Developmental milestones among Aboriginal children in Canada

BACKGROUND:

Windows of achievement provide age ranges for the attainment of early developmental skills. Group-specific research is warranted given that development may be influenced by social or cultural factors.

OBJECTIVES:

To examine developmental milestones for Inuit, Métis and off-reserve First Nation children in Canada, based on developmental domains collected from the 2006 Aboriginal Children’s Survey. Sociodemographic and health predictors of risk for developmental delay were also examined.

RESULTS:

The ranges in which children achieve certain developmental milestones are presented. Gross motor and self-help skills were found to be achieved earlier (across the three Aboriginal groups), whereas language skills were achieved slightly later than in Canadian children in general. Furthermore, health factors (eg, low birth weight, chronic health conditions) were associated with late achievement of developmental outcomes even when sociodemographic characteristics were considered.

CONCLUSIONS:

Findings suggest that the timing of milestone achievement may differ for Aboriginal children, highlighting the importance of establishing culturally specific norms and standards rather than relying on those derived from general populations. This information may be useful for practitioners and parents interested in identifying the age ranges for development, as well as age ranges indicating potential for developmental risk and opportunities for early intervention among Aboriginal children.     

Respiratory infections in schoolchildren: co-morbidity and risk factors

Aims

To assess co‐morbidity and risk factors for otitis media, tonsillopharyngitis, and lower respiratory infections in school children.

Methods

Logistic regression analysis of co‐morbidity and risk factors for airway infections in a population based sample of 10 year old children living in Oslo, Norway. Main outcome measures: otitis media, tonsillopharyngitis, and lower respiratory infections in past 12 months.

Results

Airway infections in 10 year old children were common, and significant co‐morbidity was found between the various airway infections. Home dampness was a risk factor for all infections, adjusted odds ratios ranging from 1.2 (95% CI 1.0 to 1.5) to 1.4 (95% CI 1.1 to 1.6) for otitis media and tonsillopharyngitis respectively. Atopic disease was a constitutional risk factor, particularly strong for lower airway infections (adjusted odds ratio 2.4, 95% CI 1.8 to 3.1). African or Asian ethnicities were associated with the airway infections, adjusted odds ratios ranging from 1.2 (95% CI 0.9 to 1.7) to 1.7 (95% CI 1.2 to 2.3).

Conclusions

Respiratory tract infections were common in 10 year old children. There was substantial co‐morbidity between upper and lower airway infections. Environmental and constitutional factors were identified and positively associated with the infections. Results support the hypothesis of 1957 that the whole respiratory tract is one unit.     

The relationship between childhood behaviour disorders and unintentional injury events

OBJECTIVE

To examine the controversy regarding the existence of a relationship between behavioural disorders and unintentional injuries in children.

DESIGN

A retrospective cohort analysis of children between six and 19 years of age, who were diagnosed with attention deficit hyperactivity disorder (ADHD) only (n=955), ADHD plus conduct problems (CP) (n=160), or CP only (n=234), were compared with a nondisorder group of children (n=21,308) for unintentional injury events resulting in a physician office or emergency room visit, or hospitalization.

RESULTS

The risk of an injury event was greater among children with a behaviour disorder diagnosis and severity of injury varied among the behaviour disorder groups. Children with ADHD were the only disorder group at increased risk for all three injury outcomes. Children with a comorbid diagnosis were at a greater risk for both minor and more serious emergency injury visits, and children with CP only were at greatest risk for the most serious injuries (hospital admission).

CONCLUSIONS

These findings provide further support that children with ADHD are at an increased risk for not only hospitalized injury events but also minor injury events. In addition, these findings provide evidence that serious injuries are more likely to be experienced by children with CP.     

Does parental body mass index status modify the associations among birth weight,early growth and childhood adiposity?

OBJECTIVES:

To examine the associations among birth weight, infant growth and childhood adiposity, and to test whether parental weight status modifies these associations.

METHODS:

The sample was comprised of 423 participants born at term who were an appropriate size for their gestational age from the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) study, a cohort of 630 children with a parental history of obesity. Infant growth velocity from zero to two years of age was estimated using slopes from simple linear regression for weight and body mass index (BMI) Z-scores. Child anthropometrics and body composition, and parental BMI were measured from eight to 10 years of age. Associations were modelled using multiple linear regressions.

