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Abstract Body

Introduction and objectives

The commitee in charge of the follow-up of neurologic diseases in the first level ( Primary Care) and the Hospital, studied the factors that may cause modifications in the usual treatment in ADHA.

Instruments and procedure

Descriptive, retrospective (2015-2019) study in the Aljarafe-Noth Seville Sanitary HealthCare District (ANSHD) was carried out in children 0-15 years old. Clinical records were reviewed looking for ADHD treatments: methylfenidate (MF), lisdexanphetamine (LA), guanfacine (GU), clonidine, that requiere an individualized authorization process, on the drug prescription data. Bivariate and multivariate analysis were conducted. Records were anonymized and treated according to International Council for Harmonisation guidelines.

Results

We reviewed 4456 patients, 79,6% male, mean age 12.4 +/- 3.1 years. The most prescribed drug was MF (88,6%), followed by LA (10,2%). MF was the most prescribed treatment in females (91.0 vs88.0; p=0.012) meanwhile, LA and GU were more prescribed in males (p=0.085) and (p=0.0041), respectively. Polytherapy decreased (4.7% to 1.9%; p=0.0005) and median overall cost associated with drugs (308.94 € to 213.71€) (p=0.0005). Based on geographic area and year of prescription, MF and LA were related to gender and age. The global cost per patient was related to year of prescription, geograpfic area in the district, gender and age (p=0.0005).

Conclusions

From 2015 to 2019, we have improved the adequacy of the specific therapy for ADHA, decreasing multiple therapy, adjusting each drug to patient characteristics and increasing the eficiency of every treatment.

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Objectives. To study the impact of indoor aerosol pollution in schools on the incidence of respiratory infections and asthma in younger school age children.

Material and methods. The aerosol particle number concentration (PNC) and particle mass concentration (PMC) were measured in 11 primary schools of Vilnius using an Optical Particle Sizer (OPS, TSI model 3330) [Prokopciuk N, et al. Environ Sci Pollut Res 2020]. 3638 children of 6-11 years of age were involved in this survey. Retrospective annual morbidity data were collected from Institute of Hygiene. Dependence of the annual morbidity on PNC and PMC was expressed by linear function y = a + b·X with constant terms (a) responsible only for morbidity due to the exposure in the household conditions and variable term (b·X) proportional to the respective indoor concentrations (X) in schools and (b) – the respective coefficient of proportionality.

Results. The level of indoor air pollution varied in schools in the range of 40.47-189.88 part/cm³ (PNC) and 2.02-7.63 µg/m³ (PMC). Strong correlation was found between incidence of asthma exacerbations and PNC and PMC in the particle size range of 0.3-1.0 µm (r=0.656, p=0.028 and r=0.696, p=0.017). No correlation was found between the level of indoor air pollution at schools and incidence of acute respiratory infections and pneumonia.

Conclusion. Elevated aerosol particle number and mass concentrations in primary schools particularly in the size range of 0.3-1.0 µm are related to increased asthma exacerbation rate in younger school age children.

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Background and Aims: Children are regularly referred to paediatric intensive care following poisoning. This study reviews referrals to the largest UK PICM transport team investigating the clinico-epidemiological profile and outcomes of these children.

Methods: This 5-year retrospective study was conducted by reviewing the transport team database April-2015 to March-2020.

Results: Ninety-one patients were referred, 40(44%) male, 51(56%) female. Intentional poisoning accounted for two-thirds (58,63.7%) and was associated with female gender and older age group. Accidental poisoning was associated with male gender and younger age (P<0.001, CI 95%).

Comorbidity (medical and mental health) predisposed to intentional poisoning, depression being most common.

Ingestion was the commonest route (86,94.5%). Prescribed drugs (61,67%) were most frequently implicated (antidepressants most common), four-fifths were intentional overdoses. Household chemicals followed (17,18.7%), all were accidental.

Neurological symptoms were most common (57,62.6%), followed by metabolic derangements (33,36.3%). 30 children required intubation for airway protection, none for respiratory symptoms.

Forty-one (45%) required ICU admission. Co-morbidity, intubation and airway/oropharyngeal trauma were associated (P<0.05). Six children developed liver failure, 2 renal failure requiring CRRT and coagulopathy, 8 airway/oropharyngeal trauma. One listed for liver transplant and 1 died (1.1%).

Conclusion: Prescription drugs and accidental ingestion of household chemicals are the most common poisons requiring referral to PICU suggesting that public health initiatives highlighting attention to security of these at home may reduce admissions. Children with mental health comorbidities are at increased risk for intentional poisoning requiring PICU. Treatment is usually supportive with antidote administration when available.

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Objective: To assess the prognostic performance of the parent-completed Age and Stage Questionnaire (ASQ) at age 2 for cognitive impairment prediction at age 5.5 in premature children.

Methods: Data from 1832 children born before 35 weeks in the French population-based cohort EPIPAGE-2, assessed at age 2 by the ASQ and at age 5.5 by the WPPSI. The primary outcome was the intelligence quotient (IQ). The overall accuracy of the ASQ was studied using a Receptor Operating Characteristic (ROC) curve with IQ<-2SD as outcome, and analyzed of according to child gender, gestational age, mother educational level. AUC, sensitivity and specificity were compared between each class of sub-group.

Results: The median ASQ score was 230 [IQR:202;260]. 159 children (6.6%) had an IQ <-2SD. The Area Under the Curve (AUC) was 0.73 [0.69;0.77]. Optimal threshold was 211 with a 0.62 [0.54;0.69] sensitivity, 0.70 [0.68;0.72] specificity. ASQ performed best in children born at 24-26 weeks with AUC = 0.83 [0.76;0.90], p=0.01 compared with children born at 27-31 and 32-34 weeks and sensitivity= 0.83 [0.7;0.96] (p<0.001). We didn’t find a significant difference between ASQ’s prognostic performance by child gender and mother educational level, regarding to AUC, sensitivity or specificity.

Conclusion: ASQ total score at age 2 could be used as a predictor of cognitive impairment at age 5.5 in premature children, with a better performance particularly in children born at 24-26 weeks. Further studies are needed to determine a better performance for a more global vision of the child's functioning at 5.5 years.