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Background: EoE perinatal network has 18 hospitals with 3 lead units. In line with network guidelines the neonatal transport service transfers babies between network lead units depending on the level of care required. This process is prolonged with potential for medication errors during each change as network units use different drug infusion policies and concentrations.Aim:1. Survey of our current infusion concentrations used within the network2. Implementation of unified drug prescription across network.Method: Between June and October 2009 an email questionnaire followed by telephone survey was sent to pharmacists and local NICU lead nurses in each unit requesting information on the concentrations of their top 10 drug infusions, and types of pumps and syringes used.Survey results: Data collected from the survey shows wide range of infusion concentrations used for commonly prescribed infusions. The results were discussed in the network board meeting, a proposal for unified prescription was put forward to the clinicians' development group and network user group which reviewed and accepted proposal. The final proposed unified drug infusion concentrations, with introduction of standard syringe labels will be implemented across the region from April 2010.Conclusion: With the development of networks and transfer of babies within the network it is important to have a common agreed prescription for infusions, pumps and syringes. We believe this will reduce time for transfers, reduce medication errors and improve the quality of care as well as supporting the national QIPP agenda.

Unsedated transnasal endoscopy (TNE) is an alternative method of examining the esophageal mucosa in pediatric patients with eosinophilic esophagitis (EoE), reducing cost, time, and risk associated with frequent surveillance esophagogastroduodenoscopies (EGD). Adequacy of transnasal esophageal biopsies for the evaluation of eosinophilic esophagitis histologic scoring system (EoEHSS) has not yet been evaluated. We compared procedure times, endoscopic findings, and EoEHSS scoring for EoE patients undergoing TNE versus standard EGD. Sixty‐six TNE patients and 132 EGD controls matched for age (mean age 14.0 years) and disease status (29.3% active) were included. Compared to patients undergoing standard EGD, patients undergoing TNE spent 1.94 h less in the GI suite (p< 0.0001), with comparable occurrence rates of all visual endoscopic findings and most EoEHSS components. TNE serves as a useful tool for long‐term disease surveillance, and consideration should be given to its use in clinical trials for EoE. •Patients with eosinophilic esophagitis (EoE) require frequent surveillance esophagogastroduodenoscopies (EGDs), resulting in significant cost burden, time investment, and potential procedural risks.•Unsedated transnasal endoscopy (TNE) is an effective alternative method of examining the esophageal mucosa in the pediatric population.•Adequacy of biopsies obtained from TNE for EoE Histologic Scoring System is unknown. Patients with eosinophilic esophagitis (EoE) require frequent surveillance esophagogastroduodenoscopies (EGDs), resulting in significant cost burden, time investment, and potential procedural risks. Unsedated transnasal endoscopy (TNE) is an effective alternative method of examining the esophageal mucosa in the pediatric population. Adequacy of biopsies obtained from TNE for EoE Histologic Scoring System is unknown. •TNE biopsies are adequate for the evaluation of eosinophilic esophagitis histologic scoring system (EoEHSS).•Compared to standard EGD, TNE biopsies show comparable occurrence rates for all visual endoscopic findings and most EoEHSS components. TNE biopsies are adequate for the evaluation of eosinophilic esophagitis histologic scoring system (EoEHSS). Compared to standard EGD, TNE biopsies show comparable occurrence rates for all visual endoscopic findings and most EoEHSS components.

Recurrent upper endoscopies are essential for monitoring therapy response and disease activity in patients with eosinophilic esophagitis (EoE), leading to increased costs, procedural complications, and anesthesia exposure. The aim of this study was to examine an office‐based model using serial sedation‐free blind esophageal epithelial brushing (BEEB) to monitor therapy response through eosinophil‐derived neurotoxin (EDN) levels and guide therapy plans in pediatric EoE patients. EoE patients (≤21 years of age) were enrolled in this prospective study. Subjects were placed on dietary, pharmacologic, or combination therapy with the goal of inducing or maintaining remission. To assess response to sequential interventions, subjects underwent sequential sedation‐free BEEBs through nasogastric tubes to measure EDN levels. Based on serial brushings, an individual plan of diet, medications, or a combination of both was created for each subject, and a final endoscopy was then performed to validate the accuracy of the individual plans. Twenty‐four subjects completed the study. The average peak eosinophil count in patients with active EoE was 58.1 ± 30.8 eosinophils per high‐power field and mean EDN level was 165.2 ± 191.3 μg/mL. A total of 42 BEEBs were completed. Individual therapy plans based on sequential BEEB were accurate in 19 out of the 24 patients (79%) and specifically nine out of 10 patients (90%) treated with elimination diets. This study suggests that office‐based sedation‐free BEEBs can be used to monitor therapy response and disease activity in pediatric EoE patients. In eosinophilic esophagitis (EoE) patients, eosinophils deposit eosinophil‐derived neurotoxin (EDN) on the luminal surface of the esophagus.EDN measured at 10 μg/mL and higher in esophageal brushing samples obtained through a nasogastric tube (NGT) is highly sensitive (97%) and specific (89%) for the diagnosis of active EoE.Blind esophageal epithelial brushing obtained via an NGT is safe and well tolerated. In eosinophilic esophagitis (EoE) patients, eosinophils deposit eosinophil‐derived neurotoxin (EDN) on the luminal surface of the esophagus. EDN measured at 10 μg/mL and higher in esophageal brushing samples obtained through a nasogastric tube (NGT) is highly sensitive (97%) and specific (89%) for the diagnosis of active EoE. Blind esophageal epithelial brushing obtained via an NGT is safe and well tolerated. Blind esophageal epithelial brushing can be used successfully to monitor therapy response and disease activity in pediatric patients with established EoE, especially those on elimination diets. Blind esophageal epithelial brushing can be used successfully to monitor therapy response and disease activity in pediatric patients with established EoE, especially those on elimination diets.

