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ObjectiveTo report the performance of clinical practice guidelines (CPG) in the diagnosis of serious/invasive bacterial infections (SBI/IBI) in infants presenting with a fever to emergency care in the UK and Ireland. Two CPGs were from the National Institutes for Health and Care Excellence (NICE guidelines NG51 and NG143) and one was from the British Society for Antimicrobial Chemotherapy (BSAC).DesignRetrospective multicentre cohort study.PatientsFebrile infants aged 90 days or less attending between the 31 August 2018 to 1 September 2019.Main outcome measuresThe sensitivity, specificity and predictive values of CPGs in identifying SBI and IBI.SettingSix paediatric Emergency Departments in the UK/Ireland.Results555 participants were included in the analysis. The median age was 53 days (IQR 32 to 70), 447 (81%) underwent blood testing and 421 (76%) received parenteral antibiotics. There were five participants with bacterial meningitis (1%), seven with bacteraemia (1%) and 66 (12%) with urinary tract infections. The NICE NG51 CPG was the most sensitive: 1.00 (95% CI 0.95 to 1.00). This was significantly more sensitive than NICE NG143: 0.91 (95% CI 0.82 to 0.96, p=0.0233) and BSAC: 0.82 (95% 0.72 to 0.90, p=0.0005). NICE NG51 was the least specific 0.0 (95% CI 0.0 to 0.01), and this was significantly lower than the NICE NG143: 0.09 (95% CI 0.07 to 0.12, pConclusionNone of the studied CPGs demonstrated ideal performance characteristics. CPGs should be improved to guide initial clinical decision making.Trial registration numberNCT04196192.

Cardiac biomarkers are used as first-line diagnostic tools in suspected myocardial injury and heart failure in adult patients. Their use in paediatric patients has been limited by variability caused by age, gender and the presence of an underlying congenital cardiac condition. There are established reference ranges for both NT-proBNP and troponin in healthy children, but these cannot be applied to all paediatric patients because of limited large studies focusing on children with congenital heart disease and/or cardiomyopathy.This article will focus on the pathophysiology of myocardial injury and heart failure in children and the subsequent cardiac biomarker correlation. It will explain how to interpret the biomarker assay levels obtained for both troponin and NT-proBNP and highlights the importance of a clear clinical question prior to requesting a cardiac biomarker assay level.Clinical cases outline scenarios that may prompt consideration of biomarker analysis in children and aims to equip the reader with an understanding of how to interpret the results.

BACKGROUND: No previous studies have validated current clinical practice guidelines for the management of non-blanching rashes in children who have received meningococcal B and C vaccinations. The aim of this study was to evaluate the performance of existing clinical practice guidelines in the diagnosis of invasive meningococcal disease in children presenting with a fever and non-blanching rash in the UK.METHODS: The Petechiae in Children (PiC) study was a prospective, multicentre cohort study involving children (aged FINDINGS: Between Nov 9, 2017, and June 30, 2019, 1513 patients were screened, of whom 1329 were eligible and were included in the analysis. The median age of patients was 24 months (IQR 12-48). 1137 (86%) of 1329 patients had a blood test and 596 (45%) received parenteral antibiotics. 19 (1%) patients had confirmed meningococcal disease. All eight clinical practice guidelines had a sensitivity of 1·00 (95% CI 0·82-1·00) for identifying meningococcal disease. The specificities of NICE guidelines CG102 (0·01 [95% CI 0·01-0·02]) and NG51 (0·00 [0·00-0·00]) for identifying meningococcal disease were significantly lower than that of tailored clinical practice guidelines (pINTERPRETATION: Invasive meningococcal disease is a rare cause of non-blanching rashes in children presenting to the emergency department in the UK. Current NICE guidelines perform poorly when compared with tailored clinical practice guidelines. These findings suggest that UK national guidance could be improved by shifting towards a tailored approach.FUNDING: Public Health Agency.

