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IntroductionInfant upper respiratory microbiota are derived partly from the maternal respiratory tract, and certain microbiota are associated with altered risk of infections and respiratory disease. Neisseria lactamica is a common pharyngeal commensal in young children and is associated with reduced carriage and invasive disease by Neisseria meningitidis. Nasal inoculation with N. lactamica safely and reproducibly reduces N. meningitidis colonisation in healthy adults. We propose nasal inoculation of pregnant women with N. lactamica, to establish if neonatal pharyngeal colonisation occurs after birth, and to characterise microbiome evolution in mother–infant pairs over 1 month post partum.Methods and analysis20 healthy pregnant women will receive nasal inoculation with N. lactamica (wild type strain Y92-1009) at 36–38 weeks gestation. Upper respiratory samples, as well as optional breastmilk, umbilical cord blood and infant venous blood samples, will be collected from mother–infant pairs over 1 month post partum. We will assess safety, N. lactamica colonisation (by targeted PCR) and longitudinal microevolution (by whole genome sequencing), and microbiome evolution (by 16S rRNA gene sequencing).Ethics and disseminationThis study has been approved by the London Central Research Ethics Committee (21/PR/0373). Findings will be published in peer-reviewed open-access journals as soon as possible.Trial registration numberNCT04784845.

ObjectiveCongenital cytomegalovirus (cCMV) is the most common infectious cause of congenital disability. It can disrupt neurodevelopment, causing lifelong impairments including sensorineural hearing loss and developmental delay. This study aimed, for the first time, to estimate the annual economic burden of managing cCMV and its sequelae in the UK.DesignThe study collated available secondary data to develop a static cost model.SettingThe model aimed to estimate costs of cCMV in the UK for the year 2016.PatientsIndividuals of all ages with cCMV.Main outcome measuresDirect (incurred by the public sector) and indirect (incurred personally or by society) costs associated with management of cCMV and its sequelae.ResultsThe model estimated that the total cost of cCMV to the UK in 2016 was £732 million (lower and upper estimates were between £495 and £942 million). Approximately 40% of the costs were directly incurred by the public sector, with the remaining 60% being indirect costs, including lost productivity. Long-term impairments caused by the virus had a higher financial burden than the acute management of cCMV.ConclusionsThe cost of cCMV is substantial, predominantly stemming from long-term impairments. Costs should be compared against investment in educational strategies and vaccine development programmes that aim to prevent virus transmission, as well as the value of introducing universal screening for cCMV to both increase detection of children who would benefit from treatment, and to build a more robust evidence base for future research.

A 15-year-old boy with trisomy 21, moderate left atrioventricular (AV) valve regurgitation and a previously repaired AV septal defect developed Aerococcus urinae infective endocarditis. The infected left AV valve and surrounding tissue were surgically removed and replaced with a prosthetic mitral valve; this was followed by 6 weeks of intravenous antibiotics. Towards the end of his antibiotic course, his C reactive protein level began to rise, and he subsequently developed worsening hip pain and severe anaemia …

Aims The General Medical Council (GMC) has recently published guidance on confidentiality, readily accessible to all registered doctors. Our audit aims to review current practice in line with the GMC guidance. Methods Interviews of paediatric doctors were conducted regarding their current practice and maintenance of patient confidentiality. Question design was based upon “Confidentiality: Frequently Asked Questions (FAQs)” published by the GMC. The audit standard was the confidentiality guidance published in October 2009. Results 40 doctors were interviewed (consultants (14), registrars (17) and SHO9s (9)). Conclusion Children9s doctors9 appear to be aware of the existence of guidance, but find its application impractical. The results demonstrate a lack of application of the GMC9s guidance in some areas of the management of health records, despite this information being readily available. While the audit indicates that the “relaxed” practice of communicating patient information on the ward could lead to inadvertent disclosure, the reverse was true with the disclosure of patient information to Public Registers. This was poorly understood; the guidance is not being followed, and data flow to registers may be impeded. With research, teaching and child protection, where clear protocols exist, the guidance is better understood and followed. This disparity reflects the different levels of knowledge of confidentiality for specified areas of children9s practice. Maintaining patient confidentiality is the cornerstone of any patient-doctor relationship, enabling patients to seek medical advice in trust, safety and it is their right by law. However, for effective patient care, advancements in research, education and public health, sharing of information is vital. Doctors require a clear understanding of confidentiality, which has not been demonstrated by our audit.