Recorded sessions on demand will be available 24 hours after the session ends

Abstract Body

Background and aims

Physical activity, psychosocial well-being and participation levels are often reduced in children and adolescents after cancer treatment. The current study determines the effects of a personalized interdisciplinary intervention program at the level of functioning, activities and participation.

Methods

Patients between 8 - 21 years and within 6 months up to 5 years post-acute cancer treatment were recruited. Body composition, maximal oxygen consumption during cardiopulmonary exercise test, quality of life (QoL), and participation levels were assessed at baseline, after 4 months of intervention and at 12 months follow-up. Intervention consisted of an individualized physical program 3 times/week. Additionally, education sessions were implemented on a monthly basis for 4 months concerning psychological well-being, nutritional habits and participation in terms of fatigue, energy management and hobbies. Time (pre and post intervention) and group (patients < 1 year and ≥ 1 year post-acute cancer treatment) were compared via linear mixed models analyses.

Results

Twenty-three patients were included (9 patients < 1 year and 14 patients ≥ 1 year post-acute cancer treatment). The results after 4 months intervention displayed significantly increased VO2peak, load, dry lean weight and QoL-fatigue reported by parents. No interaction of time with group was objectified.

Conclusions

The improvements in physical fitness, dry lean weight and QoL were not different between groups. This implicates positive effects of the intervention for both patient groups. Nonetheless, these results should be confirmed in a larger sample size. Moreover, the outcomes after 12 months follow-up are needed to steer conclusions about long-term effects.

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Background and aims

Children with fever on cancer treatment are at risk of significant infection. Febrile neutropenia, an oncological emergency, is defined as a temperature >38°C in a child with a neutrophil count of 0.5×109/L or lower. We appraised all the paediatric oncology admissions to evaluate if we are meeting the gold standard recommendation of administering intra venous antibiotics within one hour of admission/presentation.

Methods

Records of all oncology patients admitted with febrile neutropenia between Jan-Dec 2019 were retrospectively analyzed. Patients were identified from clinical coding, paediatric oncology database and minutes of the monthly paediatric oncology multi-disciplinary team meetings.

Results

8/13 active oncology patients visited hospital in 2019. Out of 53 visits for various reasons, 20 episodes of febrile neutropenia required hospital admission. Median duration from admission to antibiotic prescription and admission to administration of antibiotics was 26 minutes (2-109 minutes) and 53 minutes (12-133 minutes) respectively. Median time lag between prescription to administration of antibiotics was 18 minutes (3-41 minutes). Overall, during 13/20 (65%) episodes, patients received antibiotics within 1 hour of admission compared to 25% in 2013-14. Some of the reasons for delay were patient requiring cannulation, patient arriving at handover time and concurrent paediatric resuscitation.

Conclusions

There remains an urgent need to reach 100% target in administering antibiotics within 60 minutes of admission in febrile neutropenic oncology patients. An electronic order set for requesting investigations and antibiotic prescription has now been implemented in hospital patient record. Nurse led prescription for this group of patients is also being explored.

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Background:

Many units across the UK and Europe use HFNCO₂ only within the critical care department. Prior to the introduction of ward level high flow nasal cannula oxygen (HFNCO₂) ten percent of patients admitted with a diagnosis of bronchiolitis required high dependency (HDU) care in our tertiary centre. The median length of stay in HDU was 7.8 days for bronchiolitis patients.

Aim:

To introduce ward level HFNCO₂ for the management of bronchiolitis and audit the impact on critical care floor beds (HDU).

Methods:

1. Produced an evidence-based guideline for HFNCO₂ use at ward level in the management of bronchiolitis.

2. Created a working group and instituted staff training.

3. Sought management approval for funding of 2 machines for ward level use.

4. Implemented the protocol in September 2018.

5. Interim audit of the use and outcomes February 2019.

Results:

Thirty eight patients received ward HFNCO₂. One patient had chronic lung disease, three patients a cardiac diagnosis and one a neuromuscular comorbidity. Table 1 shows the demographics, management and outcomes. Ten patients were escalated to high dependency however only 4 of which required non-invasive ventilation.

Overall there were 103 days of ward HFNCO₂ use.

Conclusion:

The audit has shown that we have already made one HDU bed available for other patients for the equivalent of 3.3 months during the busiest period of the year when critical care beds are at crisis point. There were no adverse events. The median length of hospital stay for this patient group was not increased.

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Background:

Atelectasis frequently occurs early on during anesthesia in children.

We hypothesized that positive expiratory pressure (PEP) generated via high-flow nasal cannula (HFNC) could prevent atelectasis in non-intubated children under general anesthesia.

The objective was to compare the volume of atelectasis present in patients treated via HFNC to that of patients treated via a face bag-mask without PEP. The outcome used for this comparison was the ratio of the atelectasis volume to the total pulmonary volume.

Methods:

A prospective single-center, single-blind, randomized trial was conducted in a tertiary hospital from November 2018 through May 2019. The trial subjects were infants and children between six months and six years of age who required anesthesia for an MRI.

The children were randomized to receive sevoflurane for maintenance of anesthesia either via a classic face bag mask or by HFNC.

