ObjectivesTo identify what is known empirically about the screening, treatment and harm of exposure to neonatal hypoglycaemia.DesignScoping review that applied a preregistered protocol based on established frameworks.Data sourcesMedline and Embase, up to 12 May 2020.Study selectionComparative and case-series studies, as well as guidelines, published in English or French, on the topic of immediate inpatient postnatal glucose screening in newborns.Data gatheringArticle selection and characterisation were performed in duplicate using predefined data extraction forms specific to primary studies and guidelines.Results12 guidelines and 74 primary studies were included. A neurodevelopmental outcome was primary in 32 studies: 30 observational studies followed up posthypoglycaemic, and the 2 intervention studies included 1 randomised controlled trial (RCT) about treatment thresholds. Three other RCTs assessed dextrose gel (two) and oral sucrose (one). 12 of 30 studies that evaluated non-neurodevelopmental primary outcomes were intervention studies. Only one cohort study compared outcomes in screened vs unscreened newborns. The guidelines did not arrive at a consensus definition of postnatal hypoglycaemic, and addressed potential harms of screening more often than primary studies.ConclusionsThe primary literature that informs hypoglycaemia screening is a series of studies that relate neurodevelopmental outcomes to postnatal hypoglycaemia. Further research is needed to better define an optimal threshold for hypoglycaemia that warrants intervention, based on long-term neurodevelopmental outcomes and a better delineation of potential screening harms.

Embryonal tumor with multilayered rosettes is a rare and highly malignant early childhood brain tumor. We report a case of embryonal tumor with multilayered rosettes in the parietooccipital region of a 2-year-old girl. Histopathology of the tumor demonstrated amplification of the 19q13.42 locus and strong positivity for LIN28A. Treatment was multimodal and included 3 surgical resections, adjuvant chemotherapy with autologous stem cell rescue, and focal radiotherapy. The use of the agents vorinostat and isotretinoin, and the addition of focal radiation have not been extensively described in this patient population, but may attribute to our patient's sustained remission at 2.5-years follow-up.

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Primary Subject area Hospital Paediatrics Background Paging is an important method of communication in hospitals but can also interrupt clinical care unnecessarily. These interruptions decrease workflow efficiency and negatively affect patient care. Objectives The goal of this project was to decrease clinical care interruptions from non-urgent pages to pediatric residents by implementing a priority indication system that was: (1) consistently used (90% pages with a priority level indicated); (2) clearly defined (80% concordance in the priority levels between senders and recipients); and (3) satisfying to end users (80% rating the paging system as satisfied). Design/Methods The Plan-Do-Study-Act method of quality improvement was used. The study was conducted at an academic children’s hospital, where numeric paging occurs through a switchboard operator. Three priority levels (1 being most urgent) with a respective expected callback time (5-15, 15-30, 60+ minutes) were determined through a pilot study and stakeholder consensus. A priority level was selected by the page sender and displayed beside a callback number. Process measures were indication of priority levels and concordance of priority levels between senders and recipients. Outcome measures were reduced interruptions to clinical care from non-urgent pages and user satisfaction. Balancing measures included patient safety incidents. Run charts, surveys, and page logs were used to track the impact of interventions. Results In the first two months, 1325 out of 2208 (60%) pages had a priority level indicated. In the subsequent two months after providing feedback to users, the proportion increased to 1822 out of 2410 (76%). Subsequent bimonthly indication rates have ranged between 74% and 83%. Among pages with a priority level indicated over 16 months (n=13,934), 26% were assigned priority 1, 62% priority 2, and 11% priority 3. There was a 74% concordance in priority levels between senders and recipients. 26% of pages were received while a resident was directly interacting with a patient. Fewer residents felt that their workflow was being frequently interrupted by non-urgent pages (from 65% to 39%). End user satisfaction improved. There were no patient safety incidents. Conclusion Using existing infrastructure, we implemented a paging priority indication system that decreased interruptions to clinical care. Residents reported improved workflow efficiency, and end users expressed improved satisfaction with paging communication. The gap in the perception of urgency between senders and recipients will need to be further evaluated. While a priority level indication is particularly pertinent to hospitals using numeric pagers, a standardized indication of priority levels can also be beneficial in hospitals using an alternative communication system.

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