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3c4be61abc0cdcc66111bc134d538c2fa62235b1	##chycardia, seizures, hypotonia, lethargy, poor peripheral perfusion, hypotension and acidosis. in an analysis of 2785 symptomatic and asymptomatic infants with birth weights ≥2000 g, the sensitivity and negative predictive value of clinical signs were 92 % and 99 % respectively, in contrast to sensitivities of \ < 5...	guidelines
3c4be61abc0cdcc66111bc134d538c2fa62235b1	##ingitis is suspected, infants should receive antibiotics that penetrate into csf, in appropriate doses. when cultures are positive and sensitivities determined, therapy can be modified to the most appropriate antimicrobial agents. # # well \ - appearing term infants with risk factors the incidence of eos in asymptom...	guidelines
3c4be61abc0cdcc66111bc134d538c2fa62235b1	sepsis and have ready access to health care. parental understanding of when to seek medical care should be confirmed. if these conditions cannot be met, infants should be observed in hospital until 48 h of age. gbs \ - positive mothers with additional risk factors, with and without iap : maternal fever and prolonged r...	guidelines
3c4be61abc0cdcc66111bc134d538c2fa62235b1	is usually diagnosed on the basis of maternal temperature \ > 38oc plus two other signs ( uterine tenderness, maternal or fetal tachycardia, foul / purulent amniotic fluid, maternal leukocytosis ). chorioamnionitis remains difficult to diagnose clinically because the prevalence of maternal fever during labour is high,...	guidelines
3c4be61abc0cdcc66111bc134d538c2fa62235b1	for at least 48 h before being discharged home. recommendations are graded using the grade system. it should be noted that this is an area in which few prospective and high quality comparative studies have been done ; hence the low quality evidence. # # newly born * unwell - term infants ( ≥37 weeks ’ ga ) 1. infants ...	guidelines
3c4be61abc0cdcc66111bc134d538c2fa62235b1	infants should be examined at birth, observed closely in hospital with vital signs every 3 h to 4 h, and reassessed before discharge home. they may be discharged home after 24 h if they remain well and meet other discharge criteria, providing there is ready access to health care and the parents understand and are able...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	the circumcision of newborn males in canada has become a less frequent practice over the past few decades. this change has been significantly influenced by past recommendations from the canadian paediatric society and the american academy of pediatrics, who both affirmed that the procedure was not medically indicated....	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	” was initially performed, which yielded 1596 articles. these articles were subsequently reviewed, as were their references when appropriate. the focus was on neonatal and infant male circumcision and its outcomes. the hierarchy of evidence from the centre for evidence \ - based medicine was applied, using levels of e...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	( paraphimosis ) in 0 \. 5 % of cases. both conditions usually resolve with medical therapy but, if recurrent, can cause phimosis. an estimated 0 \. 8 % to 1 \. 6 % of boys will require circumcision before puberty, most commonly to treat phimosis. the first \ - line medical treatment of phimosis involves applying a to...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	circumcision status was maintained. since the publication of this meta \ - analysis, a further prospective cohort study, in which a series of urine cultures were obtained in boys up to 15 months of age, also found a lower incidence of uti in individuals who had undergone newborn circumcision ( 0 % versus 2 %, p \ < 0 ...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	of the foreskin is rich in langerhans and other hiv target cells that are exposed to infection during sexual intercourse, which is speculated to be one mechanism leading to hiv acquisition. if true, then removing the foreskin could theoretically have a protective effect against hiv acquisition. conclusive evidence tha...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	for which an exposure category was reported were attributed to msm and 13 \. 7 % to idu. the proportion of new cases attributed to heterosexual transmission involving individuals not originally from a country where hiv is endemic was 20 \. 3 %, while 16 \. 9 % of new cases were in individuals originally from hiv \ - e...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	##is, it should be emphasized that other preventative measures, including abstinence, use of condoms and other safe sex practices, must continue to be taught and practiced. # # cancer reduction female partners of circumcised men have a reduced cervical cancer risk, with ors ranging from 0 \. 18 to 1 \. 61 depending on...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	jelly to the glans for up to six months following circumcision. partial re \ - adherence of the penile skin to the glans is not uncommon. such adhesions often resolve spontaneously by puberty but, when they are extensive, may also benefit from treatment with a topical steroid preparation. surgical lysis is rarely requ...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	associated with male circumcision, particularly in high \ - risk populations. infant circumcision reduces the incidence of uti in young boys and eliminates the need for medical circumcision in later childhood to treat recurrent balanoposthitis, paraphimosis and phimosis. circumcised men have a lower risk of developing...	guidelines
