Mansoor Ahmed

Comparison between transcutaneous bilirubinometry and total serum bilirubin measurements in preterm infants <35 weeks gestation.

Background Neonatal hyperbilirubinaemia is a common treatable cause of brain injury. The treatment for this condition is phototherapy. The decision whether to use phototherapy is currently dependent upon serum bilirubin assay results. However, repeated blood sampling is not only traumatic but may also be a cause of anaemia in neonates. We evaluated a transcutaneous bilirubin assay method to determine whether it was suitable for routine use in preterm infants. Methods One hundred and eighty-three transcutaneous bilirubin measurements were taken contemporaneously with blood samples for laboratory measurement of serum bilirubin. The study was carried out with informed parental consent and approval by the local research ethics committee. Results The transcutaneous bilirubin method (BiliChek ®) exhibited a consistent positive bias compared with the laboratory bilirubin assay. Consequently, for a given detection rate, the transcutaneous method had a higher screen positive rate, i.e. more neonates would be given phototherapy if transcutaneous bilirubin results were used to decide. There was a margin of safety in the transcutaneous bilirubin assay calibration. Conclusion The BiliChek transcutaneous bilirubin assay is a safe alternative to laboratory bilirubin assay in deciding whether to give preterm neonates phototherapy.

Management of early-onset neonatal infections

Early-onset neonatal infection (EONI) refers to an infection arising within first 72 h after birth. In August 2012, the National Institute of Health and Care Excellence (NICE) published guideline on the use of antibiotics to prevent and treat early-onset bacterial infection in newborn babies.1 Key recommendations included treating suspected EONI as quickly as possible and minimise antibiotic exposure in babies who do not have EONI. NICE recommends measuring C-reactive protein (CRP) at presentation when starting antibiotics and repeating CRP 18–24 h later. Furthermore, it suggests stopping antibiotics at 36 h if baby is clinically well, blood culture (BC) is negative and CRP values/trends …

G287 Impact of telephone reminders on attendance rate at paediatric clinics

Background Non-attendance in clinics has a major economic impact in the National Health Service. Literature review indicates that the major reason for non-attendance is patients or parents forgetting their appointment and reminders before clinic appointment reduces the “did not attend” (DNA) rate. Telephone call reminders were introduced for all paediatric outpatient appointments from February 2014 in our District General Hospital setting. Aim We aimed to evaluate the DNA rate at the paediatric outpatients after implementation of telephone reminders. Methods Using our hospital outpatient database, DNA rates were reviewed for 6 months (Feb–July 2013) and compared with the DNA rates for similar duration in 2014 (before and after the introduction of reminders). For Feb–July 2014 period, comparison was also made for patients who confirmed attendance during reminders versus those left a voice message and those who didn’t receive a call or did not answer. Results Total number of patients in 6 months (2013) were 4156 [2674 follow-up (F/U), 1482 New] and 4732 (3100 F/U, 1632 New) in 2014 (Figure 1). Overall DNA rate for both F/U and New appointments in 2014 was 11.4% (post intervention), which was 5.1% (p value < 0.0001) lower than the total DNA rate in 2013 (16.5%). Although reduction was noticed in both F/U and New appointments but it was only statistically significant in follow up (6.9%, p value <0.0001) compared to new appointment (1.7%, p value 0.1470). Abstract G287 Figure 1 DNA rate results DNA rate was lowest at 3.4% in the patients who answered and confirmed the appointment. Patients confirming attendance were less likely to DNA compared to those patients who had voice messages (10.98% DNA, p value 0.0041) or not answering phone/not called (13.65% DNA, p value 0.0001). Conclusion Our results endorse the usefulness of telephone reminders and validates that confirmation of clinic appointment plays a significant role in reducing the DNA rate in the Paediatric outpatient setting. Telephone reminders and text messaging are extremely cost effective interventions, and hence routine reminders with confirmation of appointment should become standard NHS practice.

1568 Burton Neonatal track and Trigger Observation Chart

Background The use of early warning system scores and track & trigger charts is widespread in adult and paediatric hospitalised patients. Its use in neonatal group is not well recognized. Lack of well established normal ranges for biophysical variables in preterm/term neonates illustrate difficulties in establishing a scoring system that can potentially be used on the neonatal units and postnatal wards. Aim To develop neonatal track and trigger observation chart in order to enable early identification of neonates in need of urgent medical assessment and intervention. Methods A core group involving local paediatricians, neonatal nurses and midwifery sister was established to lead the project. The group contacted various neonatal units in different newborn networks in England seeking information if early warning scores or track & trigger system was being developed or already well established. Literature search was carried out to identify studies related to newborn early warning system scores. Results One relevant published study was retrieved from Medline search (Roland 2010). None of the neonatal units contacted had an established early warning neonatal scoring system. Group developed newborn observation chart for “At Risk” and “High Risk” Infants. It was based on neurophysiological parameters, intervention criteria and staff concerns. A decision tree was devised based on trigger scores. Conclusions Prospectively evaluation of Burton neonatal track and trigger observation chart is required to ascertain its efficacy. If found to be reliable and valid, it will facilitate observation of neonates deemed to be at risk and prompt an early review in triggered neonates.

