In-Person Presentations: Chieng Family Atrium

Finding a Poster

Refreshments

Chan Centre for Family Health Education

Morning In-Person Sessions: 10:00 – 11:30 AM

Session #2 | Posters – #10 – 18A

Session #3 | Posters – #19 – 27

Session #4 | Posters – #28 – 35

Afternoon In-Person Sessions: 1:30 – 3:00 PM

Session #6 | Posters – #45 – 53

Session #7 | Posters – #54 – 62

Session #8 | Posters – #63 – 71

Session #9 | Posters – #72 – 80

*This drawing is intended for visual reference only and is not to scale

Since 1987, the Summer Student Research Program has provided 1,500+ students with the opportunity to participate in projects related to child and family health under the supervision of researchers on the Oak Street Campus.

2023 Registered Summer Student

110 Hours of professional development

25+

110 research projects pursuing new discoveries and innovations to transform the lives of families in BC and beyond

$150,000+

BCCHR & Partnered Summer Studentship funding awarded

97 Onsite projects

Participant Details

17 Remote projects

80 Undergraduate Students

24 Medical Students

6 Alumni & Master’s Students

82 BCCHR Research Teams

13 National Universities |11 International Universities

BC Institute of Technology

Johns Hopkins University

McGill University

McMaster University

New York University

Pitzer College

Pomona College

Queen’s University

Royal College of Surgeons in Ireland

Simon Fraser University

University of Galway

University of Alberta

University of British Columbia

University of British Columbia, Okanagan

University of California

Participant Universities www.bcchr.ca/ssrp

University of Edinburgh

University of Ottawa

University of Southern California

University of St Andrews

University of Toronto

University of Waterloo

University of Western Ontario

Western University

SESSION #1: BASIC SCIENCE & CLINICAL

Moderator:

Maryam Rahimi Balaei

Participants:

Maisa Samiee

Natasha Kaprelova

Ariel Qi

10:00

11:30 AM

Online: bcchr.ca/posterday

Emily Simpson

Venessa Thorsen

Rory Trevorrow

Amrith Vincent

Thumri Waliwitiya

Maisa Samiee

Undergraduate Student, University of British Columbia | Supervisor: Simon Massey

Monitoring Antagonism of Neuromuscular Blockade: BCWH Current Practice Compared to the American Society of Anesthesiologists 2023 Practice Guideline: a retrospective clinical audit

Maisa Samiee, Eduardo Sutherland & Simon Massey

Background: 2023 American Society of Anesthesia (ASA) guidelines recommend using a Quantitative Neuromuscular Monitor (QNM) when administrating muscle relaxants and reversal agents for surgery. Research reveals that undetected residual muscle block causes Post Operative Pulmonary Complications. QNM measures a train of four counts (To4) and provides a T ratio; which is a ratio of the fourth twitch compared to the first. T ratios of 0.9 or greater are the current standard for safe extubation without reversal agents such as sugammadex or neostigmine. T ratios below 0.90 require neuromuscular blocking agent reversal.

Objective: QNM’s provide both the train of four counts and the T ratio; neither is automatically recorded onto the Electronic Patient Record (EPR), unlike most other monitor data. For an anesthetist to record this data into the EPR, currently, they must manually enter it. This Retrospective Audit reviews EPRs to identify the recorded use of Neuromuscular Monitors at BC Womens’ Hospital compared to the ASA Practice Guidelines.

Methods: 200 Retrospective Laparoscopic Anaesthesia patient records were reviewed. The data collected includes; use of muscle relaxant, QNM or Manual Qualitative Neuromuscular Monitor (MQNM), T ratios and/or To4 count recorded on EPR during the procedure.

Results: Our institution’s EPR’s indicate; 176 (88%) patients undergoing laparoscopic surgery received muscle relaxants. Of these 176, only 88 (50%) indicate the use of neuromuscular monitoring; 32 of 88 (36%) used QNM, and 56 (64%) used MQNM. Of the 32 cases using QNM, 13 (41%) recorded only To4 count values, 17 (53%) recorded T ratios, and 2 (6.25%) recorded neither.