ObjectiveTo report the diagnostic test accuracy of dipstick urinalysis for the detection of urinary tract infections (UTIs) in febrile infants aged 90 days or less attending the emergency department (ED).DesignRetrospective cohort study.PatientsFebrile infants aged 90 days or less attending between 31 August 2018 and 1 September 2019.Main outcome measuresThe sensitivity, specificity and predictive values of dipstick urinalysis in detecting UTIs defined as growth of ≥100 000 cfu/mL of a single organism and the presence of pyuria (>5 white blood cells per high-power field).SettingEight paediatric EDs in the UK/Ireland.ResultsA total of 275 were included in the final analysis. There were 252 (92%) clean-catch urine samples and 23 (8%) were transurethral bladder catheter samples. The median age was 51 days (IQR 35–68.5, range 1–90), and there were 151/275 male participants (54.9%). In total, 38 (13.8%) participants had a confirmed UTI. The most sensitive individual dipstick test for UTI was the presence of leucocytes. Including ‘trace’ as positive resulted in a sensitivity of 0.87 (95% CI 0.69 to 0.94) and a specificity of 0.73 (95% CI 0.67 to 0.79). The most specific individual dipstick test for UTI was the presence of nitrites. Including trace as positive resulted in a specificity of 0.91 (95% CI 0.86 to 0.94) and a sensitivity of 0.42 (95% CI 0.26 to 0.59).ConclusionPoint-of-care urinalysis is moderately sensitive and highly specific for diagnosing UTI in febrile infants. The optimum cut-point to for excluding UTI was leucocytes (1+), and the optimum cut-point for confirming UTI was nitrites (trace).Trial registration numberNCT04196192.

We measured serum SARS-CoV-2 antibodies in 215 children of healthcare workers to estimate secondary attack rates. Twenty-one families had a parent with confirmed COVID-19. There was strong evidence of family clustering (P

Background During the first wave of the pandemic in 2020, Covid-19 symptoms of cough, fever and loss of taste/smell were identified in the adult population and aided diagnostic PCR testing. However, children with similar symptoms appeared less likely to test positive or to develop severe disease. As part of a multi-centre observational cohort study from 16th April 2020 to 3rd July 2020, 992 paediatric participants aged 2-15 years, were recruited and underwent SARSCoV- 2 antibody testing and provided symptom data. Objectives To identify the proportion of healthy children who demonstrated antibody response to SARS-CoV-2 infection in this cohort of healthcare worker's children. To identify the symptoms experienced by participants who had the presence of SARS-CoV-2 antibodies. To assess if there was correlation between different symptoms experienced and SARS-CoV-2 antibody titres in a paediatric population. Methods 1007 participants were enrolled and 992 were included in the final analysis. Participants were identified across 5 UK sites-Belfast, Glasgow, Cardiff, Manchester and London. All participants were healthy children of NHS healthcare workers. Participants underwent phlebotomy and provided blood samples for SARS-CoV-2 antibody testing and information on their symptoms in the form of an electronic case report form (CRF). Serum and/or plasma was tested for antibodies to SARS-CoV-2 using nucleocapsid and spike protein assays. Study data was recorded on a CRF using REDCap and information recorded included age, sex, previous health, recent symptoms and potential predictors of presence of SARs-CoV-2 antibodies including contact with confirmed or suspected cases. Results Of the 992 patients included, 962/992 (97%) had complete CRFs. The median age of study participants was 10.1 years (2.03-15.99yrs) and 51% were male. There were 68/992 participants with positive SARS-CoV-2 antibodies, giving a seroprevalence of 6.9%. Of those with positive SARSCoV- 2 antibody tests, 34/68 (50%) were asymptomatic. In the symptomatic participants (34/68), the most commonly reported symptoms were fever 21/68 (31%), gastrointestinal symptoms 13/68 (19%) and headache 12/68 (18%). The presence of fever, cough or change in smell/taste was reported by 26/68 (38%) of antibody positive participants. None of the participants experienced severe symptoms requiring hospital admission. One of the assays (Abbott Architect SARS-CoV-2 IgG assay), indicated a small but significant increase in mean antibody titres between asymptomatic 4.3 S/C (95% CI 3.4 to 5.2) and symptomatic participants 5.5 S/C (95% CI 4.7 to 6.2), but this was not replicated with Roche Elecsys or DiaSorin LIAISON assays which found no significant difference. Conclusions Following the first wave of the pandemic, 68/992 (6.9%) of children of healthcare workers in UK had evidence of previous SARS-CoV-2 infection. Importantly, only 50% of these children experienced symptoms and this highlights the potential for asymptomatic children to be missed by current NHS testing guidelines. The symptoms which adults often experience, namely pyrexia, cough and loss of taste/smell, were only experienced by 38% of children who had SARSCoV- 2 antibodies. These children were more likely to experience gastrointestinal symptoms or lethargy and headache and therefore raises the question of whether this should be factored into current symptomatic testing guidelines.

