Background: To inform the development of the European Academy of Allergy and

BackgroundBlood volume and haemoglobin (Hb) levels are increased by delayed umbilical cord clamping, which has been reported to improve clinical outcomes of preterm infants. The objective was to determine whether Hb level at birth was associated with short term outcomes in preterm infants born at ≤32 weeks gestation.MethodsData were collected retrospectively from electronic records: Standardised Electronic Neonatal Database, Electronic Patient Record, Pathology (WinPath), and Blood Bank Electronic Database. The study was conducted in a tertiary perinatal centre with around 5,500 deliveries and a neonatal unit admission of 750 infants per year. All inborn preterm infants of 23 to 32 weeks gestational age (GA) admitted to the neonatal unit from January 2006 to September 2012 were included.The primary outcomes were intra-ventricular haemorrhage, necrotising entero-colitis, broncho-pulmonary dysplasia, retinopathy of prematurity, and death before discharge. The secondary outcomes were receiving blood transfusion and length of intensive care and neonatal unit days. The association between Hb level (g/dL) at birth and outcomes was analysed by multiple logistic regression adjusting for GA and birth weight (BWt).ResultsOverall, 920 infants were eligible; 28 were excluded because of missing data and 2 for lethal congenital malformation. The mean (SD) GA was 28.3 (2.7) weeks, BWt was 1,140 (414) g, and Hb level at birth was 15.8 (2.6) g/dL.Hb level at birth was significantly associated with all primary outcomes studied (P <0.001) in univariate analyses. Once GA and BWt were adjusted for, only death before discharge remained statistically significant; the OR of death for infants with Hb level at birth <12 g/dL compared with those with Hb level at birth of ≥18 g/dL was 4.1 (95% CI, 1.4–11.6). Hb level at birth was also significantly associated with blood transfusion received (P <0.01) but not with duration of intensive care or neonatal unit days.ConclusionsLow Hb level at birth was significantly associated with mortality and receiving blood transfusion in preterm infants born at ≤32 weeks gestation. Further studies are needed to determine the association between Hb level at birth and long-term neurodevelopmental outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0247-6) contains supplementary material, which is available to authorized users.

BackgroundThere is clinical uncertainty about the effectiveness and safety of allergen immunotherapy (AIT) for the treatment of allergic asthma.ObjectivesTo undertake a systematic overview of the effectiveness, cost-effectiveness and safety of AIT for the treatment of allergic asthma.MethodsWe searched nine electronic databases from inception to October 31, 2015. Systematic reviews were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using the Critical Appraisal Skills Programme quality assessment tool for systematic reviews. Data were descriptively and thematically synthesized.ResultsWe identified nine eligible systematic reviews; these focused on delivery of AIT through the following routes: subcutaneous (SCIT; n = 3); sublingual (SLIT; n = 4); and both SCIT and SLIT (n = 2). This evidence found that AIT delivered by SCIT and SLIT can improve medication and symptom scores and measures of bronchial hyper-reactivity. The impact on measures of lung function or asthma control was however less clear. We found no systematic review level evidence on the cost-effectiveness of SCIT or SLIT. SLIT had a favorable safety profile when compared to SCIT, particularly in relation to the risk of systemic reactions.ConclusionsAIT has the potential to achieve reductions in symptom and medication scores, but there is no clear or consistent evidence that measures of lung function can be improved. Bearing in mind the limitations of synthesizing evidence from systematic reviews and the fact that these reviews include mainly dated studies, a systematic review of current primary studies is now needed to update this evidence base, estimate the effectiveness of AIT on asthma outcomes and to investigate the relative effectiveness, cost-effectiveness and safety of SCIT and SLIT.