9d181ce2c8897c63ec01ba64c2e497534f08a314	religious and cultural beliefs. - parents who choose to have their sons circumcised should be referred to a practitioner who is trained in the procedure. - neonatal male circumcisions must be performed by trained practitioners whose skills are up \ - to \ - date and strictly adhere to hygienic and analgesic best pract...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	this statement will help health care providers assess and advise on early literacy with families in almost any practice setting. it defines emergent literacy skills, including early language learning and storytelling, and explores the benefits of reading, speaking, and singing with infants and toddlers for both childr...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	about $ 67 billion \ ]. this statement focuses on the benefits of reading, speaking, and singing with infants and toddlers, with particular focus on family, relational, and social \ - emotional health. when “ parent ” ( singular or plural ) is used, it includes any primary caregiver and every configuration of family. ...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	infants learn about language long before they first speak. live, social interactions are critical to this process. interacting one \ - on \ - one, using infant \ - directed speech ( sometimes called “ parentese ” ) — which involves a higher tone of voice, exaggerated pitch contour, and a singsong quality \ ] — heighte...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	, which benefits multiple language learning and important social competencies into preschool and beyond \ ] \ ] \ ]. milestones of language development are the same for children who learn more than one language. children exposed to more than one language may split their time and attention unequally between them and he...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	over since repetition allows them to internalize the story and master its pieces. as families relate experiences together, they construct a shared narrative, strengthen family bonds, and teach what makes a good story \ ] \ ]. stories are also a passport into a child ’ s own or another culture \ ] \ ] \ ]. storytelling...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	and improved parental responsiveness. research is also showing how these relational factors are enhanced by behaviours associated with reading together, such as “ snuggling up ” ( see ) \ ] \ ] \ ]. # incorporating books into routines there is strong evidence that early shared reading also reinforces positive family r...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	networks while doing so. e \ - books do much of this work for them, such that their brains are significantly less engaged \ ]. the simpler the technology, the better it is for early brain development. the benefits of singing one recent us cohort study revealed that, in the newborn period, many families do not consider...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	, these skills are acquired in meaningful, active, and expressive contexts \ ]. music can be an entry point to a new language for children, who may be more socially comfortable singing along than speaking out \ ]. rather than getting stuck on words while reading, familiar melodies can help young children ( or their pa...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	setting \ ] \ ]. see. talking to parents about the benefits of reading, speaking, and singing with their children from birth is something health care providers can do in virtually any context ( e. g., at prenatal and well \ - child visits, during a hospitalization, or in a continuity clinic ). the intervention can be ...	guidelines
e463db7af246c2ac72f48f66f7a976c39b9a5eb8	a one \ - hour, self \ - directed cme developed by the canadian paediatric society and the canadian children ’ s literacy foundation - : canadian paediatric society - : alberta family wellness initiative - : harvard university center on the developing child - : caring for kids new to canada, canadian paediatric societ...	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	red blood cell transfusion is an important and frequent component of neonatal intensive care. the present position statement addresses the methods and indications for red blood cell transfusion of the newborn, based on a review of the current literature. the most frequent indications for blood transfusion in the newbo...	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	pubmed clinical series algorithms for therapy, diagnosis and prognosis were used, as appropriate, to explore each of the statements attributed with a level of evidence. for therapeutic recommendations, cochrane reviews were given preference and updated as appropriate. # transfusion therapy blood products for transfusi...	