The atelectasis volume was measured from thoracic MRI images. The judgment criterion was the ratio of the atelectasis volume to the lung volume.

Results:

Of a trial group of 42 patients, 21 received anesthesia via a face bag-mask and 21 via HFNC. After three patients were excluded for technical issues, the data for 39 patients were analyzed.

The atelectasis volume to the lung volume ratio in the HFNC group was significantly smaller than the ratio for the face bag-mask group (1.6 % vs. 6.8 %, respectively; p = 0.002).

Conclusion:

HFNC was associated with a lower atelectasis lung ratio compared to using a face bag-mask during anesthesia for children maintained with spontaneous ventilation

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Background

Children with adrenal insufficiency are unable to mount a physiological stress response and are at risk of life-threatening adrenal crises if glucocorticoid replacement is not increased appropriately during times of illness. There is a paucity of evidence defining exactly when ‘sick day rules’ should be instituted and as a result significant variability in practice occurs. ESPE guidelines currently recommend increased steroid replacement during febrile illness (>38.5C), gastroenteritis with dehydration, major surgery and trauma. We sought to ascertain the current level of knowledge amongst a cohort of paediatric doctors.

Methods

An anonymous questionnaire was issued to 50 doctors working in a tertiary paediatric hospital in Ireland. Doctors from a variety of disciplines and with varying levels of experience were surveyed.

Results

Of 50 questionnaires issued, 36 were returned completed. Very few respondents had personal experience of managing children with adrenal insufficiency and even less reported confidence in the initial management of an adrenal crisis, despite the existence of local guidelines. Significant deficits in the understanding of indications for stress dosing, types of steroid replacement utilised, appropriate dosing regimens and the management of adrenal crisis were identified.

Conclusion

Adrenal crisis remains a significant cause of paediatric mortality and though preventable, continues to occur in children with known adrenal insufficiency. This study highlights the need for increasing awareness of the clinical presentation and management of adrenal insufficiency in children. Local guidelines were updated and formal education commenced at our institution following this study.

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Background: Juvenile inflammatory idiopathic myopathies (JIIM) are a group of acquired autoimmune disorders affecting muscle and skin. Time-to-diagnosis is usually prolonged, with mean delay of 6 months. Method: We report the cases of 3 adolescents with final diagnosis of JIIM over 5-year-period. Their medical charts were reviewed. Results: Three adolescents were admitted to our Pediatric Unit for persistent asthenia and elevation of muscle enzymes. They had started manifesting fatigue and reduced exercise tolerance median 8 months before admission. First laboratory tests showed high levels of CPK, GOT and GPT; the physicians had hypothesized Ebstein-Barr virus (EBV) infection in all. Persisting asthenia, they were hospitalized. The distribution of muscle impairment (neck and girdles) and the markedly increased muscle enzymes (median values CK 2832 U/L) led to the suspicion of JIIM. Whole-body MRI revealed high level of muscle inflammation using the proposed activity score. Myositis specific antibodies (MSA) and Myositis associated antibodies (MAA) showed positivity of anti-NXP-2 and anti-HMGCR in two cases, who later developed severe skin involvement and calcinosis and necrotizing myositis, respectively. All patients underwent to IVIG and high-dose intravenous methylprednisolone pulse-therapy, followed by oral steroid therapy associated with immunosuppressant (MTX and MMF) Conclusions: Despite the low incidence, JIIM should be taken into account facing adolescents with chronic asthenia and weakness: in this setting, including LDH, CPK, aldolase, GOT, GPT in blood tests can reduce diagnostic delay. Whole-body MRI can be useful to confirm the JIIM suspicion. MSA and MAA can contribute to predict the patient’s prognosis.

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DIABETES SURVEY FOR PAEDIATRIC TRAINEES WORKING IN A TERTIARY HOSPITAL ABOUT DIABETES MANAGEMENT

M Alkotamy¹, T Idris¹

University Hospital of North Midlands¹, UK

Background:

Type 1 diabetes affects more than 25 000 children and young people in the United Kingdom and incidence is increasing. Intensive glycaemic control decreases complications of T1D and multidisciplinary team work is crucial for improved outcome.

Aims of the survey:

Self-assessment of paediatric trainees for their confidence in managing different diabetes related problems.

Identify trainees’ educational needs in managing different diabetes related problems.

Make a plan to Improve diabetes teaching for trainees and subsequently to improve care of diabetic children.

Methods:

Four-point confidence rating scale of Royal College of Physicians was used. Trainees working in the general paediatric ward, children assessment unit and PICU at University Hospital of North Midlands in the period from September to December 2019 were included.

Results:

31 trainees responded to the survey, 15 middle grade and 16 junior doctors.

Only 1/2 of trainees were fully confident in diagnosing and managing diabetes and DKA.

2/3 of trainees found both fluid management and electrolyte imbalance the most challenging part of DKA management.

Nearly 1/3 of the registrars were not confident in adjusting insulin doses prior to surgeries and procedures or giving telephone advice.

Conclusion:

Nearly half of the trainees were not confident in managing different aspects of diabetes in children .A plan was made to conduct more teaching sessions in various topics related to diabetes and to encourage trainees to attend diabetes clinics.