Conclusion: Our EPR Audit results suggest that our current practice does not meet the 2023 ASA Guidelines. In only 18% of cases where QNM is recommended, was it used. This EPR data may not reflect true practice because, currently, QNM data is manually and not automatically entered into the EPR, although the QNM results are displayed during use. Our anesthetic department requires consultation on the implementation of the 2023 ASA guideline. Thereby possibly improving practice which may reduce postoperative pulmonary complications. Improved practice implementation and automated QNM EPR data entry are necessary prior to repeating the Audit cycle.

Natasha Kaprelova

Master’s Student, University of British Columbia | Supervisor: Chinten James Lim

Investigating MYC Amplification in IL-6/JAK/STAT3-Mediated Treatment Resistance in Group 3 Medulloblastoma

Natasha Kaprelova, Chinten James Lim

Medulloblastoma (MB) is the most common malignant brain tumor diagnosed in children, accounting for 20% of all pediatric brain cancers. MB has been classified into four molecular subgroups, Sonic Hedgehog (SHH), Wingless (WNT), Group 3 (Grp3), and Grp 4. Each subgroup exhibits distinct biology, prognoses, and risks. Currently, the 5-year overall survival rate for MB is about 70%. Group 3 makes up 25% of all MB cases and is the most aggressive MB subgroup, characterized by rapid tumor growth, metastasis, and disease relapse. Grp3 has a 5-year overall survival rate of 50%, which drops further to 20% for a subtype of Grp3 tumors with amplified cancer-inducing gene, MYC. Chemotherapy, in combination with surgery and radiation, remains the gold standard for treatment of MB. However, a major drawback of chemotherapy is the ability of tumor cells to acquire drug resistance, resulting in treatment failure and relapse. The molecular pathways that drive drug resistance in Grp3 MBs remain undefined, emphasizing the need for research into mechanisms that contribute to the dismal prognosis of this subgroup.

My research aims to provide further understanding of how MYC, a gene known to drive Grp3 MB tumors, renders Grp3 tumors drug resistant. We will use cutting edge genetic tools such as CRISPR to abolish MYC function in Grp3 MB cell lines and establish its contribution to tumor cell survival and drug resistance. In addition, I will evaluate the ability of selective MYC inhibitors as a therapeutic to overcome drug resistant Grp3 MB. The acquired knowledge will aid in future development of novel therapeutic regimes that can be used to manage the most aggressive forms of pediatric brain tumors.

SESSION

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Ariel Qi

Medical Student, Queen’s University | Supervisor: S. Evelyn Stewart

Exploring Family Factors in Pediatric Obsessive-Compulsive Disorder and Psychiatric Outpatient Controls

Ariel Qi, John R. Best, Gordon Andjelic, Anna MacLellan, Boyee Lin, Cynthia Lu, S. Evelyn Stewart

Background: Child and youth psychiatric illness can place a heavy burden on the family. In turn, the family environment could impact prognosis and treatment adherence in the youth. Thus, consideration of family factors is critical in the context of pediatric psychiatric illness. Disorder-related family functioning assessment provides a nuanced examination of family routines, emotional responses and socio-occupational impacts. Family functioning impairment has been well studied in pediatric obsessive-compulsive disorder (OCD) patients, and exerts a negative influence on treatment trajectory. Further, parents with low tolerance of their child’s distress may struggle to respond with behaviors that alleviate disease severity. In pediatric OCD, parents’ poor child distress tolerance and accommodation behaviors are associated with increased symptom severity and treatment resistance. There is limited knowledge on how family functioning impairment and parental tolerance of child’s distress (PTCD) in OCD compare to that experienced in families coping with other youth psychiatric conditions.

Objectives:

1. Compare various aspects of family functioning impairment and PTCD between pediatric OCD and non-diagnostically selected psychiatric controls.

2. Explore how patient/family characteristics influence the degree of disease-related family functioning impairment and PTCD.

Methods: We will analyze data from the psychiatry outpatient clinics (n=6) at BC Children’s Hospital in the Family Input Tool database (FIT: n=3560, years 2019-2023), and previously collected data of the Provincial OCD Program (n=405). Family functioning and PTCD are measured by the 21-item Family Functioning Impairment Scale (modified from the validated OCD Family Functioning Scale) and the 3-item PTCD Scale (modified from the validated Distress Tolerance Scale), respectively. Other factors of interest include patients’ demographic factors, medical history and family characteristics. Statistical analysis will utilize multivariable linear regression models, whereby the family-related outcome score is regressed on clinical predictors and covariates.

