BACKGROUND: In Canada the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. FASD is the leading cause of developmental and cognitive disabilities in Canada. No study has examined the cost to parents/caregivers of raising a child with FASD in Canada. OBJECTIVES: To calculate an estimate of direct and indirect costs associated with raising a child with FASD at the patient level. DESIGN/METHODS: Cross-sectional study design was used. Two-hundred and thirty (230) participants completed the study tool. Participants included caregivers of children from day of birth to 18 years of age, living in urban and rural communities throughout Canada. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total average costs per individual with FASD were calculated by summing the costs in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs of raising a child with FASD. RESULTS: Total adjusted annual costs associated with FASD at the individual level was $31, 640 (95% CI $25,342; $38,642). Severity of the child’s condition, age, and relationship of the individual to the caregiver (biological, adoptive, kinship) were significant determinants of costs (p < 0.001). Thirty-two (32) percent of the total costs were paid by families caring for the children: The total annual cost to parent(s)/caregiver(s) of a child with FASD was $10,124.80. These costs were beyond the costs of raising a healthy child and only associated with costs of FASD. CONCLUSION: Study results demonstrated thecost burden of FASD in Canada to parents/caregivers. Implications to practice, policy, and research are discussed.

BACKGROUND: Simulation is an effective tool in medical education. The extent and manner in which simulation is used within Neonatal Resuscitation Program (NRP) courses across Canada is currently unknown. In order to improve NRP education, current practices must be better understood. OBJECTIVES: To characterize current practices and use of simulation in NRP courses across Canada. DESIGN/METHODS: A REDCap survey, consisting of questions about instructor demographics, practices in NRP instruction and use of simulation, was developed and distributed to all NRP instructors across Canada. Simple statistics were used to tabulate responses and the chi-squared test was used to assess differences in simulation use between different types of instructors. RESULTS: Five hundred sixty nine of 1390 (40.9%) NRP instructors completed the survey. Participants included 88 (15.5%) physicians, 74 (13.0%) respiratory therapists, 345 (60.6%) registered nurses and 28 (4.9%) nurse practitioners. Two hundred fifty eight (45.4%) worked in institutions providing Level III care. Overall, 560 (98.4%) respondents used simulation, of which only 176 (31.4%) reported using high-technology simulation. Only 180 (31.6%) instructors who used simulation reported having received formal training in high-technology simulation. When asked about the role of simulation in NRP instruction, 545 (95.8%) agreed or strongly agreed that simulation is a valuable educational tool in NRP instruction, but only 219 (39.1%) felt comfortable using high-technology simulation. There was no difference in use of high-technology simulation between physician and non-physician instructors (I2 0.90, p=0.34). Of the instructors who used high-technology simulation, 160 (90.9%) and 134 (76.1%) had learners and instructors, respectively, from multiple healthcare disciplines present in some or all sessions. There was a non-significant trend towards higher use of interprofessional learners among physician instructors (I2 3.8, p=0.052). An impressive 554 (98.9%) debriefed after some or all simulation sessions, with only 295 (51.8%) instructors having received formal training in debriefing techniques. CONCLUSION: Almost all NRP instructors use simulation and feel that it is valuable, though few have received formal training and feel comfortable using high-technology simulation. Most simulation use is low-technology, in keeping with the Canadian Paediatric Society (CPS) recommendations, though the optimal methods of use of simulation in NRP instruction are not known. The majority of instructors debrief with learners, as recommended by the CPS, though only half have had training in debriefing. The results of this study support further investigation into the optimal type of simulation in NRP teaching and more formal education in simulation and debriefing for NRP instructors.

BACKGROUND: Canadian and US studies suggest that the organisms responsible for early-onset neonatal sepsis (EONS) are changing, with an increase in Escherichia coli (EC) as well as antibiotic-resistant organisms. Current Canadian guidelines for prevention and treatment of EONS are based on Group B streptococcus (GBS) as the likely organism. Population-level data may inform updates to these national strategies. OBJECTIVES: To determine the incidence, types of organisms and corresponding resistance patterns involved in EONS in Canada. To identify how the organisms are affected by maternal antibiotic prophylaxis and other factors. DESIGN/METHODS: Cases of EONS (defined as positive blood and/or cerebrospinal fluid (CSF) culture at <7 days of age) between January 2011 and December 2012 were identified through the Canadian Paediatric Surveillance Program (CPSP). Neonates were excluded if they were asymptomatic with a positive culture likely to be a contaminant, or if the CSF culture was positive as a result of an intracranial procedure. RESULTS: Over the 2-year period, 127 cases meeting our criteria were identified, and there were 754,849 total Canadian live births. The incidence for EONS was 0.17/1000 live births. 79.5% of cases presented within the first 24 hours of life, while 15% presented between 72 h-7 days. GBS accounted for 41.7% of cases, while EC accounted for 35.4%. Resistance was noted in 33.9% of cases overall. 55.6% of EC were resistant, with ampicillin resistance being the most common. The species of infecting organism was significantly associated with gestational age, very low birth weight, age at presentation, the mother having received GBS prophylaxis, and rupture of membranes lasting more than 18 h. GBS was most common in term and EC in preterm neonates. The overall EONS case fatality rate was 11%, with most of these being deaths from EC. CONCLUSION: Our study suggests a lower rate of EONS than historically suggested, with differing dominant organisms based on gestational ages of the neonates. Later ages at presentation and high rates of resistance especially among EC cases further complicate the picture. We recommend a review of the Canadian prevention and treatment guidelines based on our findings.