Background

Up to 40% of pediatric cancer patients require admission to PICU during the course of their disease. However, scarce are available on the standard of care in critical care delivery for this patient group, nor are systematic multi-center outcome data.

Objectives

To obtain consensus on the top five research priorities in the field of pediatric cancer patient critical care.

Methods

We conducted a three-round modified Delphi consensus process among pediatric intensivists and pediatric oncologists in Europe. An anonymous questionnaire was distributed online via SurveyMonkey. POKER consortium members drafted ten candidate research topics. Participants rated these topics using a 4-point scale. Research questions that met a priori consensus thresholds for >80% high priority were included in round 2, complemented with additional research topics suggested by participants. Round 2 yielded consensus on high prioritiy topics, which were ranked by POKER member in round 3 to create a final top five .

Results

One-hundred seventy-four and 154 colleagues participated in rounds 1 and 2, respectively (Fig. 1). Five research topics were identified as top priorities: (1) Optimal timing of the use of life-sustaining therapies; (2) Development of specific early warning scores; (3) Role of non-invasive ventilation in acute respiratory insufficiency; (4) End-of-life care and ethical issues; (5) Sepsis.

Profession and country of residence of the participants.

Conclusion

Admissions of pediatric cancer patients contribute to a substantial proportion of critical care patient- and work-load. In particular, optimum use of critical care resources in this group is an area requiring urgent research.

Background

Achieving adequate nutrition in preterm or very sick infants is vital but equally challenging for different reasons.

Objectives

Objective

To describe practices around gastric residual volume (GRV) measurement in UK neonatal units (NNUs) as part of a feasibility study.

Methods

Methods

Cross-sectional electronic survey of all UK neonatal units, in October 2018. A doctor, nurse and dietician triad were asked to complete the survey collaboratively.

Results

Results

95/183 (52%) NNUs completed the survey, a mixture of neonatal intensive care units (71%), local neonatal units (47%) and special care baby units (33%). 85% (81/95) NNUs had written guidance around enteral feeding. Most (94.7% 90/95) units fed by bolus feed with only 5% feeding continuously. 42% NNUs provided guidance around GRV measurement. 29% (5/17) NNUs that admitted both medical and surgical babies reported having different guidance for these different babies. NNUs reported variable frequency of GRV measurement from before every feed (22%) to only when clinically indicated 30% with a range of ‘other’ responses. Decision-making around GRV aspirate was made predominantly by the bedside nurse (62.2%) or nurse in charge (28.9%).

Conclusion

Conclusions

The routine measurement of GRV remains a common practice in UK NNUs, further work will explore in more detail clinicians and parental views around this practice.

Funding acknowledgement
This study was funded by the NIHR HTA ref 16/94/02

Department of Health and Social Care disclaimer
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.