1483 Burton Paediatric Early Warning System Score

Background Early warning scores compliment clinical decision making and can identify trends depicting deterioration in patient’s condition. Age appropriate Burton Paediatric Early Warning System (BPEWS) score charts were developed in 2011 using nine indicators which included physiological parameters, therapeutic intervention and doctor/nurse concern. Aim To assess the usefulness of BPEWS as a reliable and valid indicator for all children in need of urgent medical assessment and intervention. Methods A retrospective analysis of all children transferred to paediatric intensive care setting over the preceding 12 months was carried out to validate BPEWS charts. Detailed case notes review was undertaken to evaluate if BPEWS could have been useful to alert us of patients’ deterioration in the 24 hour period prior to transfer. Each case note was assessed by two reviewers. Results An average of 8.7 sets of observations per patient was recorded in the 24 hours period prior to intensive care transfer. Off the 200 sets of observations recorded in 23 patients, 93% sets would have triggered based on BPEWS. 44% sets of observation scores were in amber (4–7) while 35% were in red (>7) category. Average highest BPEWS score was 9.5 (range: 4–19). In 43% and 57% of patients, highest BPEWS score fell in amber and red category respectively. Conclusions BPEWS score charts are effective in identifying children at risk of sudden deterioration. Timely identification is likely to enable early action to reduce the risk of death or serious morbidity thus improving the outcome of care given to hospitalised children.

157 Survey on use of Caffeine in Apnoea of Prematurity in Neonatal Units Across England

Background Apnoea of prematurity (AOP) is a significant clinical problem in premature infants and is almost universal in infants < 1000 g at birth. Caffeine has emerged as the methylxanthine of choice to treat AOP. Although it is commonly used, there is no unified consensus or guideline on its use in NNUs in England. Aim To study the current practice of caffeine use in AOP at NNUs in England. Methods A telephonic survey of level 3 and level 2 units in England was conducted, using a standardised questionnaire, over November and December, 2011. Results Out of 52 units surveyed, 48% were level 3 units. All units used caffeine for treatment of AOP (base 60% and citrate 40% of units). 92% of units have written guidelines on caffeine use. Caffeine was started by 47% of units based on gestational age, regardless of symptoms.[IS3] All units used a loading dose, which varied between 5 and 25mg/kg (median of 10mg/kg) for caffeine base and 15 to 20mg/kg (median of 20mg/kg) for citrate. The maintenance dose varied between 2.5–6mg/kg/day (median of 5mg/kg/day) for base and 5–12mg/kg/day (median of 5mg/kg/day) for citrate. Caffeine levels were routinely performed by 7% of units. Caffeine was discontinued between 30 to 36 weeks gestation. Discussion Our survey depicts that practice of caffeine use varies significantly across NNUs in England. The results from this survey could be used as a footing for further data collection, for formulation of a uniform guideline maximising the utilisation of this extensively studied drug.

Sickness absence among medical professionals

Introduction Personal health, behavioural risks, stress and working conditions are some of the key factors responsible for sickness absence among personnel of an organisation. Staff sickness absence has a significant impact on the NHS, costing money, taking up time and ultimately affecting the quality of patient care. Although healthcare professionals are increasingly susceptible to catch infections due to direct exposure to patients with infective illnesses, it is estimated that doctors have lower rate of long-term absence compared to other medical personnel and manual workers. Objective To assess the sick leave rates within the department of paediatrics and to investigate its specific prototypes. Methods Retrospective analysis was undertaken of all sick leave taken by the doctors working in the department of paediatrics over a period of 4½ years. Results 46% of all the doctors called in off sick on 132 occasions (mean=29/year). 2/3 of these requests were for one day only. 1/4 of all sick leave was taken when the doctor was supposed to be doing his/her on call duties. The majority of the sick leave were taken between December and April. Almost 1/8 of all sick leave requests were made immediately prior to or after annual leave or bank holidays. Conclusion This is a comprehensive overview of sickness absence among doctors working in the paediatric department in a district general hospital setting. Further research is needed to evaluate similar data in other medical specialties within primary and secondary care. It is also crucial to investigate some of the factors which may potentially contribute to sickness absence in order to focus on programmes to lower these rates in a sustainable way.