IntroductionThere has been a notable increase in the prevalence of overweight and obesity in school-aged children in many industrialised regions. The worldwide prevalence of childhood overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010. Although many studies have been published, the epidemiological burden of overweight and obesity in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) is unclear. There is a need to bring together and appraise relevant studies in order to estimate the epidemiological burden (including incidence, prevalence, risk factors, trend over time) of overweight and obesity in this region and thus help to inform national and regional policies.Methods and analysisWe will conduct a systematic review and meta-analysis on the epidemiology of overweight and obesity in early childhood including incidence, prevalence, risk factors and trends over time in the GCC countries. We will search international electronic databases including MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, CINAHL, Google Scholar, AMED, Psych INFO, CAB International and WHO Global Health Library for published, unpublished and in-progress epidemiological studies of interest published from inception to 2017. In addition, we will contact an international panel of experts on the topic. There will be no restriction on the language of publication of studies. We will use the Effective Public Health Practice Project (EPHPP) to appraise the methodological quality of included studies. Meta-analysis will be undertaken using random effects models.Ethics and disseminationEthical approval is not required. The outcome of the review will be disseminated through conference presentations and peer-reviewed journal publication.PROSPERO registration numberCRD42017073189.

We assessed cannulation success, time to cannulate, and correct treatment identification for each participant. Results 14 experienced (9 Fellows, 5 Consultants) and 9 junior (Registrars) medical staff attempted 46 cannulations. Experienced participants successfully cannulated 100% of treated and control sections with no significant difference in mean (SD) time to cannulate (98 (75)s and 97(51)s respectively, p = 0.97). Junior participants cannulated 89% and 67% of treated and control sections respectively (p = 0.69), and mean (SD) time to cannulate was 132 (78)s and 106 (53)s respectively (p = 0.42). GTN treated arteries were correctly identified by 43% of experienced and 22% of junior participants (p = 0.47). Conclusions This study suggests that topical application of GTN does not increase successful cannulation of umbilical arteries by experienced staff. More participants or prolonged GTN application time may be needed to confirm these findings in junior staff. Background/aims Phototherapy (PT) is an effective treatment for hyperbilirubinemia, provided a minimum irradiance level is applied. Previously, we reported on low irradiance levels of PT devices in Dutch Neonatal Intensive Care Units (NICUs). These data were shared with all NICUs. We hypothesised that this knowledge would positively affect current applied irradiance levels. Therefore we determined irradiance levels of PT devices again in 2013. Methods Irradiance levels of overhead and underneath PT devices in all 10 NICUs were measured with a Dale 40 radiometer (FlukeBiomedical, Everett, Washington, USA), in routinely applied PT practice patterns, using an infant silhouette model. The infant's distance from the overhead device was measured. Results Irradiance levels of 35 PT device-incubator combinations were measured (Table); 10 types of PT devices were in use in the 10 NICUs (8 overhead and 2 underneath). Overall irradiance levels increased (p = 0.01); irradiance levels of overhead and underneath PT devices also increased with 50% (NS) and 200% (p = 0.03), respectively. The mean (range) distance between overhead PT device and infant decreased with 7 cm to 38 (30-62) cm (p < 0.01). Minimal recommended irradiance levels of 10 mW/m 2 /nm were obtained for 70% of PT devices versus 50% in 2008 (p = 0.02). Conclusions Applied irradiance levels of PT devices in Dutch NICUs have markedly improved in 2013. Current data suggest that awareness among healthcare workers regarding requirements for effective PT results in improved use of PT devices, including smaller distances between PT device and infant. PS-199Moreover, the availability of better performing (Light Emitting Diode) PT devices might have contributed. PS-200 HOSPITAL-LEVEL VARIATION IN RADMISSION RATES OF NEONATAL INTENSIVE CARE (NICU) PATIENTS: A POTENTIAL QUALITY MEASURES Lorch, M Macheras. Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, USA 10. 1136/archdischild-2014-307384.496 Background Variation in readmission rates may assess the quality of a provider through the quality o...

Background: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. Method: This is a retrospective medical records review of 23+0–28+6 weeks’ gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. Results: There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p<0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed >grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 – 2.16)) or IVH (1.38 (0.96 – 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 – 2.50)). Conclusions: There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

Background: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. Method: This is a retrospective medical records review of 23+0–28+6 weeks’ gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. Results: There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p<0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed >grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 – 2.16)) or IVH (1.38 (0.96 – 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 – 2.50)). Conclusions: There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.