BackgroundDuring the first wave of the SARS- CoV-2 pandemic in England, children accounted for just 1% of confirmed infections, had a milder clinical course and had much lower mortality than adults, a pattern similar to other international settings. The proportion of children in the UK infected with SARS-CoV-2 was unknown, with children less likely to attend symptomatic testing and issues with the sensitivity of real time reverse transcription PCR of oral/nasal swabs.ObjectivesTo measure the seroprevalence of SARS-CoV-2 antibodies in children of healthcare workers in the UK and to characterise the antibody response to SARS-CoV-2 infection and longitudinal antibody kinetics of SARS-CoV-2 infection.MethodsMulticentre observational prospective cohort study designed to determine seroprevalence of antibodies to SARS-CoV-2 in healthy children and report on symptoms experienced. Children of healthcare workers were recruited from five UK centres and underwent phlebotomy at three time points, beginning 16 April. There were follow up plasma/serum collections at two and six months after the original collection. Serum and/or plasma were tested for SARS-CoV-2 antibodies.Results1042 potential participants were screened for inclusion, with 35 excluded. Of the 1002 included 15 were excluded from analysis due to unsuccessful phlebotomy. Of the 992 included participants at the first time point, 68 had positive SARS-CoV-2 antibody tests, giving a seroprevalence of 6.9% (95% CI 5.4% to 8.6% n=992). Belfast had a significantly lower seroprevalence than all other sites at 0.9% (95% CI 0.2% to 3.3%, n=215, p

Identifying children with serious bacterial infection (SBI) can be challenging. To aid clinicians in the UK and Ireland, the National Institute for Health and Care Excellence (NICE) provides guidance on those children at greatest risk via NICE guideline (NG51) Sepsis: recognition, diagnosis and early management. One of those ‘high risk’ groups are infants under 3 months of age presenting with a fever or history of fever over 38°C. For this high-risk group, NICE NG51 recommends extensive investigation and administration of broad-spectrum antibiotics to all within the hour.1 Internationally, however, approaches differ. In the USA and Europe, validated clinical decision tools have been developed.2 3 These tools allow for a tailored approach that reduces the need for painful interventions such as lumbar puncture, improves antimicrobial stewardship and reduces the need for hospital admission.2 3 Although approaches to assessment and management vary internationally, there are some areas where we do agree. The rates of serious bacterial infections are similar in the UK, Europe and the USA with between 10% and 20% of febrile young infants having a serious bacterial infection,2–4 the majority of which (9%–17%) will be urinary tract infections and (1%–3%) will be invasive bacterial infections such as meningitis and bacterial sepsis.2–4 We all agree that younger infants under 28 days of age are at higher risk for serious bacterial infections and finally we all agree that no pattern of clinical features or exam findings can be used to …

The limping child is a common presentation to paediatric services. In most instances the cause is benign with few, if any, investigations required. There is, however, always that concern that the limping child may have an underlying limb-threatening or life-threatening disease. This poses a challenge to clinicians, who must find that balance between correctly identifying disease early and avoiding the risks and harms of overinvestigation. In this article we discuss the diagnostic approach to the limping child and present a structure for assessment, investigation and risk management.

As technology evolves and cultural attitudes towards diagnosis change, there is an increasing move towards newer, faster and more accurate diagnostic testing. As new tests are developed, clinicians are increasingly required to appraise data from diagnostic test accuracy (DTA) studies.The accuracy of a test is fluid and changes depending on the population, setting, timing and position within the diagnostic pathway. This article attempts to provide a short guide to understanding diagnostic test accuracy and a simple approach to appraising DTA studies.

