A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription.For more information, please contact eprints@nottingham.ac.uk Financial disclosure: The other authors have no financial relationships relevant to this article to disclose. Outcomes of nosocomial viral respiratory infections in high-risk neonates Conflicts of interest:The other authors have no potential conflicts of interest to disclose. Abbreviations:VRTIs -viral respiratory tract infections BPD -bronchopulmonary dysplasia NICU -neonatal intensive care unit NEC -necrotising enterocolitis CPAP -continuous positive airway pressure Bi-PAP -bi-level positive airway pressure HFOV -high frequency ventilation ECMO -extracorporeal membrane oxygenation RT-PCR -real time polymerase chain reaction RVP -respiratory viral panel NHS -National Health Service What's Known on This SubjectViral respiratory tract infections cause severe respiratory morbidity in ex-preterm infants after NICU discharge. They are now recognized to be more prevalent in the NICU but their longterm impact, prior to discharge, during this early period of life is unclear. What This Study AddsThis study identifies the adverse impact viral respiratory infections, particularly rhinovirus, have on newborn infants during their initial NICU admission. Identification of the associated significant respiratory morbidity and healthcare costs should focus efforts on reducing these nosocomially acquired infections. Contributors' Statements:Dr Don Sharkey conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted.Drs Shairbanu Zinna, Arthi Lakshmanan, Shin Tan, Shiu Soo, Lisa Szatkowski and Miss Rebecca McClaughry and Mr Martin Clarkson carried out the data collection, initial analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted.All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. ABSTRACTBackground Neonatal respiratory disease, particularly bronchopulmonary dysplasia, remains one of the leading causes of morbidity and mortality in newborn infants. There is increasing evidence that nosocomially acquired viral respiratory tract infections (VRTIs) are not uncommon in the neonatal intensive care unit but there are few studies on their impact on neonatal respiratory outcomes and the associated healthcare costs. This study aimed to assess the association between nosocomial VRTI and neonatal respiratory disease.

outcome/survival is not significantly different between the two groups. Using a SAD may not be worth doing as it takes time to insert, meaning there is no ventilation in that time. However, in children with difficult airways who intubation poses a problem, it is worth bearing in mind the use of a SAD. Over time the effectiveness of BVM decreases, hence a more definitive airway should always be planned. Clinical bottom line A bag valve mask with oropharyngeal airway should be used initially to oxygenate and ventilate a child in cardiopulmonary arrest. A supraglottic airway should be considered in children with a difficult airway or if there is going to be delay in establishing a definitive airway (endotracheal intubation). SADsupraglottic airway device. LMAlaryngeal mask airway. OPAoropharyngeal airway. BVMbag-valve-mask. ALSadvanced life support.

AbstractsResults Of 176 potentially eligible infants 54 (GA 26.9±0.2 wks, BW 970±34 g) met the criteria for inclusion. 26% of the cases vs. 3% of the controls were from communities north of the 55° latitude (p<0.05). Serum Ca levels were within the normal range, but serum P levels were subnormal. The most significant biochemical discriminator between the two groups was the serum ALP level. Introduction and aim: Hyperglycaemia in preterm babies is a common problem. It is known to be associated with an increased risk of morbidity and mortality, especially in extreme preterm babies. Despite this, there is little established consensus of management. Nonetheless, practice is improving as the neonatal units develop local guidelines on the basis of the limited available research. Currently we don't know the specifics of the prevailing practice, and this is the first needed step in order to carry out any substantial further research. ConclusionsWe carried out the survey to study the prevailing practice in level 3/tertiary units in the United Kingdom. Methods We collated a list of level 3 units from the British Association of Perinatal Medicine (BAPM) website. We sent an online questionnaire to the Neonatal Consultant. We followed up with a phone call to get more responses. Results We received responses from 51 units (81%). It showed that the 80% of units either follow local or regional guidelines and the majority (78.4%) now use gas machine for measuring blood glucose. We found there is quite a variation in definition of hyperglycaemia, modalities of management, insulin regimen and the endpoint of treatment. Conclusions Management of neonatal hyperglycaemia is very unit dependant. We agree with other experts that large randomised trials in hyperglycaemic VLBW neonates that are powered on clinical outcomes are needed to determine whether and how the hyperglycaemia should be treated.