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	specific considerations for blood \ - banking procedures. newborns, particularly extremely low birth weight infants who are most exposed to transfusion, are already immunologically compromised and neurodevelopmentally vulnerable. all transfusion \ - transmitted infections put the newborn at risk, but cytomegalovirus (...	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	ml / kg / h can be tolerated by newborns but the evaluation of this practice is limited ; a conservative maximum would be 5 ml / kg / h. an alternative approach is to calculate the volume of blood transfused by hemoglobin target selection, which has conventionally been 150 g / l in the early newborn period. attempting...	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	normal saline, at 10 ml / kg to 20 ml / kg, while awaiting the emergency provision of group o rh \ - negative packed rbcs, which should be administered in similar volumes. a hemoglobin level only provides guidance when chronic bleeding has occurred. the collection of cord or pretransfusion blood for typing is helpful....	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	is high ( \ > 75 % ) and there is plenty of reserve oxygen available in blood. variations in blood oxygen content are easily accommodated by changes in the microcirculation, regional blood flow and fractional increases in oxygen uptake. when the requirements of the tissues are addressed by local regulation, the quanti...	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	the combined outcomes of mortality or major morbidities at first hospital discharge : bronchopulmonary dysplasia, signs of hemorrhagic or ischemic brain injury, or severe retinopathy of prematurity ( rr 1 \. 07 \ these trials did not evaluate hemoglobin thresholds \ < 100 g / l in the first week of life or \ < 75 g / ...	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	early administration of erythropoietin to stimulate erythropoiesis in preterm infants slightly reduces the need for rbc transfusions and the volumes transfused. however, because most trials enrol infants who may already have been transfused, such reductions are of limited clinical importance. there may be a significan...	guidelines
996e4190a7a4d749290f9dbe711a9ed8ec4b0e81	- specific rh \ - compatible blood must be used. starting at four months postnatal age, cross \ - matching of donor blood is required. ( strong recommendation ) - in cases of massive hemorrhage, for which a large volume of blood may be required, care should be taken to avoid hyperkalemia and dilution of coagulation fa...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	acute otitis media ( aom ) continues to be a common infection in young children. milder disease, usually due to viruses or less virulent bacteria, resolves equally quickly with or without antibiotics. a bulging tympanic membrane, especially if yellow or hemorrhagic, has a high sensitivity for aom that is likely to be ...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	illnesses. other risk factors include orofacial abnormalities ( such as cleft palate ), household crowding, exposure to cigarette smoke, pacifier use, shorter duration of breastfeeding, prolonged bottle \ - feeding while lying down and a family history of otitis media. children of first nations or inuit ethnicity are ...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	- and * m catarrhalis - will increase with the widespread use of the 13 \ - valent conjugated pneumococcal vaccine ( pcv13 \ ). it has been estimated that the routine use of pcv7 in canada has decreased the incidence of aom by 13 % to 19 % because nasopharyngeal colonization with vaccine \ - type * s pneumoniae - in c...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	##gia as a symptom should be distinguished from pain in the external canal due to otitis externa ( which results in pain on movement of the tragus and inflammation of the ear canal usually without any systemic symptoms ). the tempo, severity and duration of illness are also important to elicit because a progressively ...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	##algia ) with middle ear fluid and significant inflammation of the middle ear. as a distinct entity, aom should be differentiated from ome, which is also characterized by the presence of mee ; however, in contrast to aom, signs of acute inflammation of the middle ear are absent. as in all clinical processes, there is...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	making bulging the most important criteria for the diagnosis. other features, such as hemorrhagic patches or erythematous tm, had poor interobserver agreement, while erythema, opacity or air fluid levels alone – without a bulging tm – had poor predictive value. therefore, a bulging tm is a very sensitive and specific ...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	temporal bone inflammation, or sixth cranial nerve palsy ( failure of ipsilateral eye abduction ) due to petrous bone inflammation or infection ( gradenigo ’ s syndrome ). additional complications may include labyrinthitis, when infection spreads to the cochlear space, venous sinus thrombosis of the transverse, latera...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	cannot be properly assessed. for many reasons ( eg, a less cooperative patient, a small ear canal, an inexperienced observer or inadequate equipment ) clinicians may not be able to determine conclusively whether the tm is bulging. in these common situations, the differential diagnosis may still include viral illness a...