BackgroundDue to limited evidence to guide management of periorbital cellulitis (POC), we surveyed current practice and assessed quality and consistency of local clinical practice guidelines (CPGs) to highlight future research priorities.MethodsA web-based survey was sent to a designated emergency physician (who clinically assesses children) at Paediatric Emergency Research United Kingdom and Ireland (PERUKI) sites between 23 November 2018 to 22 January 2019. A nominated site lead offered one response as a department-wide perspective on admission, severity assessment, treatment, disposition and specialty consultation request. Sites shared their CPG. These were compared using a standardised data collection tool, and quality assessed using Standardised Reporting Practice Guidelines in Healthcare (RIGHT) criteria. Survey responses were also compared against CPG recommendations.Results83% (49/59) institutions invited submitted an individual survey response. 67% of responding sites had a CPG and 63% (31/49) submitted these. CPG quality was poor (mean 6.7/35 RIGHT criteria). 21 different severity markers were identified across CPGs. Most CPGS recommend investigations for severe disease, yet 23% (7/31) advise blood culture universally. 90% of CPGs advise discharge with oral antibiotics for milder cases, yet 86% of respondents reported departmental admission of all patients with POC. Nearly all respondents included proptosis, systemically unwell and visual disturbance as indications for admission but differed regarding importance of other signs.ConclusionsWe demonstrated variation in practice across the PERUKI network in assessment of severity and management of POC. CPGs vary in recommendations, and clinical practice appears to differ from CPGs. Guidelines were generally of poor quality when compared against RIGHT standards.

BackgroundRapid molecular diagnostic testing has the potential to improve the early recognition of meningococcal disease (MD). The aim of this study was to report on the diagnostic test accuracy of point-of-care loop-mediated isothermal amplification (LAMP) in the diagnosis of MD.DesignData were collected prospectively from three UK emergency departments (ED) between November 2017 and June 2019. Consecutive children under 18 years of age attending the ED with features of MD were eligible for inclusion. The meningococcal LAMP test (index test) was performed on a dry swab of the child’s oropharynx. Reference standard testing was the confirmation of invasive MD defined as positive N. meningitidis culture or PCR result from a sterile body site (blood or cerebrospinal fluid).ResultsThere were 260 children included in the final analysis. The median age was 2 years 11 months and 169 (65%) children were aged 5 years or younger. The LAMP test was negative in 246 children and positive in 14 children. Of the 14 children with positive LAMP tests, there were five cases of invasive MD. Of the 246 children with negative LAMP tests, there were no cases of invasive MD. The sensitivity of LAMP testing was 1.00 and the specificity was 0.97. The negative and positive predictive values were 1.00 and 0.36, respectively. The positive likelihood ratio was 28.3.DiscussionNon-invasive LAMP testing using oropharyngeal swabs provided an accurate fast and minimally invasive mechanism for predicting invasive MD in this study.Trial registration numberNCT03378258.

BackgroundStudies based on molecular testing of oral/nasal swabs underestimate SARS-CoV-2 infection due to issues with test sensitivity and timing of testing. The objective of this study was to report the presence of SARS-CoV-2 antibodies, consistent with previous infection, and to report the symptomatology of infection in children.DesignThis multicentre observational cohort study, conducted between 16th April – 3rd July 2020 at 5 UK sites, aimed to recruit 900 children aged 2 to 15 years of age. Participants provided blood samples for SARS-CoV-2 antibody testing and data were gathered regarding unwell contacts and symptoms.Results1007 participants were enrolled, and 992 were included in the final analysis. The median age of participants was 10·1 years. There were 68 (6.9%) participants with positive SARS-CoV-2 antibody tests indicative of previous SARS-CoV-2 infection. Of these, 34/68 (50%) reported no symptoms. The presence of antibodies and the mean antibody titre was not influenced by age. Following multivariate analysis 4 independent variables were identified as significantly associated with SARS-CoV-2 infection. These were: known infected household contact; fatigue; gastrointestinal symptoms; and changes in sense of smell or taste.DiscussionIn this study children demonstrated similar antibody titres in response to SARS-CoV-2 irrespective of age. The symptoms of SARS-CoV-2 infection in children were subtle but of those reported, fatigue, gastrointestinal symptoms and changes in sense of smell or taste were most strongly associated with antibody positivity.RegistrationThis study was registered at https://www.clinicaltrials.gov (trial registration: NCT04347408) on the 15/04/2020.

