Helen Coo

Simple congenital heart defects (CHDs) are frequently identified via neonatal echocardiograms (“echos”). In 2020, the American Heart Association/American College of Cardiology issued guidelines for follow-up imaging of CHDs. In this retrospective study, we evaluated adherence to these guidelines at an academic health center in Southeastern Ontario. The cohort included neonates who had one or more simple CHDs diagnosed in the first 30 days of life between April 1, 2020, and March 31, 2024. We reviewed electronic medical records up to September 30, 2025 to examine (a) rates of non-adherence to guideline-recommended follow-up imaging; (b) factors that may contribute to non-adherence; and (c) the costs of excessive imaging. Among 248 patients, 376 echos were performed over the study period. Adherence status could be determined for 320. Follow-up for 39.7% of echos did not adhere to the guidelines, primarily because repeat echos were performed earlier than recommended. Non-adherence was substantially higher for lesions requiring surveillance imaging, as per guidelines, compared with lesions where follow-up imaging is not recommended or findings were normal (91.9% vs. 12.0%; OR = 83.4, 95% CI: 37.5-185.5). The pediatric cardiologist’s recommendation was documented for 74.5% of echos, but only 48.9% of recommendations aligned with the guidelines. Non-adherence was higher when recommendations were not documented or deviated from the guidelines. Sixty-two echos were deemed excessive, corresponding to $13,339 in extra imaging costs. The high rate of non-adherence to guideline-recommended follow-up imaging for simple CHDs highlights an opportunity to reduce unnecessary healthcare costs through consistent documentation of guideline-aligned follow-up recommendations by pediatric cardiologists.

Background: Despite the many clinical benefits of Eat, Sleep, Console (ESC) to manage infants with neonatal abstinence syndrome (NAS), a recent article theorized that ESC may place infants at an increased risk of excessive postnatal weight loss. The objective of this study was to compare weight changes in the early postnatal period among infants exposed to opioids in utero and managed using 1) the Finnegan Neonatal Abstinence Scoring System (FNASS) or 2) ESC. Methods: Pre-post analysis of medical records for opioid-exposed infants born July 1, 2017-May 31, 2023. Type of feeding (exclusive breastfeeding, formula only, combination) and weight changes were compared between the FNASS (n = 45) and ESC (n = 25) groups. Results: Type of feeding differed significantly between the groups during the first 5 days of life and at discharge: higher proportions of the FNASS group were exclusively breastfed and higher proportions of the ESC group received formula. There were no significant differences in daily weight changes over the first 5 days of life when we controlled for type of feeding. The average daily weight change during hospitalization did not differ significantly between the two groups (FNASS: median = −53.3 grams/day [IQR: −65.2, −40.8]; ESC: median = −45.9 [IQR: −57.8, −25.5]; p = 0.19). Conclusions: We found no evidence of excessive weight loss in the early postnatal period among opioid-exposed infants managed using ESC as compared to FNASS. However, our findings suggest that breastfeeding should be more actively promoted and supported when centers transition from the FNASS model to ESC.

INTRODUCTION: Previous national registry studies have reported an increased risk of eating disorders in immune-mediated conditions (inflammatory bowel disease and celiac disease). Our objective was to examine the association between immune-mediated gastrointestinal (GI) diseases and incident eating disorders in Ontario. METHODS: This was a retrospective matched cohort study of individuals P-value) of eating disorders in immune-mediated GI disease was 1.99 (1.6–2.5, P < 0.001). The adjusted hazard ratio for eating disorder in cases with immune-mediated GI diseases was 1.98 (1.6–2.5, P < 0.001). In the pediatric group of incident cases (≤18 years of age), overall adjusted hazard ratio was 2.62 (1.9–3.7, P < 0.001) compared with 1.56 (1.02–2.4, P = 0.041) for adults (>18 years of age). The largest hazard ratio of 4.11 (1.6–10.3, P = 0.003) was observed for pediatric incident cases of ulcerative colitis. DISCUSSION: Inflammatory bowel disease and celiac disease are associated with the development of eating disorders. The magnitude of the association was stronger in the pediatric age group, underscoring the need for early screening and detection.

Background A high maternal prepregnancy body mass index has been associated with lower offspring IQ, but it is unclear if the relationship is causal. To explore this, our objectives were to compare maternal and paternal estimates and to assess whether certain factors mediate the association. Methods We analysed data from the Avon Longitudinal Study of Parents and Children, which initially recruited 14 541 women residing in Avon, UK, with an expected date of delivery in 1991–1992. Data were collected during and after pregnancy by questionnaire, medical record abstraction and clinical assessment. At approximately 8 years of age, psychologists administered an abbreviated form of the Wechsler Intelligence Scale for Children-III. We fit multivariable logistic regression models to estimate parental prepregnancy obesity and overweight–offspring IQ associations. Counterfactually defined indirect (mediated) effects of maternal prepregnancy obesity on offspring IQ were estimated through path analysis. Results Among 4324 mother–father–child triads and using normal weight as the referent, we observed consistently stronger associations for maternal prepregnancy obesity and offspring performance IQ (eg, adjusted β (95% CI)=−3.4 (−5.7 to −1.2) vs −0.97 (−2.9 to 0.96) for paternal obesity). The indirect effects of maternal obesity on offspring IQ through pathways involving gestational weight gain and duration of breastfeeding were small but significant. Conclusion Our findings are consistent with a weak biologic effect of maternal adiposity in pregnancy on offspring performance IQ. Given the growing prevalence of obesity worldwide, more evidence is needed to resolve the correlation versus causation debate in this area.

Validating an administrative data–based case definition for identifying children and youth with autism spectrum disorder for surveillance purposes