Significance: This project will characterize and compare family functioning impairment and PTCD in non-OCD youth psychiatric disorders in relation to OCD. Results will aid in identifying populations of patients who experience greater family dysfunction. Our findings could also inform targeted interventions, treatment strategies and social supports that are catered to the unique circumstances of the youth patients and their families.

Congratulations to Ariel on receiving a BC Children’s Hospital Research Institute Summer Studentship

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Emily Simpson

Medical Student, University of British Columbia | Supervisor: Christine Voss

Sleep quality in children and youth with type 1 diabetes: a validation study utilizing commercial activity trackers

Emily Simpson, Ty Sideroff, Nick Wall, Elizabeth Keys, Quevie Reinz Abalde, Calli Davidson, Simran Gill, Holly Buhler, Trent Smith, Deanne Taylor, Christine Voss

Background: Diabetes is a common chronic condition in children and youth, with over 2,500 youth and children in BC living with the disease. Children with type 1 diabetes are particularly vulnerable to disturbed sleep, which has negative implications for their health and wellbeing. Adequate sleep is crucial for facilitating biological processes, and inadequate sleep has been linked to reduced executive functioning, problematic behaviours, and decreased quality of life. Previous studies have shown there to be a bidirectional relationship between sleep and glycemic control in children with type 1 diabetes. However, more research is needed to fully understand the underlying mechanisms and potential implications for diabetes management in children and youth.

Objective: To establish validity of a consumer wearable, the Fitbit Charge 5, for the assessment of sleep behaviours in children and youth with type 1 diabetes.

Methods: Participants were recruited from an ongoing longitudinal study that utilizes Fitbit Charge devices to assess physical activity in children and youth with diabetes. For this validation study, parents/guardians initially completed the ‘Sleep Disturbance Scale for Children (SDSC)’ – a validated and clinically relevant questionnaire to identify sleep issues. Following this, participants wore their Fitbit continuously for 7 days. Every morning, participants received a SMS message, prompting them to complete an electronic daily sleep log. During this 7-day period, REDCap was used to extract min-by-min Fitbit sleep data via a custom-written API. Correlations between the electronic sleep log and Fitbit data is being assessed for key sleep behaviours.

Results: Data analysis is ongoing at the time of abstract submission.

Conclusions: We anticipate that this research will identify whether Fitbit Charge devices can be used in sleep research involving children and youth with diabetes. Furthermore, we expect to gain useful insight into the sleep behaviours of children and youth with type 1 diabetes in the Central Okanagan area.

Congratulations to Emily on receiving a Centre for Chronic Disease Prevention and Management (CCDPM) Clinical Research & QI Incubator Award

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Venessa Thorsen

Master’s Student, University of British Columbia | Supervisor: Kevin Harris

Knowledge to Action: Developing a Knowledge Translation Strategy to Improve Management of Familial Hypercholesterolemia in British Columbia

Kevin Harris, Stephanie Glegg, Jason Sutherland, Venessa Thorsen

Introduction/Background: Familial Hypercholesterolemia (FH) is a common, under-diagnosed genetic condition where cholesterol is improperly metabolized and exists at dangerously high levels, decreasing circulatory health. Years of cholesterol build-up blindside patients with heart attacks and strokes in young adulthood, which are preventable with early intervention.

Due to a current lack of screening, 90% of FH cases are not diagnosed during childhood. In response, the Canadian Cardiovascular Society published guidelines recommending universal screening of all children aged 9-11 for elevated cholesterol.

Research Objectives:

The primary outcomes of this project are to assess:

1. Physician self-reported confidence and familiarity with the Pediatric Lipid Guidelines.

2. Baseline cross-sectional provincial data on rates of lipid screening, diagnosis of FH and statin prescription.

Follow-up will determine if a Knowledge Translation (KT) intervention impacts adherence to guidelines and increases screening, diagnosis, and treatment of FH based on reassessment of provincial data 1-year post-intervention. We are hopeful that data from this project may also help inform the need for a National Pediatric FH Registry.

Methods: We will use PopData BC for children <18 to define baseline levels of childhood screening, diagnosis, and treatment for FH in BC. An interactive KT module intervention featuring experts in cardiology and cholesterol disorders will be delivered to participants synchronously or asynchronously, as well as one-month post-module assessments of familiarity and confidence with the guidelines.

