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Background: The incidence of transfusion-related acute lung injury (TRALI) in adults is approximately one per 5000 transfusions. The Canadian Paediatric Surveillance Program undertook the present study to determine the incidence of TRALI in the paediatric population and to describe the characteristics and outcomes of children with TRALI., Methods: The present surveillance study was conducted over a three-year period., Results: Four TRALI cases were reported, yielding an incidence rate of 1.8 per 100,000 transfusions. The degree of severity varied: in two patients, only supplemental oxygen was necessary, while the other two required mechanical ventilation., Conclusion: TRALI was reported much less often in the present study compared with adult studies; therefore, it needs to be determined whether TRALI occurs less frequently in children, or alternatively, whether TRALI is recognized less often in children. The possibility that neonates who undergo cardiac surgery are at greater risk of TRALI than other patients should be addressed in future studies.

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.

Traditionally, anecdotal data and retrospective case reports have been used for insight into the natural history, epidemiology and case management of rare diseases. This lack of information has often resulted in delayed recognition and diagnosis of rare diseases, increasing the risk of complications or death of children. Furthermore, the study of rare condiions has been hampered by the need to generate sufficient numbers to enable meaningful analysis and interpretation, a need that requires data collection from a large population. The Canadian Paediatric Surveillance Program (CPSP) was established in 1996 to contribute to the improvement of the health of children and youth by national surveillance and research into uncommon paediatric diseases and conditions. The CPSP provides the mechanism to enable the prospective collection of national epidemiological data on such diseases and conditions. After five years, has the CPSP risen to meet expectations? Is it based on scientific evidence? The CPSP has revealed itself to be a very sensitive surveillance tool, providing invaluable longitudinal, epidemiological information for public health decision-makers. The present paper reviews how the different communicable diseases on the CPSP monthly reporting form stand the test of the 1998 priority criteria for diseases under national surveillance set by Canada's Advisory Committee on Epidemiology.