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ANEMIA

Population

  • Infants age 6–24 mo.

Recommendations

USPSTF 2015, AAFP 2015

  • Insufficient evidence to recommend for or against screening.

  • Consider selective screening in high-risk childrena with malnourishment, low birth weight, or symptoms of anemia.

AAP 2010

  • Universal screening of Hgb at 12 mo. If anemic, measure ferritin, C-reactive protein, and reticulocyte hemoglobin content.

Sources

  • AAFP. Clinical Recommendations: Iron Deficiency Anemia. 2015.

  • USPSTF. Iron Deficiency in Young Children: Screening. 2015.

  • Pediatrics. 2010;126(5):1040-1050.

Comments

  1. Reticulocyte hemoglobin content is a more sensitive and specific marker than is serum hemoglobin level for iron deficiency.

  2. One-third of patients with iron deficiency will have a hemoglobin level >11 g/dL.

  3. Use of transferring receptor 1 (TfR1) assay as screening for iron deficiency is under investigation.

aIncludes infants living in poverty, Blacks, Native Americans, Alaska natives, immigrants from developing countries, preterm and low-birth-weight infants, infants whose principal dietary intake is unfortified cow’s milk or soy milk, bottle feeding beyond one year, having a mom who is currently pregnant, living in an urban area and having less than two servings per day of iron-rich foods (iron-fortified breakfast cereals or meats).

CRITICAL CONGENITAL HEART DISEASE

Population

  • Newborns.

Recommendation

AAP 2011

  • All newborns should have pulse oximetry screening for CCHD at or greater than 24 h of life but prior to discharge home from the hospital.

Source

  • AAP. Endorsement of HHS Recommendation for Pulse Oximetry Screening for CCHD. 2012.

Comment

  1. Obtain oxygen saturations in the right hand and in one foot.

DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)

Population

  • Infants.

Recommendations

AAP 2017, AAFP 2017

  • Examine newborn and continue periodic surveillance physical exam for DDH including length discrepancy, asymmetric thigh or buttock creases, performing Ortolani test, and observing for limited abduction.

  • Selective ultrasonography for “high-risk” infants 6 wk to 6 mo of age: history of breech presentation, family history, parenteral concern, history of clinical hip instability on exam, or history of lower extremity swaddling.

  • Radiography can be considered after 4 mo of age in high-risk infants without physical exam findings or any child with positive physical exam findings.

  • Indication for orthopedic referral: unstable or dislocated hip in physical exam. Referral does not require any prior imaging.

Comment

  1. There is evidence that screening leads to earlier identification; however, 60%–80% of the hips of newborns identified as abnormal or suspicious for DDH by physical ...

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