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	##llin \ - resistant – * s pneumoniae , beta \ - lactamase \ - negative h influenzae - and gas. for clinical cure of aom, the levels of amoxicillin in the middle ear should be adequate for over 50 % of the day. administering 45 mg / kg / day to 60 mg / kg / day of amoxicillin in three divided doses will achieve ade...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	compared with the beta \ - lactams ( eg, penicillins or cephalosporins ). only rarely are other medications indicated, such as doxycycline in children ≥8 years of age or quinolones ; however, such alternatives should only be considered in consultation with an infectious disease physician. symptoms should improve withi...	guidelines
1dc2b65bdd3507b04cf6303e2b6670693278e6d9	months of age who have mild illness with appropriately diagnosed aom criteria or children who do not fully meet diagnostic criteria, a watchful waiting approach for 48 h is an option if follow \ - up can be assured. advice regarding analgesics must be provided. it is recommended to : - reassess the child within 24 h t...	guidelines
64e424d47dd3317a2b11cfafd15757bbf9c20c74	prophylactic antibiotics for urinary tract infections are no longer routinely recommended. a large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community \ - acquired urinary tract infections. the results of three recent significant st...	guidelines
64e424d47dd3317a2b11cfafd15757bbf9c20c74	. \ ] however, a cochrane meta \ - analysis of 12 studies that included children in varying age groups indicated that if the largest and best \ - designed studies ( montini et al, \ ] published in 2008, and the prevention of recurrent urinary tract infection in children with vesicoureteric reflux and normal renal trac...	guidelines
64e424d47dd3317a2b11cfafd15757bbf9c20c74	to follow \ - up did not have utis, antibiotics would have to be prescribed for one year for 17 children with uti with or without vur ( privent \ ] ) or for two years for nine children with vur ( rivur \ ] ) to prevent recurrent utis in one child. as expected, the montini et al and rivur trials described a much higher...	guidelines
64e424d47dd3317a2b11cfafd15757bbf9c20c74	gastrointestinal side effects. \ ] developing local resistance to the antibiotic prescribed was a common finding in studies in which this was assessed. \ ] \ ] \ ] the vast majority of children receiving uti prophylaxis do not benefit. there is no evidence that prophylaxis prevents renal scarring or other long \ - ter...	guidelines
64e424d47dd3317a2b11cfafd15757bbf9c20c74	to crush the pills and mix the powder with yogurt or apple sauce. there is insufficient evidence to recommend a specific dose ; however, traditionally, one \ - quarter to one \ - third of the daily total treatment dose is given once per day. there are no data on the efficacy of the practice of alternating prophylactic...	guidelines
64e424d47dd3317a2b11cfafd15757bbf9c20c74	- pathogens that are potentially resistant to usual prophylaxis, which further supports a ‘ watchful waiting ’ approach for otherwise healthy children with a first uti, even when they have vur. # cps infectious diseases and immunization committee ( 2015 \ ) members : robert bortolussi ( past chair ) ; natalie a bridge...	guidelines
64e424d47dd3317a2b11cfafd15757bbf9c20c74	3. finnell sm, carroll ae, downs sm ; subcommittee on urinary tract infection. technical report – diagnosis and management of an initial uti in febrile infants and young children. pediatrics 2011 ; 128 ( 3 \ ) : e749 \ - 70 \. 4. american academy of pediatrics, committee on quality improvement. subcommittee on urinary...	guidelines
64e424d47dd3317a2b11cfafd15757bbf9c20c74	with vesicoureteral reflux. n engl j med 2014 ; 370 ( 25 \ ) : 2367 \ - 76 \. 12. hari p, bagga a. antimicrobial prophylaxis for children with vesicoureteral reflux. n engl j med 2014 ; 371 ( 11 \ ) : 1071 \ - 2 \. 13. morello w, baskin e, jankauskiene a, et al. antibiotic prophylaxis in infants with grade iii, iv, or...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	bronchiolitis is the most common reason for admission to hospital in the first year of life. there is tremendous variation in the clinical management of this condition across canada and around the world, including significant use of unnecessary tests and ineffective therapies. this statement pertains to generally heal...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	care for bronchiolitis have demonstrated decreased use of diagnostic testing and resource utilization, along with cost reduction and improved outcomes. \ ] \ ] however, while there has been some decrease in testing and treatments since the release of the aap recommendations, \ ] uptake has not been widespread. bronchi...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	infants, and in no case did the results change acute management. \ ] while routine cxr is not supported by current evidence, it should be considered when the diagnosis of bronchiolitis is unclear, the rate of improvement is not as expected or the severity of disease raises other diagnostic possibilities such as bacter...