The Canadian Paediatric Surveillance Program: a framework for the timely data collection on head injury secondary to suspected child maltreatment.

The extent and nature of head injury secondary to child maltreatment in Canada is inadequately understood. These cases, although reasonably rare, are of great clinical importance as a large proportion of them result in death or permanent neurologic deficits. Internationally, published incidence data may underestimate the extent of the problem because of the failure of professionals to recognize and report inflicted head injury. National data on head injury secondary to suspected child maltreatment can inform educational efforts for early detection, guide prevention strategies, and be a foundation for the development of policies and programs to effectively address the needs of victims and their families. The Canadian Paediatric Surveillance Program is described as a system for active surveillance of uncommon high-impact conditions and is ideally suited to the collection of data on head injury secondary to child maltreatment.

Canadian Paediatric Surveillance Program confirms low incidence of hemorrhagic disease of the newborn in Canada.

OBJECTIVES: To determine the incidence of hemorrhagic disease of the newborn (HDNB) in Canada and its relationship to the administration of vitamin K(1) (hereafter referred to as vitamin K) following birth. METHODS: The Canadian Paediatric Surveillance Program sent monthly surveys to over 2100 Canadian paediatricians requesting identification of infants with defined criteria for HDNB. Reports were confirmed with subsequent case-specific data, including coagulation test results. RESULTS: Of the 26 reports (10 in 1997, eight in 1998, four in 1999, four in 2000), two were from before the start of the study, three were duplicate reports, four cases erroneously identified hemolytic disease of the newborn, three had coagulation studies which were normal or not done, and seven had other disorders with bleeding. Of the six confirmed cases of infants with HDNB (one classic, five late), all had intracranial bleeding and five suffered neurological sequelae. The estimated incidence of HDNB in Canada (including infants who had oral vitamin K prophylaxis or did not receive vitamin K) is approximately 0.45/100,000. CONCLUSION: This study confirmed the relatively low incidence of HDNB in Canada and validated the Canadian Paediatric Society's recommendation that all newborns should be given intramuscular vitamin K shortly following birth. To alleviate confusion with haemolytic disease of the newborn, Britain and Australia modified the title of their subsequent HDNB study to vitamin K deficiency bleeding.