on 4736 injured youth ice hockey players (10-15 years old) reported by the Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) and 4959 (12-15 years old) injured players reported by the Hockey Canada Insurance Database (HCID). Main Outcome Measures: Proportions of injuries according to constituent year (first vs second year of participation within 2-year youth ice hockey age bands). Independent Variables: The influence of age band (Atom, 10/11; Peewee, 12/13; Bantam, 14/15) and level of competitive play on constituent year injury proportions were examined. Results: Injured Atom and Peewee players (CHIRPP) were more likely to be in constituent year 2 (Atom: odds ratio [OR], 1.72; 95% confidence interval [CI], 1.46-2.03; Peewee: OR, 1.25; 95% CI, 1.10-1.42). Injured players (HCID) at the highest tiers of competitive play were more likely to be in constituent year 2 (eg, Peewee: OR, 2.91; 95% CI, 1.92-4.41; Bantam: 1.89; 95% CI, 1.46-2.46). Conclusion: Constituent year may be a factor in determining injury risk and may be relevant to those managing the risk of injury for youth ice hockey players.

Breastfeeding and Aboriginal women: validation of the Breastfeeding Self-Efficacy Scale-Short Form.

The purpose of this methodological investigation, part of a prospective cohort study, was to test the reliability and validity of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among Aboriginal women.The sample comprised 130 breastfeeding Aboriginal women from the postpartum ward of an urban tertiary care hospital or a rural community hospital.The women provided baseline information while in hospital and were telephoned at 4 and 8 weeks postpartum for assessment of their method of infant feeding. The BSES-SF was found to be a valid and reliable tool for assessing breastfeeding self-efficacy among Aboriginal women. Significant differences were found in BSES-SF in-hospital scores among women who at 4 weeks postpartum were exclusively breastfeeding, combination feeding, or solely feeding formula (F(2) = 7.31, p = 0.001).The authors conclude that Aboriginal women with low breastfeeding self-efficacy in the early postpartum period may be at risk for early cessation and could benefit from additional breastfeeding support.

Relationships among Risk Factors for Concussion in Minor Ice Hockey

There is increasing concern among parents, coaches, and officials about injury risk in youth ice hockey, particularly in light of recent evidence suggesting that incidence of serious injury is considerably under reported. However, an adequate method for ascertaining injury risk for concussion does not yet exist. The purpose of this study was to examine the relationships among variables measuring exposure and head impact forces in a group of representative level bantam aged hockey players. Across an entire hockey season, trained research assistants attended games and recorded the duration of time spent on the ice for each player (i.e., exposure time) and total number of body contacts using time-on-task software designed specifically for this study. A body contact included any intentional or incidental contact between two players. Collectively, these variables provide a simple, easily administered measure of head injury risk for researchers collecting data in this area. However, their relationship to actual brain trauma is unknown. To this end, head acceleration data were also collected using helmet-based accelerometers that provide measures of linear accelerations experienced by each player. These data were collected by telemetry methods and represent data that are likely very useful for injury researchers but not without sufficient costs. Results demonstrated low associations among the data sources. A method based on combining data sources (through an examination of their potential relationships) is proposed to maximize the potential to identify at-risk youth in minor hockey.

Paediatric sports-related mild traumatic brain injury

Mild traumatic brain injury (mTBI) is a common but relatively understudied childhood injury that can impact cognitive functioning and development. The present report describes a case study of a 14-year-old boy who sustained two consecutive sports-related mTBIs within a 24 h period. Neurocognitive functioning at 2, 6, 8, 55 and 225 days after injury is compared to baseline prior to injury assessment on the same measures. Results from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Conner Continuous Performance Test 2 (CPT-II) and the Attention Network Test (ANT) revealed decreased performance in attention, visual memory functioning and impulsivity, with some measures still not returning to baseline at 225 days post injury. The results are discussed with respect to return to normal activities at 4 days post injury. This case study highlights the need for increased research regarding the clinical management of mTBI in the paediatric population, particularly the potential deleterious effects of cumulative injuries.

Measuring Athlete Exposure and Body Contact Using Time-on-Task Technology in Ice Hockey

It is common for athlete exposure (AE) and body contact (BC) to be incorrectly estimated in epidemiologic research due to the technical challenges associated with field-based research in ice hockey. Time-on-task technology has shown promise in accurately quantifying AE and BC using computer technology through direct measurement during real time games. The purpose of this prospective cohort study was to adopt time-on-task technology to monitor AE and BC in Atom hockey players who were permitted body checking versus those not allowed to body check. We evaluated 579 boys (age 9–10 year olds) from 42 representative Atom hockey teams over 107 games during the 2003–2004 regular season from five hockey associations using a time-on-task computing program running on a tablet computer. Body checking was allowed in four associations [Northern Ontario Hockey Association (NOHA), Minor Hockey Alliance of Ontario, Ontario Minor Hockey Association, Greater Toronto Hockey League], while one association was non-body checking (HNO). Body contact was 4.5 times greater in the body checking associations versus the non-body checking association per game. No significant difference in mean AE per game was found between body checking and non-body checking associations. However, greater AE was reported in NOHA games compared to the remaining four associations. Conversely, BC in the NOHA was significantly less compared to the remaining body checking associations, but not the HNO. Time-on-task technology was valuable in monitoring AE and BC, accounting for variability in individual players. Expected AE and BC was observed between checking and non-body checking associations. Unexpectedly larger AE in NOHA is attributed to smaller team roster size and longer duration games. Furthermore, decreased BC in NOHA players may be due to smaller roster size intrinsic factors contributing to the inverse relationship between AE and BC. Time-on-task technology is valuable in monitoring AE and BC in Atom ice hockey. This is a practical method of monitoring important aspects of the game.