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	have demonstrated predictive validity. respiratory rate, subcostal retractions and oxygen need may be the most helpful parameters used in the various bronchiolitis severity scores. \ ] repeated observations over a period of time are important because there may be significant temporal variability. consistent predictors...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	, may have an increased risk of aspiration and may not be safe to feed orally. \ ] when supplemental fluids are required, a recent randomized trial found nasogastric ( ng ) and intravenous ( iv ) routes to be equally effective, with no difference in length of hospital stay. \ ] ng insertion may require fewer attempts ...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	needed to assess the role of combination therapies. pending better definition of its risks and benefits, this combination is not recommended for the therapy of otherwise healthy children with bronchiolitis. therapies not recommended based on evidence # salbutamol ( ventolin ; glaxosmithkline, usa ) children with bronc...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	children. \ ] in patients with or at risk for particularly severe disease, antivirals could be considered, but this decision should be made on an individual basis in consultation with appropriate subspecialists. \ ] \ ] \ ] # 3 % hypertonic saline nebulization it has been hypothesized that hypertonic saline increases ...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	documentation of respiratory rate, work of breathing, oxygen saturation, findings on auscultation and general condition, including feeding and hydration status. scoring tools have been developed in an attempt to standardize assessments and facilitate communication among caregivers. however, there is insufficient evide...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	. readiness for discharge from hospital should be based on clinical judgement and consider the family ’ s ability to recognize and respond to signs of deterioration. in general, patients may be safely discharged from hospital once they are improving clinically and meet criteria listed in. the optimal management of bro...	guidelines
207637ef001801634120f889fd39bcbc31742ce6	high \ - risk children in the acute phase of illness, and intermittent monitoring or spot checks are appropriate for lower \ - risk children and patients who are improving clinically.	guidelines
59a15090d14ae52b1d9f52b2a8db0e7178e3a6b9	although immunization has decreased the incidence of bacterial pneumonia in vaccinated children, pneumonia remains common in healthy children. symptoms of bacterial pneumonia frequently overlap those present with viral infections or reactive airway disease. optimally, the diagnosis of bacterial pneumonia should be sup...	guidelines
59a15090d14ae52b1d9f52b2a8db0e7178e3a6b9	pus in the pleural space ), a lung abscess or a necrotic portion of lung parenchyma implies the development of a complicated pneumonia. the most common causes of pneumonia in infants and preschool children are viruses that usually, but not exclusively, circulate in winter ( eg, respiratory syncytial virus, influenza, ...	guidelines
59a15090d14ae52b1d9f52b2a8db0e7178e3a6b9	significant illness because hypoxemia may not be clinically apparent and cyanosis is only associated with severe hypoxemia. however, a normal oxygen saturation does not exclude the possibility of pneumonia. physical signs suggesting pneumonic consolidation include dullness to percussion, increased tactile fremitus, re...	guidelines
59a15090d14ae52b1d9f52b2a8db0e7178e3a6b9	##stitial infiltrates that appear to be more extensive relative to the milder but persistent symptoms. ultrasound at the point of care appears to be sensitive and specific for detecting pneumonic infiltrates but requires further validation. \ ] ultrasound and computed tomography are also useful in the diagnosis of com...	guidelines
59a15090d14ae52b1d9f52b2a8db0e7178e3a6b9	##neumococcal vaccine era. as adequate volumes of blood are more likely to yield a pathogen, the minimum volume of blood cultured should be at least 1 ml to 2 ml in infants, 4 ml to 5 ml in children \ < 10 years of age and 10 ml to 20 ml in older children. guidelines for referral to hospital or hospital admission most...	guidelines
59a15090d14ae52b1d9f52b2a8db0e7178e3a6b9	cephalosporin because it offers broader coverage. ceftriaxone or cefotaxime offer better coverage than amoxicillin or ampicillin for beta \ - lactamase \ - producing * h influenzae * and may be more efficacious against high \ - level penicillin \ - resistant pneumococcus – and possibly provide empirical coverage for t...	guidelines
59a15090d14ae52b1d9f52b2a8db0e7178e3a6b9	very common in * m pneumoniae * in asia and sometimes occurs in canada. \ ] \ ] in children ≥8 years of age ( minimum ), doxycycline is likely to be effective against such strains. if patients with suspected bacterial pneumonia do not respond to therapy within 48 h to 72 h, a chest radiograph should be obtained and a ...	guidelines
59a15090d14ae52b1d9f52b2a8db0e7178e3a6b9	##edema, hypotension or bronchospasm following the dose of penicillin, the patient should be observed for 30 min following the first dose of cephalosporin in a setting where epinephrine is available. \ ] clarithromycin or azithromycin may also be used, but pneumococcal resistance to these antimicrobials is increasingl...	guidelines
