Depuis près de 25 ans, le programme canadien de surveillance active de l'immunisation (IMPACT) assure une surveillance active des effets secondaires suivant l'immunisation (ESSI) ainsi que des maladies évitables par la vaccination chez les enfants. Le réseau, qui consiste en un groupe de chercheurs bénévoles en matière de maladies infectieuses infantiles provenant de 12 hôpitaux de soins tertiaires pédiatriques, constitue une composante importante du système de surveillance canadien d'ESSI. Le réseau est doté d'infirmières dans chacun des établissements afin de repérer et de déclarer de possibles ESSI aux autorités sanitaires publiques locales, provinciales et nationales. La nature active des activités de surveillance permet un degré élevé de vigilance en cas d'ESSI chez les enfants.

METHOD: Institutions that publish pediatric dosing guidelines as a separate publication or as part of a hospital formulary were mailed a survey of questions to describe their publications. Publications that met the inclusion criteria were evaluated using twelve assessment criteria: approval or submissions by medical specialty groups, drug inclusion, dosing guidelines, dosing in organ failure, pharmacokinetic/pharmacodynamic parameters, therapeutic guidelines, intravenous (IV) and oral (PO) administration guidelines, adverse drug reactions/drug interactions, referencing, drug acquisition costs, organization, and readability. RESULTS: Nine hospital centres responded to the request for published pediatric dosing guidelines either as a separate publication or as part of a hospital formulary. Three centres were excluded that identified themselves as only publishing neonatal guidelines (Royal Victoria Hospital Montreal, Children's Hospital of Eastern Ontario Ottawa, Mount Sinai Hospital Toronto). One centre was excluded that only published an emergency manual for pediatrics (Ottawa Hospital Civic Site), and another centre only identified itself as publishing pediatric critical care dosing guidelines (London Health Sciences Centre). In addition, three Canadian pediatric publications were identified that incorporate pediatric dosing chapters in general reference handbooks: The similarities in these publications in combination with the consistency of drug information provided suggest that a collaboration of effort to produce a national pediatric publication may be justified. When reviewing these publications, it becomes evident that, for many drugs, there is a lack of evidence-based guidelines generated from well-designed pediatric clinical trials. Faced with this reality of few well-designed pediatric drug studies, these references have collated the available published information with institutional experience and historical practice to produce one of the few sources of pediatric dosing information. EFFECT OF DELIVERY TYPE ON BREASTFEEDING IN THE EARLY NEONATAL PERIODL Di Liddo, AM Carceller, M Gonthier, AC Bernard-Bonnin, I Fortier, I Chevalier OBJECTIVE: Breastfeeding is the optimal source of nutrition for term infants. Many factors influence its initiation and weaning. The goal of this pilot study was to determine breastfeeding initiation rates at SteJustine Hospital, a tertiary maternal and pediatric health care center. We also hypothesized that during hospitalization, the risk of formula supplementation and weaning in breastfed infants would be higher in infants delivered through cesarean section rather than vaginally. METHODS: We reviewed medical records of 234 healthy singleton infants greater than 35 weeks of gestational age born the first week of each month between March and June 2000. Abstracted data included: maternal prenatal intention regarding infant feeding, gestational age, sex, birth weight, analgesia during labour, delivery type, and infant feeding practice during hospitalization. Breastfeeding was ini...

a standardized protocol implemented in 2005. We assumed children with the following criteria could have been sent home with O 2 , instead of being kept in hospital: age = or >2 months, distance between home and hospital <50 km, in-hospital observation = or >48 hr, need for iv fluids <50 mL/kg/day, no gavage feeding, O2 requirement = or > 0.5 L/min and stable clinical condition over the last 24 hrs. Children with significant underlying disease were excluded. results: One hundred seventy-seven infants were included in the study. Median age was 2.0 months (range 0-11); 54.8% were male. Eighty eight per cent (156/177) were admitted for a first episode of bronchiolitis, and 75.3% of those tested were RSV positive (116/154). Median length of stay was 3.0 days (range 0-18). Admission to PICU and mechanical ventilation were required for 14.7% and 13.6% of patients, respectively. Forty five percent of patients (79/177) received oxygen during their hospital stay. Of these 79 children, 49.4% were = or >2 months of age, 72.2% lived within 50 km of the hospital and 91.1% were hospitalized 48 hr or more. Criteria for early discharge with HOT were met in only 9 children (5.1% of all patients), a mean of 1.1 days (SD 0.8) prior to discharge. For the entire cohort, the number of patient-days of hospitalization which would have been saved with HOT was 10, representing 1.4% of total patient-days of hospitalization for bronchiolitis in otherwise well children over the study period (10/703). conclusions: In our setting, HOT would be minimally effective in reducing length of stay of infants hospitalized for bronchiolitis. . We found differences in patient volumes, workload, distance walked and supervision between the 3 periods (medians reported): of assigned patients (23.5, 27, 22, p=0.002), overnight admissions (4, 3, 2, p<0.0001), pages (27.5, 24, 15.5, p<0.0001), minutes entering orders (70, 105, 65, p=0.003), minutes examining patients (75, 120, 90, p=0.0004), minutes communicating with patients and families (100, 140, 120, p=0.004) and minutes communicating with the staff physician (not measured, 87.5, 30, p<0.0001). Patient emergencies were reported in 9 (15%), 46 (83%) and 15 (24%) shifts (p<0.0001). Trainees reported learning at any stage during 54 (89%), 39 (71%) and 48 (76%) shifts, and specifically overnight during 46 (75%), 14 (25%), 20 (32%) shifts (p<0.0001). conclusions: We performed a before and after evaluation of the effect of duty hour reductions in a paediatric teaching hospital using prospective self-report. We found significant differences in workload and supervision between periods. The overall proportions of shifts where trainees reported learning was similar, although perceived learning during the night portion of the shift reduced significantly from 2005 to 2009. The inclusion of a remote control group provides additional context in which to frame the shorter term comparisons before and after implementation of the July 2009 duty hour regulations. sHoUld tHis HosPitaliZed cHild receiVe eMPiric treatMeNt WitH ...

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