Aims The influence of the COVID-19 pandemic on attendance to out-of-hospital cardiac arrest (OHCA) has only been described in city or regional settings. The impact of COVID-19 across an entire country with a high infection rate is yet to be explored. Methods The study uses data from 8629 cases recorded in two time-series (2017/2018 and 2020) of the Spanish national registry. Data from a non-COVID-19 period and the COVID-19 period (February 1st–April 30th 2020) were compared. During the COVID-19 period, data a further analysis comparing non-pandemic and pandemic weeks (defined according to the WHO declaration on March 11th, 2020) was conducted. The chi-squared analysis examined differences in OHCA attendance and other patient and resuscitation characteristics. Multivariate logistic regression examined survival likelihood to hospital admission and discharge. The multilevel analysis examined the differential effects of regional COVID-19 incidence on these same outcomes. Results During the COVID-19 period, the incidence of resuscitation attempts declined and survival to hospital admission (OR = 1.72; 95%CI = 1.46–2.04; p < 0.001) and discharge (OR = 1.38; 95%CI = 1.07–1.78; p = 0.013) fell compared to the non-COVID period. This pattern was also observed when comparing non-pandemic weeks and pandemic weeks. COVID-19 incidence impinged significantly upon outcomes regardless of regional variation, with low, medium, and high incidence regions equally affected. Conclusions The pandemic, irrespective of its incidence, seems to have particularly impeded the pre-hospital phase of OHCA care. Present findings call for the need to adapt out-of-hospital care for periods of serious infection risk. Study registration number ISRCTN10437835.

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Primary sternal osteomyelitis is very rare in children, with less than 100 cases published to date. Its clinical presentation is often non-specific, which results in a diagnostic delay.Here we describe 2 new cases of primary sternal osteomyelitis. Both referred fever, malaise, chest pain, and refusal to lie down, with pre-sternal erythema in one of the cases. The erythrocyte sedimentation rate and C-reactive protein values were high in both cases. The diagnosis was confirmed by imaging studies; methicillin-sensitive Staphylococcus aureus was isolated in the blood culture of one of them. Both recovered without complications with antibiotic treatment.Primary sternal osteomyelitis should be considered in the differential diagnosis of chest pain, especially if accompanied by fever, local inflammatory signs, intolerance to lying down, or increased acute phase reactants.

participating neonatal units within the network. 10 cases from each unit were included. These referred to term or preterm infants who required intravenous antibiotics for suspected or confirmed early onset sepsis with a minimum length of stay of 10 days. The data were analysed using SPSS 17.0. Results 15 units participated. 149 babies were recruited with a mean gestational age of 32+2 weeks. 91.3% of babies received intravenous benzyl penicillin and gentamicin as first line treatment. In 25% of cases there were prescribing issues regarding gentamicin. 20.1% received cefotaxime. 19.5% of babies underwent a lumbar puncture. 17.5% of babies received antifungal agents. In 15.4% of which as treatment. Conclusions The overall outcome was positive with prompt recognition of risk factors and initiation of treatment across all units. This unified policy promotes good quality of care. However, the percentage of prescribing issues regarding gentamicin was worryingly high. Hence, further studies and review of literature are required to evaluate the efficiency of our practice and to establish alternative choice of antibiotics. PS-217 IMPACT OF THE NEW ALGORITHM FOR MANAGEMENT OF NEWBORNS WITH RESPECT TO RISK FOR EARLY-ONSET GBS DISEASEM García Díaz, T González Martínez, V García González, J GonzáLez García, B Fernández Martinez, C Pérez Mendez. Servicio de Pediatria, Hospital de Cabueñes, Gijon, Spain 10. 1136/archdischild-2014-307384.516 Background Guidelines for the prevention of perinatal group B streptococcal (GBS) disease were updated in 2010, including a revised algorithm for management of newborns with respect to risk for early-onset GBS disease (EOD-GBS). Aim To know the impact of this new algorithm on EOD-GBS evaluations, hospital admissions, and detection of EOD-GBS cases in a newborn unit. Methods Retrospective cohort study of infants of GBS-colonised mothers born at ≥36 weeks gestational age in two periods of time: from July to December 2010, and from July to December 2012. The following variables were analysed: gender, gestational age, chorioamnionitis, indication for and prescription of antibiotics to the mother, EOD-GBS evaluations, infant admission and outcome. Continuous data were compared by using t test; discrete data using chi square. Preventable fraction in the exposed (Pf e ) was used to quantify the impact or the new algorithm. Results One hundred and fifty-two neonates were included in 2010 and 130 in 2012. No significant differences between both groups were found regarding gender, gestational age, chorioamnionitis, obstetric care and antibiotic prophylaxis received by mothers. There were no cases of GBS infection in both periods. The new algorithm avoided 88% evaluations in EOD-GBS screening from 2010 to 2012 (Pf e = 0.88, 95% confidence interval [CI]: 0.39-0.96). The number of infants admitted for suspected EOD--GBS was reduced by 48.1% (Pf e : 0.481, 95% CI: -0.648-0.864). Conclusions Implementation of the 2010 algorithm resulted in a decrease of EOD-GBS evaluations and the number of newborn adm...