5e22440400f739ca233aa160ce99182c79e9117a	preterm infants younger than 37 weeks corrected gestational age are at increased risk for abnormal control of respiration. the infant car seat challenge has been used as a screening tool to ensure cardiorespiratory stability before discharging preterm infants from many hospitals in canada. while it is clear that infan...	guidelines
5e22440400f739ca233aa160ce99182c79e9117a	“ neonate ”. all articles were limited to the english language, with no date limit being set. the hierarchy of evidence from the centre for evidence \ - based medicine was applied to the publications identified ( ). recommendations are based on the format by shekelle et al ( ). # what is the historical basis for perfo...	guidelines
5e22440400f739ca233aa160ce99182c79e9117a	position. later studies examining both preterm and term infants clearly demonstrated that the former population are at much higher risk for oxygen desaturation and / or bradycardic events when they are placed in a semi \ - upright position. this finding cannot be explained by deterioration in pulmonary function. wille...	guidelines
5e22440400f739ca233aa160ce99182c79e9117a	hypoxemia experienced in car seats. one 2004 study reviewed the evidence from 55 eligible articles linking adverse neurodevelopmental outcome with chronic or intermittent hypoxia. the vast majority of articles ( 76 \. 4 % ) pertained to children who had either congenital heart disease or sleep \ - disordered breathing...	guidelines
5e22440400f739ca233aa160ce99182c79e9117a	at higher risk of apnea and oxygen desaturation when placed in a car seat, another larger study indicated that late preterm infants ( 340 / 7 weeks ’ ga to 366 / 7 weeks ’ ga ) are at highest risk. davis et al retrospectively reviewed icsc results from 1173 preterm infants and identified a failure rate of 4 \. 3 %. in...	guidelines
5e22440400f739ca233aa160ce99182c79e9117a	even with cardiac and saturation monitoring, for detecting cardiorespiratory events. schutzman et al described a cohort of 785 infants studied with the icsc and psg. out of 313 infants who had both tests, 157 who passed the icsc failed the psg, for a discordance rate of 56 \. 6 %. given that more formal testing appear...	guidelines
5e22440400f739ca233aa160ce99182c79e9117a	initial pass. finally, the icsc is not as accurate as polysomnography for identifying episodes of oxygen desaturation, apnea or bradycardia. clinicians cannot feel confident that an infant ’ s ‘ passing ’ an icsc test indicates safety for discharge. - the canadian paediatric society does not recommend routine icsc tes...	guidelines
73504a8583829efcf1c74a059840730472f19493	suicide is a leading cause of death among canadian adolescents. the present practice point provides paediatricians and child health professionals with a framework for assessing the adolescent with suicidal thoughts and / or behaviours. the epidemiological context, general considerations and practical suggestions for h...	guidelines
73504a8583829efcf1c74a059840730472f19493	of the limits to confidentiality as early in the assessment as possible. although protection of the right to privacy is important, confidentiality is not absolute. clinicians must use their judgement to determine whether the level of risk to the adolescent ’ s life warrants the breach of the adolescent ’ s confidentia...	guidelines
73504a8583829efcf1c74a059840730472f19493	history of impulsive behaviour ( eg, physical aggression, risk \ - taking behaviours ). # # precipitating factors it is important to understand the factors that precipitated the suicidal thoughts or attempt to be able to address these stressors, or the adolescent ’ s reaction to them, directly. stressors leading to fe...	guidelines
73504a8583829efcf1c74a059840730472f19493	##active substances, which may affect the mental status examination. 1 \ ) there are several aspects of suicidality for health providers to consider when interviewing the adolescent : clinicians should ask about the frequency, intensity and quality of the suicidal thoughts that the adolescent has experienced, recogniz...	guidelines
73504a8583829efcf1c74a059840730472f19493	to end your life? ” - “ how close have you come to for an identified plan, paediatricians should determine whether the adolescent has access to the means necessary ( eg, firearms, medications ) to carry out his / her plan. 2 \ ) when taking a history about the suicide attempt, the clinician should determine : - the me...	guidelines
