Provision of optimum healthcare for infants with atypical genitalia requires a clear understanding of the occurrence of this condition. The objective of this study was to determine the prevalence of atypical genitalia and its initial management. A prospective, electronic survey of clinicians within managed clinical networks in Scotland was undertaken between 2013 and 2019. Notification from clinicians was sought for term neonates requiring specialist input for atypical genitalia. Additional information was also sought from the 4 regional genetics laboratories that provided details for neonates who had an urgent karyotype performed for atypical genitalia or sex determination. In total, the study identified 171 term infants who required some investigation for atypical genitalia in the neonatal period, providing a birth prevalence of 1:1,881 term births. Of the 171 infants, 97 (57%) had specialist input over the first 3 months of life, providing a birth prevalence of 1:3,318 term births that received specialist input for atypical genitalia. A total of 92 of these 97 cases had complete 3-month follow-up data, 62 (67%) presented within 24 h of birth, and age at presentation ranged from birth to 28 days. Age at sex assignment ranged from birth to 14 days, and in 63 cases (68%), sex assignment occurred at birth. Thus, the birth prevalence of a case of atypical genitalia where sex assignment was reported to be delayed beyond birth was estimated at 1:11,097 births. In 1 case sex was re-assigned at 3 months. Atypical genitalia requiring specialist input within the first month of life are rare in term newborns, and in only a third of these cases, sex assignment is delayed beyond birth. This study provides new clinical benchmarks for comparing and improving the delivery of care in centres that manage these conditions.

No abstract

Background/motivationThe Trainee Lead (TL) initiative was devised by the Medical Education Team to bridge the gap between trainees and management and empower trainees to become involved in improvement processes.National training surveys (GMC/Scottish training survey) have highlighted the need for an inclusive approach and collaborative culture. The aim of the TLs is to engage trainees, promoting better communication and model a positive environment for learning and quality improvement (QI).How we did itThere are nine TLs across the divisions of Medicine, Surgery, Women’s and Children and Support Services. The role of TLs is to engage with trainees within their Divisions by having regular meetings with trainees and feeding back to the medical education team within the health board. By participating in medical education and managerial meetings, TLs have developed management skills and driven quality improvement projects.The monthly Trainee Forum was set up to raise awareness of the roles and structure of the management team. Guest speakers from the management Divisions have provided trainees with an insight into how the health board functions and provided a platform to raise issues directly with the management team.Some examples of initiatives include trainee-led QI projects to enhance teaching opportunities include rota restructuring, development of hospital at night for surgery to ensure safe and adequate cover out of hours, involvement of trainees in organisation of morbidity and mortality meetings.Furthermore, a monthly Trainee Newsletter was set up to signpost trainees on upcoming forums and advertise QI sessions and workshops.OutcomesThe TL initiative is an ongoing project with regular feedback in the form of TL meetings, forums and trainees. As TL’s we have shared methodologies that have worked well to create a supportive and nurturing environment.The initiative has resulted in increased awareness of management and their vital role in the running of the National Health Service. This in turn has led to improved trainee engagement. On a fundamental level, trainees have been able to raise issues and be part of implementing change.The futureThrough collaboration between trainees, across Divisions and with management, we will continue to engage trainees, sustain change and build resilience.

of meningitis is rarely considered or treated. The use of antiviral agents in meningitis have been shown to reduce morbidity and mortality from viral meningitis. Antiviral agents should therefore be considered in the management of meningitis in this setting in order to improve outcomes of patients and promote judicious use of antibiotics. Further research to describe the viral aetiology of meningitis in this setting is required.

BackgroundTrainee led initiative in response to National Training Survey (NTS) reflecting disengagement and disenchantment among trainees.AimTo set up a Trainee Forum in a Neonatal Intensive Care Unit, which would be chaired by the senior trainees. The purpose was to identify trainee issues in a timely manner and highlight them to trainers, clinical director, deanery and the medical education team.MethodsA bi-monthly, closed meeting for trainees was established. Issues raised included improving teaching structure, postnatal ward set up, handover, valuing trainees and prioritising training needs. This was fed back by the senior trainee at the departmental Senior Staff Meeting. Working groups to target the different areas were established. Sessions with the ‘Workplace Behaviour Champion’ were organised to support and empower trainees. Trainee experience was measured at six months using PHEEM (Postgraduate Hospital Educational Environment Measure) and at twelve months on the NTS.ResultsA joint medical/nursing education group was set up, resulting in revision of the teaching schedule and simulation. A ‘What’s on’ bulletin of teaching opportunities was emailed out weekly. Teaching sessions were also highlighted at staff handovers. The handover structure was revised. A Quality Improvement(QI) project was established, reviewing ward rounds to maximise training opportunities. Positive behaviours were reinforced and mentoring was provided for trainees by senior trainees, management and the deanery. ‘Baby-check’ clinics were also set up as a QI project. The PHEEM questionnaire demonstrated improvement in some areas at six months, particularly in availability of training opportunities, education and morale. This was sustained on the NTS survey at 12 months.ConclusionsThe Trainee Forum was successful in bringing all staff groups together as a team and motivating them to be the vehicles of change. This is an ongoing project with continuous feedback in real time from trainees. This multi-prong approach has demonstrated improvement in training on initial survey. Changing attitudes can be challenging but this process continues to engage trainees, consultants and managers towards modelling a positive work environment. It has also provided a platform for senior trainees to be involved in clinical leadership and engage with managers in a very meaningful way.

No abstract

No abstract

BackgroundSeveral risk factors are implicated in the development of necrotizing enterocolitis (NEC), one of which is receiving a blood transfusion. Recent evidence suggests that newborn (cord) red blood cells expressing CD71 can suppress potentially damaging immune responses to bacteria colonising the gut. Therefore, a blood transfusion, currently from adult donors, might effectively dilute these preventative properties, resulting in damaging inflammatory responses against gut bacteria, and subsequent NEC.AimWe wished to identify in neonatal cord blood samples the early red cell population (CD71+/CD235+) purportedly responsible for the immunosuppression, and to establish a time course of their development with respect to gestational age. We also compared to adult blood donors, and assessed their potential anti-inflammatory activity.MethodResidual routine blood samples were obtained from preterm babies in the Neonatal Unit, after informed parental consent. Sequential samples were obtained until the infants were discharged. Neonatal/cord/adult blood samples, were separated by density centrifugation into mononuclear (buffy) cell layer (MNC) and red cells (RBC). MNC and RBC populations were immunofluorescently labelled with anti-human CD71 and anti-human CD235a and analysed by flow cytometry. We have assessed normal umbilical cord (term, elective sections) and healthy adult blood to investigate the anti-inflammatory properties of newborn cord RBC compared to adult RBC in simulated in vitro transfusions. Pro- and anti-inflammatory cytokine production by innate immune cells in response to pathogenic gut bacteria were also evaluated.ResultsThe proportion of RBC and MNC CD71 +cells were significantly greater (p<0.0001) from neonates (term cord and preterm infants) compared to adults. While transfusion did elicit suppression of pro-inflammatory cytokine production in response to bacterial challenge, regardless of the donor RBC source, the net effect of adult RBC transfusion is dilution of the innate CD71 +population.ConclusionLogistics aside, we suggest that transfusion using umbilical cord progenitor RBC, rather than adult RBC donations, might afford an alternative option for pre-term infants to lessen their risk of post-transfusion associated NEC.