RESULTS:

Increased birth weight and growth velocity independently predicted increased childhood adiposity. Effects of infant growth velocity on later adiposity were stronger with higher maternal BMI but not with higher paternal BMI. Similar interactions with birth weight were not found.

CONCLUSIONS:

Early childhood measures of growth and the mother’s BMI score should be included in investigations on obesity risk.     

The impact of an oral rehydration clinical pathway in a paediatric emergency department

OBJECTIVE:

To measure the impact of implementing an oral rehydration clinical pathway for children with mild to moderate dehydration from gastroenteritis in the paediatric emergency department (ED) on the indicators of health care utilization.

METHODS:

ED charts of children, six months to 17 years of age, meeting the criteria for the oral rehydration clinical pathway were reviewed. There were three 12-month periods of data collection: pre-implementation, transition and postimplementation. The clinical pathway consisted of a standard nursing assessment form and instructions on oral rehydration to be initiated and maintained by caregivers while waiting to see a physician. The primary outcome measure was ED length of visit (LOV) for children treated using the clinical pathway. This was compared with LOV for all other ED visits during the study periods to highlight the effect of the clinical pathway implementation. Secondary outcome measures included rate of intravenous rehydration, unscheduled return visits to the ED and hospital admission.

RESULTS:

During the three data collection periods, 11,816 children met the eligibility criteria. A decrease in the mean LOV of 24 min (95% CI 17 to 31) was observed, as well as a trivial decrease in the rate of intravenous rehydration therapy (14.6% to 12%) with implementation of the clinical pathway.

CONCLUSION:

The implementation of an oral rehydration clinical pathway in the ED led to a modest reduction in the ED LOV.     

Fetal growth restriction: relation to growth and obesity at the age of 9 years

Objective

To assess growth patterns of 9‐year‐old children, some of whom had intrauterine growth restriction (IUGR).

Method

75 9‐year‐old children (41 were IUGR infants) were weighed and measured at birth, at 1 year, at 2 years and at 9 years of age. Using general linear models for continuous data, changes in weight z scores were used to quantify growth rate between birth and 9 years of age.

Results

IUGR children were smaller at birth (weight z score –2.1 v 0.2 in normal children; p<0.001) but showed a greater increase in their weight between birth and 9 years (change of weight z score 1.5 v 0.4 in normal children; p = 0.001). At the age of 9 years the weight, height and body mass index (BMI) z scores were lower in IUGR children than the control children (weight z score –0.4 v 0.6, respectively; p<0.001, height z score –0.5 v 0, respectively; p = 0.002, BMI z score −0.2 v 0.7, respectively; p = 0.002). The predictors of these differences were IUGR, birth weight and maternal and paternal heights.

Conclusion

IUGR infants grow faster but remain shorter and lighter than their normal counterparts—that is, they fail to fully catch up by 9 years of age.     

Are wait times and length of stay in Alberta emergency departments for children’s mental health meeting national benchmarks? Trends from 2002 to 2008

OBJECTIVE:

To describe wait times, treatment times and length of stay (LOS) for pediatric mental health visits to emergency departments (EDs).

METHODS:

The present study was a retrospective cohort analysis of mental health visits (n=30,656) made by children <18 years of age between April 2002 and March 2008 to EDs in Alberta using administrative data. Wait time (time from triage to physician assessment), treatment time (time from physician assessment to end of visit) and LOS (time from start to end of visit) were examined for each visit. Wait time and treatment time data were available for 2006 to 2008, and LOS data were available for all study years. Wait times and LOS were compared with national benchmarks for the Canadian Triage and Acuity Scale (CTAS; levels 1 [resuscitative] through 5 [nonurgent]). All times are presented in h and min.

RESULTS:

Median wait times for visits triaged as CTAS 1, 2, 3 and 4 exceeded national recommendations. The longest wait times were for visits triaged as urgent (CTAS 3; 1 h 46 min) and less urgent (CTAS 4; 1 h 45 min). Lower-acuity visits had wait times that exceeded treatment times (CTAS 4: 1 h 45 min versus 1 h 8 min; CTAS 5: 1 h 5 min versus 52 min). Across all CTAS levels, the LOS in the ED increased during the study period, but met national benchmarks.

CONCLUSIONS:

Most median ED wait times for pediatric mental health visits exceeded national recommendations, while the median LOS for all visits met recommendations. Lower-acuity visits had wait times that exceeded treatment times. Future research should explore whether longer wait times are associated with adverse outcomes, and whether current wait/treatment times are warranted to ensure that ED throughput is optimized.     