Results: N/A

Conclusion: N/A

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Rory Trevorrow

Medical Student, University of British Columbia | Supervisor: Lise Leveille

Perioperative Management of Juvenile Idiopathic Arthritis (JIA) in Anterior Cruciate Ligament (ACL) Reconstruction

Rory Trevorrow, Daniella D’Amici, Joyce He, Helen Crofts, Hayley Spurr, Kristin Houghton, Lise Leveille

Background: Juvenile idiopathic arthritis (JIA) refers to a group of conditions of unknown etiology characterized by joint inflammation presenting prior to 16 years of age and persisting for a minimum of 6 weeks duration. JIA may co-occur with other musculoskeletal injuries and diseases, including anterior cruciate ligament (ACL) rupture. In the paediatric population, early operative management of ACL rupture is associated with a decreased likelihood of joint instability, pathological laxity, and symptomatic meniscal tears compared to non-operative management. In children with JIA, the inherent inflammatory environment of the joint may interfere with post-surgical healing and rehabilitation. As such, optimal management of disease activity in the perioperative period may be critical to improve surgical outcomes and reduce complication rates following paediatric ACL reconstruction.

Objective: The aim of the present study is to determine best practices for the medical management of JIA during the perioperative period of pediatric ACL reconstruction.

Methods: Existing literature on the management of inflammatory arthritis in the perioperative period was gathered through a structured search of MEDLINE, Embase and CINAHL databases. A combination of keywords and subject headings related to juvenile arthritis, ACL reconstruction, orthopaedic procedures, and perioperative care was used to identify articles with potential relevance. In addition, recent cases of ACL reconstruction in patients diagnosed with JIA will be identified from the health records of BC Children’s Hospital and reviewed for trends in JIA management and surgical outcomes.

Preliminary Results: A total of 1688 references were identified by the initial search, with 1297 references remaining after the removal of duplicates. Title and abstract screening by a single reviewer yielded 383 articles for full-text review.

Implications: The findings of the present study may serve to guide the management of DMARDs, corticosteroids, and other antirheumatic medications in the perioperative period. Optimal medical management of JIA in the perioperative window could serve to improve surgical outcomes and reduce complication rates for paediatric ACL reconstruction and other orthopaedic procedures.

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Amrith Vincent

Medical Student, Royal College of Surgeons in Ireland | Supervisor: Linlea Armstrong

Path to Progress: Managing Leukemia Predisposition in Pediatric Patients

Amrith Vincent, Linlea Armstrong, Caron Strahlendorf

Background: As one of the most common childhood cancers, accounting for 29% of childhood cancers, leukemia presents several complex challenges in the pediatric population. While most pediatric leukemia patients have sporadic somatic variants, some are at risk due to germline variants. These genetic variants affect key regulatory processes at the cellular level. The most common genes affected are ones that can be somatically mutated in other cancers (eg. TP53, RUNX1, IKZF1, and ETV6).

Objectives: The primary objective is to create a comprehensive care pathway that will allow clinicians to identify pediatric patients at risk for leukemia due to predisposition syndromes and provide these patients and their families with personalized care plans.

Methods: A comprehensive literature search was performed using the PubMed database and internet search engines. Search terms included “leukemia,” “pediatric,” “predisposition,” and “therapeutics.” Exclusion criteria included adult only predisposition syndromes.

Significance/Overview: Through a systematic review of the literature, we are developing a comprehensive care pathway to assist clinicians identify and manage pediatric leukemia patients with predisposition syndromes. The pathway encompasses all stages of clinical care. Topics included are: prevention and early detection strategies, diagnosis focused on recognition of genetic syndromes, investigations, referral guidelines and evidence-based management recommendations. The care pathway will also provide guidance on transitioning pediatric patient care to adult care. In addition to patient care, predisposition syndromes have implications for family members. The care pathway will provide recommendations for at-risk family screening.

Conclusion: The care pathway will be a valuable resource for clinicians navigating the complex landscape of pediatric leukemia predisposition syndromes. The care pathway provides the blueprint for the creation of personalised care plans throughout the patient’s journey.

