Transformational Insight in Pediatric Palliative Care

"This was a child who really needed more than she could access, good pain and symptom control. [6-year-old child in a Rohingya refugee camp in severe pain, near end-of-life]."

"She [her memory] has stayed with me."

"It is not just about saving peoples' lives. It is just as important to relieve peoples' suffering. There is a moral obligation to the patient in front of you to give them good care, to relieve suffering."

"We can't say 'We can help them, just put them over there'."

Dr. Megan Doherty, palliative pediatric care physician, Children's Hospital of Eastern Ontario (CHEO)

Dr. Megan Doherty is receiving an award for the work she has done globally making sure children in some of the toughest situations in the world (including refugee camps), get the kind of palliative care that children in Ottawa receive. Photographed Wednesday at Roger Neilson House in Ottawa. Photo by Julie Oliver /POSTMEDIA

 

The image of the suffering child, a little girl whose name was Taslim, remained with Dr. Doherty over the years "like a guiding light", in fact steadily guiding her toward her life's focus in bringing palliative care to children who live in some of the most difficult world conditions; in refugee camps and settlements. Dr. Doherty has spent her professional life persuading the global medical community that with training, access to medication and a finer understanding of the need for pain management, children like Taslim deserve end-of-life care under any circumstances.

A palliative care specialist at CHEO, and director of the pediatric palliative care residency program, Dr. Doherty was honoured by the Canadian Society of Palliative Care Physicians for her humanitarian work, making "a great impact" in serving suffering children whose medical conditions place them in a category of early death.

"When I started, there were no palliative programs anywhere in the world for children."

"Everything I do in palliative care is better because of everything I do internationally. I have learned to teach better, how to break down what I do into more operation steps, how to teach communication, how to help people who haven't had a lot of training to better communicate with children and their families."

Dr. Megan Doherty, pediatric palliative care physician

Dr. Megan Doherty (L) and palliative care consultant Dr. Spandana Rayala following a palliative care workshop at the Hyderabad Centre for Palliative Care in Hyderabad, India. Photo by Sandra Broughton /TWO WORLDS CANCER COLLABORATION

 

She is a pediatric palliative director with Two Worlds Cancer Collaboration and other organizations, with which she has helped to develop training, guidelines and materials for physicians, nurses and community health workers to bring palliative care to children throughout Asia and other regions of the world. She also works to break down barriers making it difficult to access medicine for patients in need of palliative care during humanitarian crises.

Advocating for oral morphine availability and the development of pediatric pain and palliative care policies and guidelines are among her duties. She has encountered long-held beliefs preventing children from accessing palliative care. Arguments that urgent humanitarian efforts were too stretched in saving the lives of people, to venture beyond that goal. She has been witness to growing awareness through her own work of the need for pediatric palliative care during her years of global humanitarian work.

Dr. Doherty feels that her work in helping develop systems to train and support health workers in the provision of palliative care makes a large impact. She provides telemedicine advice on a weekly basis around the world. Operating within CHEO was for her the perfect fit since it is one of the few centres in Canada with a developed pediatric palliative care program. She has been allowed to make an impact with humanitarian work through the support given her at CHEO. In this relatively new field of pediatric palliative care, CHEO is the first Canadian hospital to offer a medical residence in pediatric palliative care.

Dr. Megan Doherty checks on the 15-day-old Mallesh at the Mandara Hospice for Children in Hyderabad, India, March 16, 2022. Photo by Harsha Vadlamani /TWO WORLDS CANCER COLLABORATION

"This is a place where there is so much need but you can make such a profound difference for patients and families."

"It is transformational and so rewarding."

Dr. Megan Doherty

COVID Vaccinations During Pregnancy -- No Side Effects

"Our study found no evidence of increased risk of preterm birth, very preterm birth, small-for-gestational-age at birth, or stillbirth following COVID-19 vaccination during pregnancy."

"The results of this study provide further evidence for care providers and pregnant people about the safety of COVID-19 vaccination during pregnancy."

Dr. Deshayne Fell, scientist, CHEO Research Institute, associate professor of medicine, University of Ottawa 

MothertoBaby

 

A new retrospective study led by the CHEO Research Institute examined thousands of births in Ontario, concluding that being vaccinated against COVID-19 while pregnant does not have the effect of increasing risk of complications, such as giving birth early or having a small or stillborn baby. Their findings were published in The BMJ (British Medical Journal).

Starting with the acknowledgement that acquiring the virus while pregnant links to a higher risk of complications that include admission to hospital, maternal death and both preterm birth and stillbirth, the researchers were interested in settling the conviction that vaccination against COVID during pregnancy truly has demonstrated benefits helping protect mothers and their babies. Limited evidence linking pregnancy outcomes after vaccination drew them to this study.