Paediatricians’ awareness of children’s oral health: Knowledge,training, attitudes and practices among Turkish paediatricians

BACKGROUND:

In Turkey, 74.1% of children between three and six years of age develop dental caries.

OBJECTIVE:

To assess the depth of oral health and dental knowledge among paediatricians in Turkey, to determine their level of oral health education and to determine factors that were associated with higher knowledge scores.

METHODS:

A cross-sectional survey of demographics that assessed the participants’ knowledge of oral and dental health, attitudes regarding oral health during well-child visits and opinions regarding infant oral health care visits was conducted. The outcome variables were the proportions of paediatricians who adhered to good clinical practice guidelines, recommended dental visits for children younger than one year of age, and having a knowledge score >50%.

RESULTS:

The participant characteristics that were significantly associated with a greater mean number of correct answers were female sex, good clinical practice, confidence in detecting dental caries and the presence of a dentistry department in their hospital (P=0.001, P<0.001, P<0.001 and P=0.02, respectively). Only 13.9% of paediatricians referred children younger than one year of age to a dentist. After adjusting for the level of oral health education received during residency training, sex and having children, only the knowledge score was significantly associated with referring patients younger than one year of age to a dentist (P=0.01).

CONCLUSIONS:

Some paediatricians’ knowledge was found to be associated with practices that were in accordance with professional society recommendations. The lack of dental knowledge and training in residency limits the paediatricians’ role in promoting children’s oral health in daily practice.     

High prevalence of vitamin D deficiency in newborn infants of high-risk mothers

Objective

To determine the prevalence of vitamin D deficiency in newborn infants of mothers at risk of vitamin D deficiency because of dark skin or the wearing of concealing clothes (such as a veil) compared with a group presumed not to be at risk. A second aim was to correlate these newborn infants'' vitamin D concentrations with biochemical parameters of vitamin D metabolism and bone turnover at birth.

Design

A prospective study conducted between April 2004 and February 2006 including women delivering during this period and their newborn infants.

Setting

The outpatient clinic of the obstetrics department, Sint Franciscus Gasthuis, Rotterdam, the Netherlands.

Patients

Eighty seven newborn infants of healthy mothers with either dark skin and/or concealing clothing (risk group) or light skin (control group).

Results

We found a significant difference in the prevalence of vitamin D deficiency (25‐hydroxyvitamin D₃ <25 nmol/l) between newborn infants of mothers at risk and those of mothers in the control group (63.3% vs 15.8%; p<0.001). Mean alkaline phosphatase concentrations were significantly higher in the at risk group.

Conclusions

Newborn infants of mothers with dark skin or wearing concealing clothes are at great risk of vitamin D deficiency at birth. The clinical implications are unknown. Further research is necessary to determine the long‐term consequences of maternal and neonatal vitamin D deficiency so that guidelines on vitamin D supplementation during pregnancy can be issued.     

Congenital tracheoesophageal fistula and coordination of care: Expectations and realities

BACKGROUND

Tracheoesophageal fistula (TEF) is a rare congenital anomaly with chronic morbidities. Aside from health care costs, the authors suspected that additional burden rests on the family due to hospitalizations, radiological and surgical procedures, and frequent outpatient visits. It was speculated that this complex care is poorly coordinated. The objective of the present study was to document utilization and coordination of health care services for children with TEF at the Alberta Children’s Hospital (Calgary, Alberta).

METHODS

Medical records of children with TEF (primary surgical repair at Alberta Children’s Hospital between April 1994 and September 1999) were reviewed for demographics, TEF type, associated anomalies, age at diagnosis and repair, health services utilization data, and radiological and surgical procedures.

RESULTS

Twenty-two children were identified, of whom 18 survived beyond one year. Ten of these 18 children were male. Average gestational age and birth weight were 37.4 weeks (range 32 to 42 weeks) and 2512 g (range 780 g to 3950 g), respectively. Seventy-eight per cent of children had at least one associated anomaly. Median initial hospital and intensive care unit stays were 27.5 days and 12 days, respectively. During year 1 of life, there was a median of 31 radiological examinations, five surgical procedures, 2.5 hospital admissions and five outpatient clinic visits. Coordination of procedures and outpatient visits was poor. In year 2 of life, children had fewer procedures, admissions and outpatient visits; between years 2 and 5, procedures or admissions were rare.