73504a8583829efcf1c74a059840730472f19493	should not replace clinical assessment. any child or adolescent scoring high on a suicide scale should receive clinical evaluation. suicide is a leading and preventable cause of death among canadian children. adolescents who have attempted suicide are a high \ - risk group who require assessment of their mental state ...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	reducing blood loss and the need for blood transfusions in extremely preterm infants is part of effective care. delayed cord clamping is well supported by the evidence and is recommended for infants who do not immediately require resuscitation. cord milking may be an alternative to delayed cord clamping ; however, mor...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	is to summarize evidence \ - based strategies to reduce blood sampling and blood transfusions in very preterm infants. a comprehensive search of the literature was performed by an expert librarian using medline, including in process and other nonindexed citations ( 1946 to august 31, 2014 \ ), embase ( 1947 to august ...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	in the need for blood transfusion in infants born \ < 30 weeks ga ( 57 % versus 79 % ), as compared with historical controls. no benefit to cord milking was observed in a study involving 44 infants by allan et al, or in a second study involving 58 infants by rabe et al. none of these studies reported harm or higher ra...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	transfusions? a randomized controlled trial ( rct ) involving 20 infants weighing \ < 1500 g by wong et al found that receiving 20 ml / kg versus 15 ml / kg of prbc did not effect the need for further transfusion. however, methodological limitations prevent drawing any firm conclusions regarding efficacy. paul et al o...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	higher risk for severe rop was observed in the early group ( rr 1 \. 40 \ ; nnh \ = 6 \ ) ( level of evidence : 1a ). in an rct conducted by gumy \ - pause et al, a progressive increase in the dose of erythropoietin based on the absolute reticulocyte count did not prove more effective than a fixed dose. also, a small ...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	after 14 days. however, many had been transfused by the time they were seven days of age. taylor et al randomly assigned 153 infants weighing \ < 1500 g who received supplemental iron ( 2 mg / kg / day ) above and beyond iron \ - fortified formula or expressed breast milk when their feeds had reached 120 ml / kg / day...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	0 \. 82 \ ). in infants with significant pulmonary disease, the end \ - tidal co2 partial pressure of co2 may be quite discrepant due to large dead space volumes. no evidence of poorer accuracy in the monitoring devices was found for vlbw infants ( level of evidence : 3b ). in one systematic review ( 22 trials, 1628 i...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	##bin ) had been introduced in the nicu, despite steady numbers for the tests being performed. madan et al ( n \ = 80 \ ) also found a decrease in the number of transfusions and phlebotomy losses per infant. point \ - of \ - care testing should be considered in preterm infants. this strategy requires support from the ...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	arterial sampling requires skill and experience. capillary sampling requires less skill. however, no literature was available to determine whether one technique was superior to another in terms of minimizing blood loss or the need to repeat testing because of sampling difficulties. # is there evidence to support limit...	guidelines
f47d6aa0e0978ccdbe75c6db4d924c26eb78f837	##age and delivery method should be individualized if parents withhold consent to transfuse blood ( grade a recommendation ). - supplemental iron does not appear to reduce the need for blood transfusion in preterm neonates. for treatment beyond two months of age, however, iron supplements may improve hematological val...	guidelines
1d976779d99b0c0f533af328a8eeeee4c4c739d2	retinopathy of prematurity is a proliferative disorder of the developing retinal blood vessels in preterm infants. the present practice point reviews new information regarding screening and management for retinopathy of prematurity, including the role of risk factors in screening, optimal scheduling for screening exam...	guidelines
1d976779d99b0c0f533af328a8eeeee4c4c739d2	were screened, as recommended by the royal college of paediatrics and child health, and the royal college of ophthalmologists, united kingdom, the likelihood of an unscreened infant developing advanced rop that requires treatment would be extremely low. the 2013 aap policy statement differed somewhat, recommending scr...	guidelines
1d976779d99b0c0f533af328a8eeeee4c4c739d2	a birth weight ≤1250 g and more mature infants believed to be at high risk for rop, has a very small likelihood of an unscreened baby having treatable rop. # # when to screen the scheduling of rop screening examinations should ensure that eyes likely to need treatment are identified in a timely manner while, at the sa...	guidelines
1d976779d99b0c0f533af328a8eeeee4c4c739d2	that can be transmitted electronically, improves availability of screening in the community, a practice that is family \ - centred and may be cost efficient. a recent report concluded that digital retinal photography has high accuracy for detection of clinically significant rop. the sensitivity for detection of mild r...	guidelines
1d976779d99b0c0f533af328a8eeeee4c4c739d2	outcome even with therapy. when infants are transferred from one unit to another, arrangements must be made by the neonatal team for appropriate ophthalmological follow \ - up at the receiving centre. results of rop screening and the plan for ongoing screening must be accurately communicated to receiving health care p...	guidelines

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