SESSION #1 Poster #9

Thumri Waliwitiya

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Medical Student, University of British Columbia | Supervisor: Tim Oberlander

Game Based Intervention for Improving Executive Function in Children with Congenital/Acquired Heart Disease

Background: More than 90% of children with congenital heart disease (CHD) survive into adulthood, and despite improvements in survival, many are at risk of poor executive function (EF). EF skills are required to plan and execute complex tasks that are critical for academic and social success, self-care, and successful transition from the pediatric to adult medical system. EF is a multi-process system that functions in a coordinated manner to permit decision making and goal driven behavior. Children with CHD may have problems with working memory, inhibition, and shifting in both performance-based tasks. Thus, early intervention in children with CHD could have long term health benefits. Recently there has been interest in delivering online cognitive interventions. There is mounting evidence that computerized attention/EF training can be effective for developmentally and neurologically diverse populations if delivered appropriately.

Study Objectives:

1. To work with stakeholders (CHD patients and team) to administer the EF intervention.

2. To determine the feasibility of using this intervention, the level of engagement, and satisfaction of CHD patients, their family, and their CHD team with the EF intervention.

3. To measure EF, academic outcomes, and brain function in children with CHD. To measure quality of life (QoL) in parents of children with CHD pre- and post-implementation of the EF intervention.

Methods: The EF intervention is DinoIsland, a therapeutic computer ‘game’ designed to strengthen EF measures through massed practice distributed over several weeks. Eligible participants in the BC Children Heart Center will be contacted will complete EF testing measuring verbal intelligence, fluid reasoning, verbal working memory, cognitive flexibility, spatial working memory, and sustained attention.

Significance: As most children with CHD survive into adulthood, there has been a shift to optimize long-term outcomes in these patients. Our study will aim to improve EF in children with CHD using innovative game-based intervention which has shown to be effective in other clinical populations with poor EF skills. Improving EF and academic skills may be beneficial for long-term health outcomes and QoL in children with CHD. Congratulations

SESSION #2: BASIC SCIENCE & CLINICAL

Moderator:

Rozalyn Chok

10:00 –11:30 AM

In-Person: Chieng

Family Atrium

Participants:

Ally Baaske

Sanya Grover

Caroline Kim

Madeleine Kruth

Tyrone Ly

Kudrat Mundi

Iqbal Sarai

Rene Tandun

Zixin Grace Yang

Layan Bashi

SESSION #2 Poster #10

Ally Baaske

Watch In-Person:

Thursday, July 27 | 10:00 - 11:30 am

Chieng Family Atrium, BCCHR

Medical Student, University of British Columbia | Supervisor: Edmond Chan

Soluble protein content and sublingual penetration rate of commercially available food powders versus glycerinated extracts for the treatment of food allergy

Ally Baaske, Edmond S. Chan, Lianne Soller, Yigong Guo, Anubhav Pratap-Singh, Bryant Hartono, Brock A. Williams, Stephanie C. Erdle

Introduction: Sublingual immunotherapy (SLIT) is a safe, effective therapy for food allergy. SLIT consists of a small dose of the allergenic food held under the tongue for ≥1 minute with the remainder swallowed. Studies demonstrating SLIT efficacy have relied on glycerinated food extracts for the administration of food allergens, which are less accessible and more expensive than whole food alternatives, limiting treatment availability.

Objective: This study compared the soluble protein content and sublingual protein penetration rates of whole food powders with glycerinated extracts (the current standard in research).

Methods: Peanut, cashew, egg, cow’s milk, salmon, and sesame powders were tested for soluble protein content (average±standard deviation) using Bradford protein assay and in vitro sublingual protein penetration rates using human buccal carcinoma cell lines at 1 hour incubation at 37oC, in comparison to glycerinated extracts.

Results: Soluble protein content for peanut, cashew, egg, cow’s milk, salmon, and sesame powders and extracts was: 0.33±0.0004mg/mg and 7.75±0.001mg/mL, 0.20±0.002mg/mg and 10.42±0.002mg/mL, 0.57±0.004mg/mg and 4.71±0.03mg/mL, 0.36±0.003mg/mg and 2.56±0.01mg/mL, 0.040±0.01mg/mg and 0.0088±0.0004mg/mL, and 0.44±0.2mg/mg and 0.88±0.002mg/mL, respectively.