CONCLUSIONS

Children with TEF endure multiple procedures and lengthy hospital admissions in early life. There was easy access to, but minimal coordination of, subspecialist care, procedures and admissions. A dedicated multidisciplinary clinic for children with TEF should improve care.     

Disparity in childhood immunizations

BACKGROUND

Incomplete immunization coverage is common in low-income families and Aboriginal children in Canada.

OBJECTIVE

To determine whether child immunization coverage rates at two years of age were lower in low-income neighbourhoods of Saskatoon, Saskatchewan.

METHODS

Parents who were and were not behind in child immunization coverage were contacted to determine differences in knowledge, beliefs and opinions on barriers and solutions. A multivariate regression model was designed to determine whether Aboriginal cultural status was associated with being behind in childhood immunizations after controlling for low-income status.

RESULTS

Reviewing the past five years in Saskatoon, the six low-income neighbourhoods had complete child immunization coverage rates of 43.7% (95% CI 41.2 to 45.9) for measles-mumps-rubella, and 42.6% (95% CI 40.1 to 45.1) for diphtheria, pertussis, tetanus, polio and Haemophilus influenzae type B. The five affluent neighbourhoods had 90.6% (95% CI 88.9 to 92.3) immunization coverage rates for measles-mumps-rubella, and 78.6% (95% CI 76.2 to 81.0) for diphtheria, pertussis, tetanus, polio and H influenzae type B. Parents who were behind in immunization coverage for their children were more likely to be single, of Aboriginal or other (non-Caucasian or non-Aboriginal) cultural status, have lower family income and have significant differences in reported beliefs, barriers and potential solutions. In the final regression model, Aboriginal cultural status was no longer associated with lower immunization status.

INTERPRETATION

Child immunization coverage rates in Saskatoon’s six low-income neighbourhoods were approximately one-half the rate of the affluent neighbourhoods. The covariates with the strongest independent association with complete childhood immunization status were low income and other cultural status. Aboriginal cultural status was not associated with low child immunization rates after controlling for income status.     

Cognitive and motor function of neurologically impaired extremely low birth weight children

BACKGROUND:

Rates of neurological impairment among extremely low birth weight children (ELBW [<1 kg]) have decreased since 2000; however, their functioning is unexamined.

OBJECTIVE:

To compare motor and cognitive functioning of ELBW children with neurological impairment, including cerebral palsy and severe hypotonia/hypertonia, between two periods: 1990 to 1999 (n=83) and 2000 to 2005 (n=34).

METHODS:

Measures of function at 20 months corrected age included the Mental and Psychomotor Developmental Indexes of the Bayley Scales of Infant Development and the Gross Motor Functional Classification System as primary outcomes and individual motor function items as secondary outcomes.

RESULTS:

Analysis failed to reveal significant differences for the primary outcomes, although during 2000 to 2005, sitting significantly improved in children with neurological impairment (P=0.003).

CONCLUSION:

Decreases in rates of neurological impairment among ELBW children have been accompanied by a suggestion of improved motor function, although cognitive function has not changed.     

Cardiovascular risk factors and health behaviours in elementary school-age Inuvialuit and Gwich’in children

OBJECTIVES:

To determine cardiovascular risk factors and health behaviours in Aboriginal children from the Beaufort-Delta region (Northwest Territories).

METHODS:

A total of 91 elementary school-age children underwent a cross-sectional assessment of body mass index, waist circumference, blood pressure and aerobic fitness. Healthy living knowledge and behaviours, including frequency of self-reported physical activity (PA) and dietary intake, were also evaluated.

RESULTS:

A total of 49.5% of children were obese/overweight and 31.9% had elevated blood pressure. The percentages having one, two or three cardiovascular risk factor(s) were 64.4%, 42.2% and 15.6%, respectively, with no significant difference between boys and girls. Overall, the students obtained higher mean scores in the areas of healthy PA, body image, self-esteem and nutritious beverage knowledge (89%, 85%, 79% and 71% of the maximum scores, respectively). The lowest scores were in nutritious food consumption and healthy PA frequency (46% and 56% of the maximum scores, respectively). On average, children consumed 2.7 L of sugar-sweetened beverages weekly and <2 servings of fruits or vegetables daily. Children spent approximately 2 h per day watching television, playing games or using a computer.