Eosinophilic esophagitis (EoE) is a chronic and progressive immune-mediated esophageal disorder. Given its increasing incidence, it is now a leading cause of dysphagia and food impaction in the United States. Eosinophilic esophagitis is most common in adult White men and has a high concurrence rate with other atopic conditions like allergic rhinitis, bronchial asthma, and eczema. The initial presentation includes symptoms of esophageal dysfunction, classically solid-food dysphagia. Without treatment, inflammation can progress to fibrosis with the formation of strictures, leading to complications such as food impaction. It is a clinicopathologic disease requiring compatible clinical symptoms and histologic evidence of eosinophil-predominant inflammation of the esophageal epithelium with more than 15 eosinophils per high-power field. The mainstay of management includes the 3 d’s (diet, drugs, dilation): dietary modifications to eliminate trigger food groups; medications including proton pump inhibitors, swallowed topical glucocorticoids, and dupilumab; and esophageal dilation to manage strictures. Various elimination diets have been found to be effective, including 1-food, 2-food, 4-food, and 6-food elimination diets. Dupilumab, a humanized monoclonal antibody that regulates interleukin 4 and 13 signaling pathways, has shown promising results in clinical trials and was approved by the Food and Drug Administration in 2022 for use in EoE. Symptom alleviation, although important, is not the sole end point of treatment in EoE as persistent inflammation, even in the absence of symptoms, can lead to esophageal fibrosis and stricture formation over time. The chronic nature and high recurrence rates of EoE warrant maintenance therapy in patients with EoE after initial remission is achieved.

The incidence of eosinophilic esophagitis (EoE) is 3−5 times greater in patients with inflammatory bowel disease (IBD) compared with the general population. This study aimed to differentiate true EoE from esophageal eosinophilia in IBD patients by evaluating expression of major basic protein (MBP) and interleukin‐13 (IL‐13) in esophageal biopsies. This retrospective study included subjects who had an esophagogastroduodenoscopy with esophageal biopsies for IBD work up or suspicion for EoE. Patients were classified into 5 groups: EoE with ≥15 eosinophils per high power field (eos/hpf), EoE‐IBD with ≥15 eos/hpf, IBD eosinophilia with 1−14 eos/hpf, IBD and control groups. Biopsies were stained with MBP and IL‐13 antibodies and the results (% staining/total tissue area), demographic, and clinical findings were compared among the groups. The median for MBP staining levels in EoE‐IBD was 3.8 (interquartile range 1.3−23), significantly lower than in EoE at 52.8 (8.3−113.2), but higher than in IBD eosinophilia at 0.2 (0−0.9; p< 0.001) and negligible in the IBD and control groups. IL‐13 expression in EoE was significantly higher only compared with IBD and controls not with EoE‐IBD or IBD eosinophilia. MBP predicted EoE with 100% sensitivity and 99% specificity while IL‐13 had 83% sensitivity and 90% specificity using cutoff point from the cohort without EoE‐IBD patients. Based on MBP cutoff point that distinguished EoE from non EoE, 56% in EoE‐IBD were MBP‐positive whereas 100% in EoE group (p< 0.05). MBP may be an excellent marker in distinguishing true EoE from eosinophilia caused by IBD. Our data implied that MBP together with endoscopic and histologic changes can assist EoE diagnosis in IBD patients. Eosinophilic esophagitis (EoE) is 3−5 times greater in patients with inflammatory bowel disease (IBD) compared with the general population.Eosinophil infiltration (≥15 eosinophils per high power field) of the esophagus is 1 of the key features of EoE.Major basic protein (MBP) and interleukin‐13 (IL‐13) have been shown to be upregulated in esophageal biopsies of EoE. Eosinophilic esophagitis (EoE) is 3−5 times greater in patients with inflammatory bowel disease (IBD) compared with the general population. Eosinophil infiltration (≥15 eosinophils per high power field) of the esophagus is 1 of the key features of EoE. Major basic protein (MBP) and interleukin‐13 (IL‐13) have been shown to be upregulated in esophageal biopsies of EoE. EoE‐IBD patients had significantly lower MBP expression compared with EoE patients.Our study cohort indicates that the EoE‐IBD is a heterogeneous group consisting of true EoE with high MBP expression and esophageal eosinophilia elicited by IBD inflammation with low MBP.IL‐13 expression was significantly higher in EoE patients compared with IBD only and control patients. EoE‐IBD patients had significantly lower MBP expression compared with EoE patients. Our study cohort indicates that the EoE‐IBD is a heterogeneous group consisting of true EoE with high MBP expression and esophageal eosinophilia elicited by IBD inflammation with low MBP. IL‐13 expression was significantly higher in EoE patients compared with IBD only and control patients.