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Background Hepatitis remains a key public health priority globally. Most childhood cases are caused by viruses, especially hepatitis A virus (HAV) and hepatitis B virus (HBV). This study aimed to estimate the burden of acute infectious hepatitis in hospitalised children and to describe their clinical characteristics and outcomes. Methods Paediatricians in the UK and Ireland reported cases in children aged 1 month to 14 years diagnosed between January 2014 and January 2015 (inclusive) through the British Paediatric Surveillance Unit (BPSU) and completed a detailed questionnaire. Additional HAV and HBV cases in England and Wales were identified through a national electronic database, LabBase2. All confirmed cases were followed up at 6 months with a second questionnaire. Results The BPSU survey identified 69 children (annual incidence, 0.52/100 000), including 27 HAV (39%), three HBV (4%), 16 other viruses (23%) and 23 with no aetiology identified (33%). LabBase2 identified an additional 10 HAV and 2 HBV cases in England. Of the 37 hospitalised HAV cases, 70% had travelled abroad, but only 8% had been vaccinated. Similarly, three of the five children with acute HBV had not been immunised, despite being a household contact of a known infectious individual. All patients with HAV recovered uneventfully. In contrast, three children with acute HBV developed liver failure and two required liver transplantation. Conclusions Acute infectious hepatitis is a rare cause of hospital admission. Most children recovered without complications, but those with acute HBV had severe presentations. At least three of the five HBV cases could have been prevented through appopriate vaccination of household contacts.

Background and aims Metabolic decompensation may occur in patients with disorders of intermediary metabolism during intercurrent illness. Early intervention strategies are crucial in order to halt decline. This poses a particular challenge in emergency departments (EDs), particularly at peak times. Impending deterioration may not be clinically apparent, and so may not result in prioritisation for initial assessment or subsequent triage categorisation. It is therefore crucial to ensure appropriate care pathways are in place, yet there are no existing national guidelines regarding timeliness of ED assessment for these patients. We therefore aimed to assess current practice to inform service development. Methods Retrospective electronic database and medical chart review over a 3 month period. Nine standards were set through consensus between the ED and inherited metabolic disease (IMD) teams, relating to timeliness, notifications and assessment criteria (grade of clinician and assessment performed). Results Of 38 IMD presentations, 30 were deemed at risk of decompensation due to their condition. 33 (92%) had an electronic diagnosis alert, 28 (83%) had a specific electronic ED management plan. 21 (54%) were triaged within 15 min of arrival, and following triage 8 (21%) and 19 (50%) were seen within 10 and 30 min respectively. There was no apparent correlation with triage category. 8 were discharged prior to senior review 6 of which were at risk of decompensation. 13 of the 30 patients at risk of decompensation received IV/NG fluids 5 of which were within an hour. Conclusions Patients at risk of decompensation due to an inborn error of intermediary metabolism are difficult to identify, and subsequently may not fulfil criteria for urgent assessment. Use of electronic alerts, in conjunction with training, departmental policies, and tailored management plans are likely to improve care, and have been implemented. Clarity of communication is key, specifically in identifying those most likely to deteriorate unexpectedly. However, this study was not designed to identify whether or how quickly any patient deteriorated. Further multicentre work is therefore crucial to delineate optimal assessment and intervention timelines, and will result in the development of national standards that will improve both short and long term outcomes for this vulnerable group.

Aims In many UK hospitals, the Paediatric Assessment Unit (PAU) is part of the acute paediatric ward setting that receives acutely unwell children referred from a number of sources. This study aims to investigate the pattern of attendance to a PAU at a large District General hospital in the northwest and explores parents’ satisfaction with the services provided, with the ultimate aim of improving the provision of such services. Methods A retrospective study analysed patient admissions to the PAU, between August 2011 and May 2012, using data from an electronic database (n = 5456). In addition, a questionnaire was devised to measure parent satisfaction with the services offered. One hundred and nineteen parents who accompanied their children filled the questionnaire in the period between 21st May and 13th June 2012 (n = 119). Results The mean age of children attending the PAU was 4.5 years. More children attended the PAU on weekdays than weekends, with Monday and Tuesday having the highest rates of attendance. The busiest times were from 17:00–22:00 hours. Despite a mean length of stay of 3.6 hours, parents were generally satisfied with this time (62%). Almost all parents were satisfied with the level of care provided (83.8%). Although the majority were also satisfied with the level of information given (76.5%), there remained a substantial minority who were not. Conclusion The number of patients attending the PAU varied across days of the week and times of day. Attention needs to be given to staffing PAUs between 17:00–22:00 hours as this is the busiest time with much reduced staffing usually. On the whole, parents were satisfied with their experience within the PAU. However, the length of stay of patients in the PAU needs to be reduced without harming the quality of patient care. A substantial minority were not satisfied with the level of information they received. This may be attributed to pressure of time on staff.