Background Studies based on molecular testing of oral/nasal swabs underestimate SARS-CoV-2 infection due to issues with test sensitivity, test timing and selection bias. The objective of this study was to report the presence of SARS-CoV-2 antibodies, consistent with previous infection. Design This multicentre observational cohort study, conducted between 16 April to 3 July 2020 at 5 UK sites, recruited children of healthcare workers, aged 2–15 years. Participants provided blood samples for SARS-CoV-2 antibody testing and data were gathered regarding unwell contacts and symptoms. Results 1007 participants were enrolled, and 992 were included in the final analysis. The median age of participants was 10·1 years. There were 68 (6.9%) participants with positive SARS-CoV-2 antibody tests indicative of previous SARS-CoV-2 infection. Of these, 34/68 (50%) reported no symptoms prior to testing. The presence of antibodies and the mean antibody titre was not influenced by age. Following multivariable analysis four independent variables were identified as significantly associated with SARS-CoV-2 seropositivity: known infected household contact OR=10.9 (95% CI 6.1 to 19.6); fatigue OR=16.8 (95% CI 5.5 to 51.9); gastrointestinal symptoms OR=6.6 (95% CI 3.0 to 13.8); and changes in sense of smell or taste OR=10.0 (95% CI 2.4 to 11.4). Discussion Children demonstrated similar antibody titres in response to SARS-CoV-2 irrespective of age. Fatigue, gastrointestinal symptoms and changes in sense of smell or taste were the symptoms most strongly associated with SARS-CoV-2 antibody positivity. Trial registration number NCT0434740., What proportion of children have antibodies against SARS CoV2 after the first wave of infetion in the UK? This study of healthy children of healthcare workers finds a similar proportion are antibody positive as adults (6%). Half of the positive children had no prior COVID symptoms fever, cough and vomiting/ diarrhoea occurred in most of the symptomatic children.

It’s 21:00 and you receive a stand-by call from the local ambulance service. Peter, a 9-year-old boy, was riding an electric scooter and has collided with a car. He has reduced consciousness, signs of shock and is hypoxic. How will you prepare your team? What are the possible injuries? Who will perform the primary survey? Injury is the leading cause of morbidity and mortality in the paediatric population accounting for approximately half of all attendances to paediatric emergency departments in the UK and Ireland. Major trauma can be distressing for patients, parents and physicians. Managing major trauma is challenging and it is vital to have a clear and organised approach. In this 15-minute guide we describe a structured approach to the primary survey that includes how to prepare before the child’s arrival, the suggested roles of team members and the key components of the primary survey. We discuss life-threatening injuries, the life-saving bundle and the principles of resuscitation, and the role of imaging in the initial assessment of the injured child.

A 3-month-old baby is brought to the paediatric emergency department by their parents because of a fever. You decide to check their inflammatory markers. Their C-reactive protein (CRP) level comes back as 20 mg/L. Does this affect whether or not you start antibiotic therapy? Does it influence your decision to admit or discharge the patient? CRP is a commonly used biochemical test and yet its use is constantly debated and challenged. We look at the current evidence and suggest the best way to use this test in clinical practice.

‘It is midnight and you are called to see a thirteen-year-old boy who has been brought to the paediatric emergency department with a 24-hour history of swelling and redness of his left eye. He has had a ‘runny nose’ for a couple of days. He is systemically well. His upper and lower lids are red and swollen such that his eye is not open fully, though you elicit normal eye movements when you open his eye. Pupils are equal and reactive with no afferent pupillary defect. Visual acuity and colour vision are normal on examination.’ In this article, we consider the approach to preseptal and orbital cellulitis in children including the initial assessment and management options.

Its 2am and you are called to review a “well looking child” in the emergency department who has presented with a new non-blanching rash. He has been hot at home with some coryzal symptoms. Mum is worried, she thinks the rash has spread in the last hour! What are you going to do? In this article, we discuss the aetiology and initial assessment of non-blanching rashes in children.