At 1 hour incubation, the simulated sublingual penetration rate for peanut, cashew, egg, cow’s milk, salmon, and sesame powders versus extracts was: 72.1±1.5% vs. 82.2±2.0% (p<0.05), 76.3±3.2% vs. 74.0±2.3%, 80.3±1.3% vs. 86.0±1.0% (p<0.05), 84.3±1.5% vs. 89.5±1.9% (p<0.05), 65.3±3.5% vs. 84.6±2.1% (p<0.05), and 71.4±1.8% vs. 82.4±1.5% (p<0.05), respectively.

Conclusions: Overall, powders showed lower soluble protein content than food-matched extracts, except for salmon powder. However, conclusions comparing powder and extract protein contents are limited as the units of measurement for powders (mg) and extracts (mL) are not directly comparable. At 1 hour incubation, all food powders showed slower penetration rates than extracts except for cashew, for which rates were equivalent. Future research will focus on recipe development for whole food SLIT doses, and safety and efficacy assessments of whole food SLIT.

Congratulations to Ally on receiving a BC Children’s Hospital Research Institute Summer Studentship

SESSION #2 Poster #11

Sanya Grover

Watch In-Person:

Thursday, July 27 | 10:00 - 11:30 am

Chieng Family Atrium, BCCHR

Medical Student, University of British Columbia | Supervisor: Matthew Carwana

Perspectives of Trauma-Informed Care in Pediatric Populations: A Scoping Review

Grover S, Pawliuk C, Greyson D, Udall B, Carwana M

Background: Children are at risk to experience trauma in many forms, including developmental or intergenerational (especially related to the effects of colonization). Existing literature has demonstrated that early-years trauma has the potential to cause many physical and emotional effects that may impact overall health and wellbeing. Furthermore, those that experience childhood trauma are also more likely to avoid health interactions. Trauma-informed practice is a patient-centered approach that has potential to create more safe and accessible interactions for families. It involves many multi-faceted elements, such as: acknowledging that trauma may commonly come up in clinical encounters; recognizing possible symptoms of trauma, promoting cultural safety; establishing trust in patient-provider relationships; and focusing on taking a strengths-based approach that honors resiliency. While there have been some guidelines established on trauma-informed care, little research has been done on patient and caregiver perspectives for best practices, specifically missing the lens of children and families who have experienced marginalization.

Primary Objective: To identify existing evidence regarding patient and/or caregiver perspectives on best practice guidelines for trauma informed care for children and families in pediatric settings.

Methods: A scoping review will be conducted and original peer-reviewed literature around perspectives of pediatric patients (18 years and younger), caregivers, and health providers in inpatient and/or outpatient healthcare settings will be included. The databases to be searched include MEDLINE, Embase, PsycINFO (EBSCOhost), Scopus, CINAHL (EBSCOhost), Social Work Abstracts (EBSCOhost), Academic Search Complete (EBSCOhost) and Google Scholar. Two reviewers will independently screen studies at Level 1 and 2. Data will be extracted, analyzed, and presented as a narrative synthesis of findings.

Significance: This review bridges the current literature gap by assessing the extent of evidence on patient and caregiver perspectives. These missing perspectives have the potential to further guide our understanding of trauma-informed care, allowing providers to cultivate a safer space in healthcare settings. Furthermore, too often, the experience and expertise of individuals who are marginalized and oppressed is excluded or not adequately considered in policy development. The findings of this review can spark meaningful dialogue and partnerships with vulnerable communities to assess and reform best practice guidelines.

Congratulations

SESSION #2 Poster #12

Caroline Kim

Watch In-Person:

Thursday, July 27 | 10:00 - 11:30 am

Chieng Family Atrium, BCCHR

Medical Student, University of British Columbia | Supervisor: Steven P. Miller

Effects of Chronic Lung Disease and Postnatal Infection on Brain Development and Long-term Outcomes in Preterm Newborns

Caroline Kim, Steven Ufkes, Jessie Guo, Vann Chau, Anne Synnes, Ruth Grunau, Steven P. Miller

Introduction: In preterm neonates, chronic lung disease (CLD) and postnatal infection are robust predictors of abnormal neonatal white matter development and adverse neurodevelopmental outcomes into preschool-age. Our data examining outcomes in children born preterm revealed clinically-relevant motor impairment at 4.5-years of age which was not detected at earlier assessments. These data suggest a need for continued assessment of children born preterm to identify the brain changes underlying neurodevelopmental concerns at school-age, and their relationship to CLD and postnatal infection.