Discharge planning for the well newborn is often overlooked and is increasingly recognised as an important function of any neonatal unit. We analysed factors associated with presentation of a newborn ( Aim The aim was to gather data that could inform policy on discharge planning. This includes education for parents on the services available to them and on normal newborn care. Methods Data was collected from an electronic database in the case of the PED and the local GP. It was collected prospectively manually in the maternity hospital. Results In total 276 patients under 6 weeks of age presented to the three services over the three week period. Almost half of these visits were unscheduled (137/49%). Of those that were unscheduled, 29% were felt to represent benign neonatal variants whilst 20% were simple feeding problems. Discharge rates did not vary hugely between referrals made from GPs (56%), Nurses (57%) or the parents themselves (67%). Discussion A proportion of reviews were felt to be inappropriate and could have been prevented with parental education. The similar rates of discharge between the three sources of referral also suggests that both GPs and nurses in the community are not comfortable with caring for newborns. There is room for cost saving and quality improvement of the service through education.

Background Hypoxic Ischaemic Encepalopathy (HIE) affects 1–2 per 1,000 live births in UK. The TOBY study showed that therapeutic hypothermia (TH) is beneficial for babies with moderate HIE. In view of this we established an in-house cooling service. Aim To review our experiences in establishing an in-house cooling service. Methods The Badger electronic database was used to identify babies who received TH in the last 2 years (01/01/10 to 31/12/11). The management and outcomes were analysed. Results In the last two year, 27 babies’ commenced in-house TH. 3 babies were transferred out to another unit for TH for bed capacity reasons. A further 3 babies died before discharge home. 19 babies received the full 72 hours of cooling in our centre. We did not encounter any major complications with the servo-controlled cooling mattress. Only 50% of babies had their MRI in the defined time period as per the TOBY guidelines. All babies are being followed up by a dedicated consultant Neonatologist and neurodevelopmental physiotherapist to assess their neurodevelopment up to the age of 2 years. Conclusion We have safely established an in-house cooling service by following the TOBY guidelines. The servo-controlled cooling mattress provides a safe cooling process with a rectal probe. Identifying these babies early and the interpretation of CFAM was an important aspect of training. Our main challenge was to get an MRI post cooling in a timely fashion. This has been resolved with an agreed dedicated slot for these babies at Birmingham Children’s Hospital.

Background Near term infants are prone to more medical problems than full term infants requiring more neonatal intensive careunit (NICU) admissions . Aim Study the impact of near term infants on the utilization of NICU beds. Methods Retrospective collection of hospital newborn electronic database from January 2007 – December 2011. Two groups were identified group 1 infants 37 weeks and above and group 2 near term infants 34 weeks-36+6 weeks. The following demographics collected, Birth weight (BWT), Gestational age (GA), gender, length of stay (LOS) and NICU admission. Results The number of newborns delivered during the study period were41089. Near term infants were 3722 (9%). Mean birth weight was 3.1±0.458 kg for group 1 and 2.42±497 kg for group 2 (p 0.0001) . 5835 (14%)infants required NICU admissions at birth in group 1 and 1025(28%) in group 2 (p 0.09 ). LOS was calculated a mean of 2.58±3.33 days in group 1 and 8.5±15.58 days in group 2 (p .0001). Using multiple regression analysis birth weight and male gender were predictors for prolonged hospital LOS and the need for NICU admission in both groups. Conclusion In our population near term infants were more likely to utilize NICU beds for significantly longer LOS compared to full term which increases costs and limit availability of NICU beds in our community.