Background: The COVID-19 pandemic in the UK began in late January 2020 and peaked in mid-April before declining. Children typically develop only very mild symptoms and it remains unclear what role children play in the spread of COVID-19. The aim of this study was to report the prevalence of SARS-CoV-2 antibodies in healthy children of healthcare workers. Methods: Healthy children of healthcare workers, were recruited in London during May 2020. Participants had nose and throat swabs tested for SARS-CoV-2 infection via RT-qPCR and blood serums samples for SARS-CoV-2 immunoglobulin G (IgG) antibodies. Findings: A total of 215 children from 126 families took part and 25(12%) were seropositive for SARS-CoV-2. Children of clinical healthcare workers were significantly more likely to be seropositive 23/133(17%) than those of non-clinical healthcare workers 2/83(2%); p=0.001.In children of parents with confirmed COVID-19, seropositivity was 19/47(40%) compared to 3/44(7%) in children of parents with suspected COVID-19 and 3/124(2%) in children of asymptomatic parents (p

Meningococcal disease remains a leading cause of meningitis, sepsis and death in children worldwide and in the UK. Successful vaccination programmes in the UK have, however, significantly reduced the burden of disease in children. Unfortunately, despite vaccination, a significant number of children are still diagnosed with invasive meningococcal disease each year.As the prevalence of meningococcal disease falls, it is important that we maintain awareness of the symptoms and signs of meningococcal disease because the prompt recognition of this life-threatening infection improves outcomes.In this article we discuss the pathology, epidemiology and recognition of invasive meningococcal disease in children. The aim is to maintain awareness of this rare but life-threatening infection.

Mast cell tryptase (tryptase) is an enzyme produced almost exclusively by mast cells that is easy to measure using a widely available test. In this article we discuss the physiology of the mast cell and how that relates to IgE-mediated anaphylaxis and mastocytosis. We also describe the technical aspects of testing tryptase and the reported normal ranges in health. Finally we explore the diagnostic performance of serum mast cell tryptase measurements, when used to confirm anaphylaxis, estimate future anaphylaxis risk and in diagnosing/monitoring leukaemia.

Every day we interpret examination findings and clinical tests with the aim of coming to a diagnosis. But how well do we interpret these tests? Whether it is a traditional examination technique used by doctors for centuries or a new cutting edge biomarker, the diagnostic landscape shifts over time. The aim of interpretations is to produce a library of evidence-based resources directing the use of clinical tests including examination techniques. In this article we discuss how best to tackle writing an interpretation. Interpretations are succinct evidence-based summaries that draw together research findings to provide practical answers for clinicians.

There are over 300 new cases of imported paediatric malaria in the UK each year and this has been increasing over the last 20 years. Malaria in children is particularly difficult to diagnose because the initial presenting features are subtler than in adults and do not display the classical presenting features. However, they are also more likely to deteriorate rapidly and to develop severe malaria. The 'gold standard' for ruling out the diagnosis of malaria if clinically suspected is three negative thin and thick blood films, which require serial phlebotomy and the availability of trained technicians. There are now a range of other tests, including rapid diagnostic tests and PCR, as well as clinical features that make the diagnosis more or less likely. We explore the different tests available and whether these might replace the three negative blood films currently needed. We also look at whether we are able to use clinical features to aid the tests used for a diagnosis of imported malaria.

Meningitis is a critical diagnosis not to miss in children presenting with fever. Since the early 20th century, classical clinical signs have been used to aid the diagnosis of meningitis. These classical signs are nuchal rigidity, Kernig’s sign and Brudzinski’s sign. Each of these relies on the principle that stretching the inflamed meningeal membranes causes clinically detectable irritation. Several primary studies have quantified the diagnostic performance of clinical examination in detecting meningitis in children. The results of these studies vary significantly due to methodological differences, clinical heterogeneity and interobserver variability. However, their findings demonstrate that positive meningitic signs increase the likelihood of a diagnosis of meningitis, and the absence of meningitic signs reduces this probability. These signs have greatest utility when combined with other features in the history and examination to contribute to a comprehensive clinical assessment.