The CHEO-based BORN Ontario birth registry was used by the researchers to identify infants born following at least 20 weeks or pregnancy or weighing at least 500 g between May 1 and December 31, 2021. The data gleaned was then linked to CO-VaxON, the immunization database of Ontario's COVID-19 program.

It was found that of 85,162 births, 43,099 represented people who received at least one dose of  COVID-19 vaccine during pregnancy; 99.7 percent having received an mRNA vaccine, mostly those produced by Pfizer-BioNTech, or Moderna. The study led to the discovery that vaccination during pregnancy was not associated with increased risk of overall preterm birth which was experienced by 6.5 percent of those unvaccinated; spontaneous preterm birth, at 3.7 percent versus 4.4 percent; or very preterm birth, at 0.59 percent versus 0.89 percent.

Findings, reported the researchers, were similar irrespective of when the vaccine was given, how many doses were received during pregnancy, or which mRNA vaccine was used. Extenuating factors such as the mother's age at delivery, pre-pregnancy body mass index, reported smoking or substance use during pregnancy, pre-existing health conditions, previous live births and stillbirths, location and income, were all accounted for.

 

No increase was found in the risk of babies being born small for gestational age, at 9.1 percent in the vaccinated group as opposed to 9.2 percent among the unvaccinated, or stillbirth, at 0.25 percent opposed to 0.44 percent. Research findings were similar irrespective of when the vaccine was given, how many doses were received during pregnancy, or which mRNA vaccine was used.

The mother's age at delivery, pre-pregnancy body mass index, reported smoking or substance use during pregnancy, pre-existing health conditions, previous live births and stillbirths, location and income were all taken into account.

A different study, also co-authored by Dr.Fell, showed infants whose mothers received a second or third dose of COVID-19 vaccine during the late stages of pregnancy were protected against SARS-CoV-2 infection throughout the first four months of life. That research was published in June, in JAMA Internal Medicine.

 

Doctor examine pregnant belly for baby and mother healthcare check up. Getty

Alert on Link Between Concussions and Child/Youth Mental Health

(HealthDay News)

"This study shows that concussions can be much more than a physical head injury.There can be long-term emotional and cognitive impacts on a child's life that we have to be mindful of and help address."

"During concussion followup visits, it's extremely important for physicians to screen for mental health issues and factors that might predispose children to a mental health problem."

"I don't want parents to be scared of sending their children to sports based on this study."

"I think, regardless of a concussion, we should be on the lookout for mental health issues and be open to communicating about our own mental health. "There is such a large stigma around mental health, we are not always willing to talk about it."

Andree-Anne Ledoux, professor, Brain and Mind Research Institute, University of Ottawa Faculty of Medicine

For this study, researchers looked at cases relating to 152,482 children and youth in Ontario who had suffered concussions, along with 296,482 children in the province and youth with orthopedic injuries. Excluded for this study was anyone who required mental health investigation in the year prior to their injury. Mental health conditions were found to include anxiety and neurotic disorders, mood and eating disorders, schizophrenia, substance use disorder, suicidal ideation and disorders of psychological development.

These conditions were found to be more common within the group that had suffered concussions, than within the orthopedic group. Physicians and parents, stressed Dr.Ledoux, should ideally be aware of this linked heightened risk and have conversations with children about the state of their mental health. At the same time, she felt the importance of a message that not all patients who experience concussions will go on to develop mental health issues.

The study, led by the research group at the Children's Hospital of Eastern Ontario Research Institute, and headed by Dr.Ledoux, was published in the journal JAMA Network Open. Its conclusions are considered significant due in part to its size, along with the period of time covered. The study was geared to compare children and youth between the ages of five and 18 diagnosed with concussions, as opposed to those who were diagnosed with orthopedic injuries; as example, broken bones.

The ten-year period involved and the number of individual subjects in conjunction, enabled the conclusion that children and youth with concussions were 40 percent likelier to incur mental health issues, hospitalization and self-harm after the concussion, in comparison to those study subjects who had been the recipient of orthopedic injuries.

The connection between concussion and mental health is not new, having been connected and debated previously. Dr.Ledoux theorized a number of scenarios that have the potential to impact children and youth, bringing them to heightened risk of mental issues following a concussion. Concussions "trigger a cascade of biological and chemical mechanisms in your brain", resulting in a range of symptoms. On the other hand, mental health issues could arise in children with a predisposition and with poor coping skills.

As well, a paucity of normal activity and socializing in the wake of having a concussion could as also affect the mental health of patients. And nor could pain and sleep issues be negated as a possible cause; both often associated with concussion, could as well lead to issues with mental health. Screening for possible mental health impacts following concussion should become an integral part of the focus on preventing and diagnosing concussions.