Methods: 124 preterm newborns (mean gestational age 28.2 weeks, SD 2.4) were studied prospectively with longitudinal assessment from birth to 8-years of age. Detailed clinical data (birth weight, infection, CLD, etc.) were collected day-byday through the neonatal intensive care course. White matter injury (WMI) was quantified at term-equivalent age using structural magnetic resonance imaging (MRI). Diffusion tensor imaging was acquired at 8-years of age (mean scan age 8.4 years, SD 0.4) and tract-based spatial statistics were used to compute fractional anisotropy (FA), a measure of white matter maturation. Neurodevelopmental outcomes were assessed at the same visit using the Movement Assessment Battery for Children, 2nd Edition, Kaufman Test of Educational Achievement, 3rd Edition, and the Weschler Abbreviated Scale of Intelligence, 2nd Edition, full-scale IQ.

Results: 33 newborns (27%) developed CLD, defined as requiring supplemental oxygen at 36 weeks postmenstrual age. At 8-years of age, children who had CLD exhibited significantly reduced FA (p<0.05) compared to their peers, controlling for degree of prematurity, age at scan, and presence of moderate-severe WMI on neonatal MRI. Preliminary analyses suggest CLD is associated with significantly lower scores on motor and writing assessments (p<0.05), controlling for the same clinical factors. 51 newborns (42%) were infected postnatally with positive blood, urine, or cerebrospinal fluid cultures. Preliminary analyses found no differences in white matter microstructure or neurodevelopmental outcomes at school-age compared to children without postnatal infection.

Conclusions: In children born preterm, CLD is associated with abnormal white matter maturation and adverse neurodevelopmental outcomes at school-age, suggesting early-life lung disease has long-term links with brain development. Further research is required to understand the neural mechanisms underlying abnormal brain development in children with CLD.

Congratulations to Caroline on receiving a UBC Faculty of Medicine Summer Studentship, co-funded by the Edwin S.H. Leong Centre for Healthy Aging

SESSION #2 Poster #13

Madeleine Kruth

Watch In-Person:

Thursday, July 27 | 10:00 - 11:30 am

Chieng Family Atrium, BCCHR

Medical Student, University of Alberta | Supervisor: Shahrzad Joharifard

Perspectives of surgical care providers in Liberia regarding ethical challenges in global surgery collaborations

Madeleine Kruth, Lemfuka Dieudonné, Farhad Udwadia, Catherine Binda, Kayoung Heo, Emilie Joos, Shahrzad Joharifard

Objective: To understand the ethical concerns, considerations, and priorities in global surgery collaborations from the perspective of surgical care providers in Liberia.

Background: As the field of global health continues to develop, including increased consensus on the field’s key definitions and priorities, increased attention is being paid to its ethical considerations. Many ethical issues in the field of global health and global surgery have been identified, including dissonance between the assumed needs of communities and local realities, lack of adequate pre-departure training for visitors, and the burden that visitors place on their host communities. However, there is a significant dearth in literature reviews and original research that includes the voices of providers from Low- and Middle-Income Countries (LMICs). Acknowledging the vastness, diversity, and value of the voices of surgical care providers in LMICs, this project seeks to begin to fill this gap in research by centering the voices of surgical providers in Liberia.

Methods: Using purposive/convenience sampling methods, we recruited surgical care providers (surgeons, nurses, OR technicians, and others) working in Liberia who have been involved with international partnerships for humanitarian work. Semi-structured interviews are conducted using a structured interview guide with open-ended questions. The interview guide is divided into three sections: provider background and scope of practice; experiences with high-income country partnerships; and barriers and facilitators of past partnerships and ethical challenges identified. Interviews are transcribed, made software ready (NVivo14), and analyzed using conventional thematic qualitative analysis. A preliminary codebook has be drafted based review of the interview transcripts and the lived experiences of team members practicing on the ground in Liberia.

Discussion: While still in preliminary stages of data analysis, some preliminary themes have emerged around ethical challenges and recommendations for best practice in establishing surgical partnerships. These recommendations include ensuring sustainability in partnerships; focus on capacity building; and engagement with local staff and communities. We hope this project will provide much-needed insight into key ethical considerations within the field of global surgery, prompting reflection on the value of global surgical partnerships and how to best foster supportive and impactful bidirectional coparticipatory models.