CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
-
Children with chronic illness and disability are at considerably increased risk of psychosocial problems, such as neurosis, attention deficit and poor adjustment to school. Health care professionals, especially primary care physicians, can do a great deal to prevent such problems in these children and their families. The approach outlined here is based on an understanding of the transactional model of development, in which the child interacts with--and to some extent creates--the social environment, and on a "noncategorical" concept in which common elements in chronic illness are recognized and emphasized. The physician's role is to inform the family of the child's condition as soon as possible, to offer hope, encouragement and guidance, to watch the child's development, to maintain a shared view of the child and family, and, if possible, to ensure continuity of care.
-
The initial resuscitation and stabilization provided to a critically ill or injured child is often an important determinant of outcome. Before transfer to a tertiary care facility the initial care may be provided by physicians unaccustomed to managing critically ill children. The authors outline the unique aspects of resuscitation and stabilization of the critically ill child and give guidelines for the initial management of diseases affecting the central nervous system and respiratory tract (the most frequent indications for transfer to a tertiary care facility) and other, less frequent but important problems. In many situations it is worth while to enlist the expertise of the tertiary care centre, either by telephone consultation or by dispatch of a specially trained transport team.
-
We report the outcome at 2 or 3.5 years of 1463 neonates at high risk born between 1975 and 1984 and cared for in a regional perinatal program in Alberta. Although the number of surviving infants of very low birth weight (1250 g or less) increased over the study period, the incidence rate of neurologic impairment fell significantly, from 19% to 13% (p less than 0.01), so that there was no significant increase in the absolute number of disabled children. This finding remained valid when two other groups of infants at high risk (those weighing more than 1250 g at birth and having a positive neurologic history and those born at term with asphyxial encephalopathy) were included in the analysis, so that over the decade there was a significant decrease in the incidence of disability among the total group of neonates (p less than 0.01) and no increase in the absolute number of disabled children (23 in 1975 and 19 in 1984). We conclude that neonatal intensive care has contributed to improved survival of neonates at high risk without increasing the burden of major neurologic disability.