Background This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. We used British Paediatric Surveillance Unit (BPSU) methodology; collecting data via questionnaires for preterm neonates undergoing PDA ligation (PDAL) between 1st Sept 2012 – 30th Sept 2013. Infants born less than 37 weeks gestation, who underwent PDAL prior to discharge home, with no other structural cardiac abnormality, were included. Information collected included: patient demographics, pre and post-operative clinical characteristics, pre-operative medical management, post-operative complications and outcome. Results Over the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. 88% were born extremely preterm (< 28 weeks) and 60% were male. The commonest reasons for ligation were inability to wean respiratory support (83.7%) and haemodynamically significant PDA (87.8%). Pre-operatively 65.7% received medical therapy. Surgery was performed at a median age of 33 days (range 9-260, IQR 24-48); the corrected age was less than 31 + 6 week in 50.6% babies at PDAL. Most, (90%), of procedures were open ligation; only 9 (3.4%) were catheter occlusions (PDACO). 20.5% of patients had post-operative complications. The 30-day mortality was 3%, with 93.5% surviving to hospital discharge. Conclusion This study showed there was little consensus over medical and surgical management of the PDA or timing of surgery.

AimsWith many conflicting studies it is not surprising that management of the patent ductus arteriosus (PDA) in the preterm infant remains controversial. Ibrahim et al1 advocate early surgical closure of symptomatic PDA to facilitate extubation and establish enteral feeding. Small retrospective studies such as this are unlikely to influence UK practice and assist in the development criteria for babies requiring surgical PDA ligation. This study aimed to describe the epidemiology and outcome of premature infants undergoing surgical PDA ligation.MethodsA UK wide prospective study was conducted between 1st September 2012 and 30th September 2013 through the British Paediatric Surveillance Unit (BPSU). Paediatric consultants were asked to report babies born less than 37 weeks gestation who underwent surgical PDA ligation prior to hospital discharge. Following notification a detailed questionnaire was sent to consultants.ResultsOver 13 months, 531 notifications were received, 68 cases were reported in error. 58 questionnaires were not returned. After merging duplicate questionnaires, 267 infants requiring surgical PDA ligation were identified. 161 (60%) were male, median birth gestation was 28 (range 22+5–34+4) weeks and median birth weight 740 (range 421–3460) grams. Median age of ligation was 33 (range 7–576) days and weight 1020 (range 500–4000) g. Indications for PDA ligation are shown in Figure 1. For England and Wales, the overall incidence of surgical PDA ligation was 35/100,000 live rising to 13/100 live births at 24 weeks gestation. Medical treatment commonly with Ibuprofen was administered in 154 (64%) infants prior to ligation. Open surgical ligation was the preferred method used in 240(97%) of the babies and trans-catheter occlusion in 7. Most procedures 164(68%) were performed in cardio-thoracic theatre. Post ligation complications occurred in 51(20%) cases: pneumothorax (45%) was commonest. Overall there were 17 (6.3%) deaths – none in the immediate peri-operative period.ConclusionThis is the largest prospective UK survey of surgical PDA ligation in premature infants. Surgical ligation is most commonly performed in extremely low birthweight and premature infants with excellent survival. Further work is required to determine the criteria for and timing of surgical PDA ligation.Abstract G147 Figure 1Indication for PDA ligation

IntroductionThe presentation of cardiac arrhythmias varies depending on the type and age at presentation. Appropriate investigations must be conducted as some rhythm disturbances are life threatening.1 The aim of this study was to evaluate the outcome of children presenting with concerns about the heart rate and rhythm to a clinic run by a paediatrician with expertise in cardiology.MethodsChildren referred for assessment of arrhythmias between March 2004 and August 2009 were included in the study. A retrospective analysis of their clinic letters was undertaken. Patients already known to have arrhythmias were excluded.ResultsOver 5 years, 205 children were identified. Of these, 115 (56%) were male. The median age of first clinic attendance was 12 years (range 1 month to 17 years). There were 141 (69%) general practitioner referrals and 53 (26%) were referred following inpatient admission, emergency department attendance or from other clinics. 11 (5%) children were already under cardiac review with the arrhythmia as a new concern. The commonest presenting symptoms were palpitation/tachycardia, chest pain and syncope/faint in 101 (49%), 42 (20%) and 33 (16%) children, respectively. Pathological arrhythmias were confirmed in 26 (13%) children, of these, 24 were subsequently seen in the specialist outreach clinic. Supra-ventricular tachyarrhythmias including Wolf Parkinson White syndrome were diagnosed in 18 (9%) children of whom four were less than 1 year of age at diagnosis. Electrophysiological studies with radiofrequency ablation were performed in 9 (4%) children. Prolonged QT syndrome and ventricular tachyarrhythmia was diagnosed in 4 children each. Most children 162 (79%) were discharged after their initial or first follow up appointment, 33 (16%) are followed in paediatric clinics and 10 (5%) have been transferred to adult services. There have been no deaths in this study group.ConclusionCardiac arrhythmias are commonly seen in paediatric cardiology clinics. These children require careful assessment. A significant proportion of children have pathological arrhythmias that require treatment and long-term follow-up.