Aim Recent advances in management of paediatric malignancy have resulted in improved survival. However, intensive treatment may necessitate PICU support. The aim of this study was to clarify which patients require admission to PICU, why and what happens to them? Methods A retrospective analysis of the PICU electronic database was performed. Patients from the haemato-oncology parent group admitted during a 5 year period (1st April 2006 - 1st April 2011) were identified but those with benign conditions were excluded. The records for each admission were then analysed and data extracted using a standard proforma. Results 96 patients were admitted 151 times during the 5 year period. 30 patients (42 admissions) were elective post op admissions for observation only and all were discharged to the ward within 36 hrs. 77 patients had 109 admissions for acute illness. Presumed sepsis was the main (44%) reason for admission with a further 10% due to pneumonia, 6% due to reduced conscious level, 6% with myocardial compromise and 3% with seizures. ALL was responsible for 39% admissions, AML 27%, neuroblastoma 10%, lymphoma 9% and brain tumours 5% with 9% suffering other malignancies. Half (48%) of the admissions required invasive ventilation, 42% necessitated inotropic support and 6% renal support. The length of stay ranged from 3 to 1100 hrs. 70% of the admissions were discharged to the ward, 15% were discharged but readmitted to PICU within a month, 9% resulted in death within PICU, 2% died within 1 month of PICU discharge and 3% were discharged for palliative care. 3% of admissions were transferred to another more specialist hospital. Conclusion Two distinct groups (elective post op and acute unplanned) of children with malignancy are admitted to the ICU. Leukaemia is over-represented occurring in almost 2/3 of the acute admissions and is associated with a higher mortality. Sepsis is the major reason for acute admission and the course and intervention required can be very variable. Mortality following acute admission is 9% in unit and 14% within 1 month which is an improvement compared to previous literature.

Aim Infection is a common problem in children treated for malignancy and a number of children will require PICU support during septic episodes. The aim of this study was to clarify which patients require admission to PICU for presumed sepsis, and what happens to them? Methods A retrospective analysis of the PICU electronic database was performed. Haemato-oncology patients admitted during a 5 year period (1st April 2006 - 1st April 2011) were selected but those with benign conditions were then excluded. The records for each admission were then analysed using a standard proforma and those admitted with the diagnosis of presumed sepsis / pneumonia were included in this analysis. Results 60 of 109 acute admissions were due to presumed sepsis / pneumonia in children with underlying malignancy. 12 admissions were due to pneumonia alone and these patients presented with only respiratory distress and no systemic involvement. Half of the admissions had underlying ALL with a further 13 having AML, 10 having a solid tumour, 5 having lymphoma and 2 JMML. Half (33) of the admissions required intensive care support (23 ventilated, 29 inotropic support). The median length of stay was 46.5 hours (5-889) but it was 112 hours in the intervention group. 33 of the admissions were found to have 41 positive blood cultures (5 fungus, 12 gram positive and 24 gram negative organisms). During 36 of the admissions the patients were neutropenic. 4 of the admissions resulted in death within the unit and 5 in death within the next two weeks as a result of the same illness. Overall mortality was 15% of those who required intensive care support. 8 of the 9 children who died had a leukaemic illness. Conclusion Sepsis is a common adverse event in children receiving treatment for malignancy and presumed sepsis / pneumonia is the main reason for PICU admission. Leukaemic patients appear more susceptible making up 75% admissions and the majority of deaths. Half of the patients admitted to our unit required ICU support and 15% of these children subsequently died.

Aims To collect information about patients experience of their transition from paediatric to young adult services To receive feedback from staff involved in the care of patients transferring from paediatric to adult care. To obtain baseline information on the specific processes currently in place at this trust for diabetic patients transferring from paediatric to adult care based on the recommendations set out by Diabetes UK and local standards. Methodology Two survey forms were designed, one for the staff and the other for the patients to complete. In addition, baseline data on the processes currently in place for transition of patients from paediatric to adult services was collected by retrospective case notes and electronic database review. 49 patients were identified for the audit data. Survey forms were sent to all the patients. Staff survey forms were distributed to staff involved in diabetes transition. Results 62% of patients were transferred to adult services at 17 years of age. 47% of cases transition took place at a time of relative stability and coordinated with other life transitions. 98% of cases were transferred into a dedicated adolescent clinic run jointly by paediatric and adult staff. In only 13% of the cases, a clinical psychologist was involved in the transition process. Only 27% of cases written information was provided about transition process and transition clinic. Less than 56% of patients were provided with written information about career, socialising and vocational issues. Only 40% of patients felt the age of transfer to adult services was appropriate, remaining felt it should be later Only 33% of staff felt that patients educational needs are met. Conclusion Vast majority of the patients are being transferred through a dedicated adolescent clinic. There is a lack of written information about transition process, transition clinic as well as information about career, socialising and vocational issues. There is a need to actively involve the patient and family in transition process to ensure transition takes place at an appropriate age coordinated with other life transition.