CONCLUSION:

There is an urgent need for community-based approaches to address the high rates of obesity and related cardiovascular risk factors among these Aboriginal children. Given the disconnect between healthy living knowledge and behaviour, it is important that future treatment programs address other barriers faced by Aboriginal populations living in rural and remote regions, including the high cost and limited access to high-quality nutritious foods and beverages, and limited access to indoor recreational programs over the long winter season.     

Do symptoms and initial clinical probability predict the radiological diagnosis of acute sinusitis in children?

OBJECTIVE:

To evaluate the value of signs and symptoms in children for the radiological diagnosis of acute sinusitis.

DESIGN:

Prospective cohort study.

SETTING:

University-affiliated tertiary care hospital.

PATIENTS:

All children presenting with symptoms suggestive of acute sinusitis for whom sinus radiographs were ordered.

METHODS:

Data were collected on the presence of specific symptoms and the initial probability of sinusitis. Criterion-based radiological diagnoses were made.

RESULTS:

Three hundred ninety-two consecutive children were seen; 257 children had a radiological diagnosis of acute sinusitis (66%), 128 patients (33%) presented with complete opacity of at least one sinus and 14 (4%) children had an air-fluid level. Sensitivity, specificity, predictive values and likelihood ratios were measured for clinical findings. Classical symptoms (rhinorrhea lasting more than 10 days and purulent rhinorrhea) increased the likelihood ratios the most (1.3 and 1.34, respectively). Logistic regression showed two independent predictors: purulent rhinorrhea (odds ratio 2.0) and the presence of acute otitis media (odds ratio 2.6). The initial clinical probability was more accurate than any other single finding: high probability (likelihood ratio 2.0), intermediate probability (likelihood ratio 1.1) and low probability (likelihood ratio 0.6).

CONCLUSION:

Classical symptoms are predictive of the presence of acute sinusitis as diagnosed on sinus radiographs. The physician’s overall clinical impression, expressed as an initial probability, was superior to any single historical or examination finding in the diagnosis of acute sinusitis.     

Cytomegalovirus as an occupational risk in daycare educators

BACKGROUND

Cytomegalovirus (CMV) infection continues to be an important occupational risk in the daycare setting. A comprehensive update of scientific evidence is timely to inform and promote appropriate preventive measures.

METHODS

A review of the literature was conducted to examine the evidence for an occupational risk of CMV infection in daycare educators. Sources included Medline, government documents and additional references from published bibliographies. The key words used for searches were ‘child day care centres’ or ‘nurseries’ and ‘cytomegalovirus’ or ‘cytomegalovirus infection’.

RESULTS

Eight CMV seroprevalence studies on daycare educators in industrialized countries were found: four in the United States, three in Canada and one in Italy. Risk factors for seropositivity were older age, nonwhite race, foreign birth, birth in a low- or middle-income country, diaper changing, having children at home, and a child to educator ratio greater than 6:1 in children 18 to 35 months of age. Risk factors for seroconversion were younger age and working with young children. These studies suggest that daycare centres may be a high-risk setting for CMV infection.

DISCUSSION

Recommendations to prevent CMV infection in this setting include handwashing, selective serological screening, avoiding work with younger children if pregnant and, in some cases, preventive leave from work. Evaluation and expert opinion of the effectiveness of various preventive options for CMV acquisition are needed to ensure that recommendations are evidence-based.     

A meta-analysis of the effect of high weight on asthma

Background

Prevalence rates for both overweight and asthma have been increasing among children in developed countries over the past two decades. Some recent studies have postulated a causal relation between these but have lacked power to form a definitive conclusion.

Aim

To estimate the effect of high body weight in childhood on the future risk of asthma.

Methods

Medline search (1966 to October 2004), supplemented by manual search of reference lists and grey literature. Cohort studies that examined high body weight at birth or during childhood and future outcome of asthma were included. Data from each study were extracted on exposure status, clinical outcome, and study characteristics.

Results

A total of 402 studies were initially identified, of which 12 met the inclusion criteria. The combined results from four studies that examined the effect of high body weight during middle childhood on the outcome of subsequent asthma showed a 50% increase in relative risk (RR 1.5, 95% CI 1.2 to 1.8). The combined results from nine studies that examined the effect of high birth weight on subsequent asthma had a pooled RR of 1.2 (95% CI 1.1 to 1.3). There was consistency among the results in sensitivity analyses examining studies containing only estimates of odds ratios, studies containing only the outcome of physician diagnosis of asthma, and studies including all definitions of high body weight.