Introduction British Paediatric Surveillance Unit (BPSU) promotes study of rare diseases and infections by orange card reporting system and subsequent questionnaire based surveillance. We conducted a study of surgically ligated PDA in preterm babies between September 2012 and September 2013. The questionnaire had 10 parts with a total of 43 questions to answer. 18 of these were generic questions and could have been answered by non-medical staff. The questionnaire was designed after balancing the number of questions against the completeness of the data required. The aim of this abstract is to outline some of the difficulties of such questionnaire based national surveys and possible solutions. Results 531 cases were reported and questionnaires posted to the relevant Consultants. 10% of these questionnaires were not returned and similar percentages were reported in error (see Figure 1). Abstract G134(P) Figure 1 Multiple reporting occured in 96 cases – 83 of them were duplicates, 12 were triplicates and 1 case was reported by 4 different clinicians. Incomplete data was provided in 96 cases. This was less with multiple reporting ones 11/96 (11.4%) compared to 82/199 (41%) cases which were reported once. Multiple reporting thus helped us to obtain more information about the case. But this also resulted in some discrepancies in the reporting of 12 (12.5%) cases. Conclusions In our experience, we felt that email correspondence was quicker and had a better response rate compared to paper correspondence. Division of the questionnaire into medical and non-medical parts could enable the clinician to concentrate on the relevant medical information and leaving the non-medical information to be filled in by administrative staff. The longer the time that lapsed between the case being reported to the BPSU and the questionnaire being completed by the Consultant, the more incomplete was the reported data. Improvements in data ascertainment might be possible in a neonatal project if the research team were able to access national databases such as BADGER system for named patients to improve the accuracy and quality of data. This type of surveillance has great epidemiological and clinical impact. Identifying key issues and addressing them early can ensure high quality data is collected and disseminated.

IntroductionManagement of the patent ductus arteriosus (PDA) in premature babies includes none, conservative management with diuretics, medical treatment to close the PDA, or surgical closure. When and if to close the PDA is controversial. We chose to study the population who undergo surgical closure of a PDA as a representation of those for whom the PDA is clearly thought to require closure. We wished to describe this specific population. In this abstract we describe their pathways of care and procedures.MethodsData were collected using the British Paediatric Surveillance Unit (BPSU) methodology. Those undergoing surgical closure of a PDA between 1st September 2012 and 30th September 2013 were reported monthly to the BPSU by Consultant Neonatologists, Paediatricians, Cardiologists and Cardiothoracic Surgeons. Eligibility criteria were birth gestational age less than 37 weeks, closure prior to first discharge home and absence of other congenital cardiac disease. Questionnaires were then sent to reporting Consultants and the data from these collated and analysed. Missing data or discrepancies were clarified through email or telephone contact.ResultsOver 13 months, 531 notifications were received. 68 did not meet inclusion criteria. 58 were not returned. The response rate (excluding ineligible notifications) was 405/463(87%). After merging questionnaires related to the same patient and excluding incomplete questionnaires, 268 patients with the minimum complete data set remained. Data are presented for the data available which is not 268 for all points.Surgical closure of the PDA was performed in 14 centres. The number of ligations performed in these centres varied from 1 to 50 over the 13 month study period.Contact was made with 1, 2 or 3 cardiothoracic centres in 153, 25 and 3 cases respectively to arrange the ligation. 56 babies had their procedure in the same hospital. For the 199 who had to move hospital, the average distance was 28.4 miles. 105/157 procedures were performed as day cases. 11 out of 14 centres performed day cases with 6 performing over half as day cases. 7 cases were performed as catheter occlusions (20 missing data).ConclusionsThere is wide variation in the number of ligations performed by each centre. Of those reported many were performed as day cases. A small number are performed by catheter occlusion. Referral practice is non-uniform across the UK.