Background-Surgical interventions are common in infants admitted to the neonatal intensive care unit (NICU). Despite our awareness of the broad impact of surgical site infection (SSI), there is little data in neonates. Our objective was to determine the rate and clinical impact of SSI in infants admitted to the NICU.

Referral of patients to a pediatric emergency department (PED) should be medically justified and the need for referral well communicated. The objectives of this paper were (1) to create a list of criteria for referral from the community to the PED, (2) to describe how community physicians categorize their need for referral, and (3) to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%), “Suspected life- or organ-threatening infection” (16.4%), and “Need for hospitalization” (15.7%). Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.

Background: Testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency is traditionally restricted to jaundiced neonates, as well as to those whose risk factors provide sufficient grounds to suspect the deficiency. We assumed that in a multi-ethnic, multicultural society, routine neonatal screening for G6PD deficiency would detect more affected neonates. Methods: An observational, population-based, cohort study was designed to compare the incidence of G6PD deficiency between two groups of neonates using a validated qualitative enzyme test. Incidence of G6PD deficiency was calculated retrospectively for one group of neonates born between January 2005 and July 2012 (i.e., epoch 1), when only "at-risk" newborns were tested for the deficiency (i.e., group 1). Incidence was also calculated for a second, prospective group of neonates, who were all to be born between August 2012 and April 2014 (i.e., epoch 2), and were all screened for the deficiency irrespective of risk factors. Results: A total of 39,268 live-born infants were included in our study. In epoch 1, 6.8% of all newborns were tested for the deficiency, compared to about 87% in epoch 2. The incidence of G6PD deficiency was 0.4% (119/29,332) and 1.6% (156/9,936) in epoch 1 and epoch 2, respectively (p<0.05). Among females, there was a 6.6-fold increase in incidence of G6PD deficiency between epoch 1 (0.08% [12/14,410]) and epoch 2 (0.53% [26/4,881]), while among males there was a 3.4-fold increase in incidence between epoch 1 and epoch 2 (0.72% [107/14,922] and 2.47% [125/5055], respectively). Conclusions: As universal screening for G6PD deficiency detects more affected newborns than the selective, risk-factor-based testing does, we suggest that validation of our study and cost-effectiveness analyses may further the aim of introducing universal screening for G6PD deficiency for neonates born in multi-ethnic, multicultural society setting. Disclosures No relevant conflicts of interest to declare.