Conclusions

Children with high body weight, either at birth or later in childhood, are at increased risk for future asthma. Potential biological mechanisms include diet, gastro‐oesophageal reflux, mechanical effects of obesity, atopy, and hormonal influences. Further research might elucidate the causal pathway, which could improve our understanding of the pathophysiology of asthma and perhaps lead to knowledge of potential preventive interventions.     

Doctor shopping before and after a visit to a paediatric emergency department

BACKGROUND:

Use of multiple care providers is known to be associated with poor continuity of care.

OBJECTIVES:

To estimate the prevalence of and identify risk factors for doctor shopping by parents of children with common acute illnesses seen in the emergency department (ED) of a children’s hospital.

SETTING:

ED at the Montreal Children’s Hospital (MCH), Montreal, Quebec.

METHODS:

Doctor shopping was defined as visiting three or more different care sites (the MCH ED, other EDs, outpatient clinics or private offices) for a single illness episode, including all visits occurring within successive 72 h periods up to a maximum of 15 days before and after an ED visit from April 1995 to March 1996. Logistic regression was used to compare characteristics of illness episodes with doctor shopping versus those without.

RESULTS:

Of the total 40,150 visits during the study period, doctor shopping was observed in 18% of the visits. The risk of doctor shopping was positively associated with an initial visit at other EDs (odds ratio [OR] 9.08, 95% CI 7.16 to 11.52), outpatient clinics (OR 4.47, 95% CI 3.71 to 5.37) or private offices (OR 1.71, 95% CI 1.48 to 1.96) versus those who visited the MCH ED first. The risk did not differ according to whether a paediatrician versus a general practitioner saw the child during the initial visit (OR 0.99, 95% CI 0.86 to 1.15). Some diagnoses (the reference category was upper respiratory infection), including urinary tract infection (OR 3.31, 95% CI 2.58 to 4.23) and gastroenteritis (OR 1.59, 95% CI 1.35 to 1.88), were associated with an increased risk of doctor shopping, while asthma was associated with a reduced risk (OR 0.71, 95% CI 0.60 to 0.86).

CONCLUSION:

Doctor shopping is common among parents of children with acute illnesses. Parents of children who were seen in the MCH ED first were less likely to doctor shop, perhaps because the parents were more confident about the advice and treatment received. Further research should investigate the underlying reasons for doctor shopping, eg, services other than an ED were not available and parents’ perceptions of the quality of health services.     

The Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of neonatal group B streptococcal infections in Canada

OBJECTIVES:

To determine the presentation and medical outcomes of neonatal group B streptococcus (GBS) disease in Canada, and describe maternal and obstetrical risk factors.

DESIGN:

Retrospective review of health records and laboratory databases using standardized data collection forms.

SETTING:

All neonates diagnosed with GBS infections in 1992 at 13 Canadian paediatric centres.

RESULTS:

A total of 105 infants meeting the criteria for neonatal GBS disease were identified. The majority of cases (78 or 74.3%) had early-onset disease (EOD); 78.9% (60 of 76) of these cases presented within 24 h of delivery. Rates of EOD (less than seven days) varied from 0.44/1000 live births to 2.1/1000 live births, with an overall rate of 1.2/1000 live births. Pneumonia was the most common clinical illness (43.8%), followed by bacteremia without focus (23.8%) and meningitis (16.2%). At least one maternal risk factor for neonatal GBS disease was noted in 46 of 78 (59%) infants with EOD. A median of one dose (range one to 23 doses) of intrapartum antibiotics was given in 18 of 75 (24%) of the pregnancies. Overall, the mean gestational age at birth was 36.2±4.7 weeks, with 38 of 96 (39.6%) infants having a gestational age at birth younger than 37 weeks (31 of 73 [42.5%] EOD cases were born with a gestational age younger than 37 weeks). The median birth weight was 3099 g (range 610 g to 4830 g). Thirty of 94 (31.9%) infants had a birth weight less than 2500 g. Seventeen (16.2%) infants died.

CONCLUSIONS:

In 1992, neonatal GBS disease was a significant cause of morbidity and mortality in Canadian infants. More than half of the cases identified in this study could have been potentially preventable by the use of intrapartum antibiotics for women with known risk factors. There is a need for prospective studies to better define risk factors and preventative measures for neonatal GBS infections in Canada.