Abstracts of the 2023 Annual Conference of the Canadian Paediatric Society Paediatrics & Child Health, Vol. 28, No. S1 September 2023 e27 NICU outcomes Long-term outcomes (home) Intubation Duration of intubation Spells on the tube Reintubations • Parental fear, ‘ups and downs’ Accidental extubations •Parental fear, ‘ups and downs’ Respiratory insuffciency •Fear of death •Capacity to hold baby •Steroids to prevent death Time on respiratory support •HFNC better than CPAP Work of breathing ENT problems, e.g., investi- gations, surgery, stridor Nose/face/midface injuries from ventilation/intubation Duration of oxygen past term Tracheostomy Home oxygen • Duration (more diffcult with mobile child) • More diffcult when other children or pets • Limits movement of child, parents, and family Work of breathing, coughing, wheezing •Diffculty breathing •Parental fear •Negative impact on child’s sleep •Negative impact on parent/family sleep •Isolation of familyAvoiding contacts to decrease infections and adverse pulmo- nary outcomes Recommendation to avoid daycare •Parental impact, loss of work Tracheostomy Hospital readmissions •Loss of work for parents Hospital visits •Loss of work for parents Frequent infections •Loss of work for parents ENT problems, ENT surgery •Medication needDiffculty giving it, fol- low-up, effciency Feeding/nutritional impacts of respiratory problems: e.g., oral aversion, gastrostomy Exercise limits Limited school activities CPAP Continuous positive airway pressure; ENT Ear nose and throat; HFNC High-fow nasal cannula Abstract citation ID: pxad055.060 60 NICU MANAGER’S PERCEPTION OF HIGH UNIT ACTIV- ITY AND ITS ASSOCIATION WITH PATIENT CARE IN THE NEONATAL INTENSIVE CARE UNIT Carla Herman BACKGROUND: Each year, 15,000 critically ill neonates require spe- cialized care that is offered in only 32 tertiary neonatal intensive care units (NICUs) in Canada. Previous studies have shown associations between nurse-to-patient ratios and higher bed occupancy with patient outcomes. OBJECTIVE: To explore neonatal managers’ perceptions of organiza- tional factors in Canadian NICUs. METHODS: This was a web-based cross-sectional survey, consisting of 20 questions pertaining to the determinants of resource allocation, the ascertainment of high occupancy state, as well as the different chal- lenges and mitigation strategies implemented during periods of high unit strain. The survey was designed following the CHERRIES guidelines and was critically reviewed through a two-round validation process prior to deployment. It was sent by e-mail to the unit managers of all Canadian Level-3 NICUs between August and November 2022. They were invited to respond based on their unit’s practices in 2021. The analysis was con- ducted using descriptive statistics, where units were dichotomized by size (small unit ˂36 beds, large unit ≥36 beds). RESULTS: A total of 24 unit managers (75%) completed the survey. Most respondents relied exclusively on clinical judgment to estimate the total number of nurses required per shift (33%) and the individual nurse-to-patient ratios (67%) as opposed to nursing workload assess- ment tools (8% and 21%, respectively). The response for the pro- portion of nursing shifts perceived as adequately staffed was: 0% for 100% adequately staffed, 37% for ˃80% adequately staffed, and 27% for 60%-80% adequately staffed. The response for the proportion of nursing shifts perceived as understaffed to the point of being unsafe for patient care was: 17% for no understaffed, 52% for ˂20% under- staffed, and 9% for 20%-40% understaffed. The most common orga- nizational challenges were personnel recruitment and unit occupancy (each reported as being a major issue by 38% of respondents). Although most (75%) respondents believed that high occupancy, especially when exceeding 90%, likely increases the risk of adverse patient outcomes, they revealed implementing mitigation strategies to reduce occupancy only when it exceeded 95%. At that point, the most common strategies implemented were to call for additional voluntary nurses, implement voluntary nursing overtime, and accelerate patient transfer. CONCLUSION: Although Canadian NICUs form a very heteroge- neous group, managers shared similar perspectives in terms of staffng and occupancy challenges. This emphasizes the need for collaborative NICU person-power resource management practices to improve neonatal inten- sive care service organization. Abstract citation ID: pxad055.061 61 ANTIBIOTIC RESISTANT PATTERNS OF BACTERIAL PATH- OGENS CAUSING INVASIVE NEONATAL INFECTIONS IN NORTHERN ALBERTA Joseph Ting, Adrien Lam, Alena Tse-Chang, Mao-cheng Lee BACKGROUND: Antimicrobial resistance is one of the most seri- ous global health threats facing the world today. The neonatal inten- sive care unit (NICU) is a clinical environment that houses newborn infants who are highly susceptible to overwhelming infection. Early and decisive treatment with powerful anti-microbials tends to be the preferred clinical choice for treating sick infants empirically. Prolonged exposure to antimicrobials can result in multi-drug resistant organisms (MDROs), which can be associated with mortality due to an increase in virulence, delay in appropriate treatment, and a lack of treatment options. An updated antibiogram is important for determining the opti- mal empirical antimicrobial choice for sepsis evaluations. There is cur- rently a lack of antimicrobial susceptibility data for bacterial pathogens in the Northern Alberta region. OBJECTIVES: The objective of this study is to understand the anti- biotic resistance patterns among isolates responsible for bacteremia and meningitis in the NICUs in Northern Alberta through the standard anti- biograms produced by microbiology laboratories. DESIGN/METHODS: We conducted a retrospective study to analyze antimicrobial resistance patterns found in NICUs during 2013-2021 in Northern Alberta. Bacteria isolated from blood and cerebrospinal fuid according to commonly used antibiotics in NICUs were collated to cre- ate a provincial antibiogram. RESULTS: A total of 5562 isolates were included in this antibiogram. The most frequently isolated organisms were Escherichia coli (1521), Staphylococcus aureus (1157), members of coagulase-negative staphylo- coccus (534), Enterococcus faecalis (326), and Klebsiella pneumoniae (357) in neonatal populations. Among the 1157 S. aureus isolates, 24% were resistant to oxacillin (i.e., “methicillin-resistant S. aureus” or MRSA) and 1% were resistant to vancomycin (i.e., “vancomycin-resistant S. aureus” Downloaded from https://academic.oup.com/pch/article/28/Supplement_1/e27/7281411 by guest on 26 September 2023