Background Despite successful vaccination programmes meningococcal disease (MD) remains the leading infectious cause of septicaemia and death in children in the UK and Ireland. 1,2 The early diagnosis of MD significantly improves outcomes with reduced morbidity and mortality. 1,2 The early stages of MD are often indistinguishable from a simple viral illness making an early positive diagnosis of MD difficult. 1 Hibergene have developed a commercially available bedside Loop-mediated isothermal AMPlification PCR (LAMP-MD) test that is a highly sensitive 0.89 (95%CI 0.72–0.96) and specific 1.0 (95%CI 0.97–1.0) for identifying children with invasive MD (4) (figure 1). Aims The aims of this RCEM funded study were: Assess the ease of use and suitability for the ED Determine the time taken to perform the test Independently verify LAMP-MD performance against TaqMan quantitative PCR. Method The LAMP-MD was assessed for practicality and ease of use within the ED including an assessment of training needs, footprint and health and safety requirements. For verification of the Hibergene LAMP-MD analyser and assay we used dry nasopharyngeal swabs sent for viral screening. Additional verification was undertaken using N. meningitidis genomic DNA spiked over a range of concentrations. This included serotypes A, B, C, W, X and Y and a dilution series to determine the limit of detection. All samples were then analysed using real time TaqMan qPCR. Results The LAMP-MD analyser was easy to use and could be accommodated in the ED The mean time for detection of Meningococcal DNA was 14.01 min Detection of meningococcal serogroups A, B, C, W, X and Z was confirmed The detection limit for dry nasopharyngeal swabs was below 2 genomic copies per µl No non-specific amplification was observed in 17 randomly selected negative clinical swabs The LAMP-MD assay was 100% sensitive and specific relative to real-time TaqMAN PCR. Conclusion LAMP-MD is a practical, rapid point of care test that can reliably detect all Meningococcal serotypes in less than 15 min. Funding has been secured to perform a PERUKI supported study to investigate the potential for LAMP-MD in the diagnosis of meningococcal disease in children. References Meningitis Research Foundation. Meningococcal Meningitis and Septicaemia Guidance Notes 2014. O Maoldomhnaigh, et al. Invasive meningococcal disease in children in Ireland . PMID: 27566800. NICE. Management of petechial rash . Bourke TW, et al. Diagnostic accuracy of loop-mediated isothermal amplification as a near-patient test for meningococcal disease in children . PMID: 25728843.

Introduction Approximately 3 in 10 children aged 2–15 years in the UK are overweight or obese.1 NICE guidance states that “Health professionals should tell the parents of children…about local lifestyle weight management programmes.” The purpose of this project is to better understand how overweight and obese children can be identified and managed following presentation to the paediatric emergency department in Northern Ireland. Aims Audit existing practice Compile a list of available weight management programmes Work with parents to improve the service Work with health professionals to improve the service Methods Existing practice was audited retrospectively by reviewing 100 case notes selected randomly over 12 months. Weight and demographic data were recorded, as was any intervention. Barriers to care in the department were explored through the use of focus groups. A review of existing lifestyle and weight management programs was conducted by: Contacting public health Northern Ireland, Searching district council websites Questioning clinicians Parent involvement was encouraged through a questionnaire. This collected data on; attitudes towards obesity, how best to discuss the topic and on what services parents want access to. Results No patients had weight issues discussed. There are no endorsed or well recognised obesity services for children in Northern Ireland Health professionals felt uncomfortable discussing obesity and those that did discuss the issue felt the lack of available lifestyle and weight management services undermined any discussion they had. 51 questionnaires were returned by parents. 98% felt that obesity was an important health issue with 84% stating that overweight or obese children should be identified in the emergency department. Our parents told us that 77% of them would want to be referred on to a dietetic or weight loss service. Conclusion Parents are worried about obesity and the vast majority would like to be told (even if it is in the emergency department). Health professionals however, find it difficult discussing weight issues when they know there are no community services to refer to. There is an urgent need for community obesity services for children in Northern Ireland.

Monogenic diabetes accounts for 1–2% of all cases of diabetes mellitus and presentation is often in childhood. Recognizing the clinical features of monogenic β-cell dysfunction prevents misdiagnosis and allows for more effective management and genetic counseling. Monogenic β-cell dysfunction is a diverse collection of clinical phenotypes underpinned by common mutational pathways. Mutations affecting the glycolytic glucokinase enzyme, the mitochondria, the KATP channels and transcription factors have been known for some time. Until recently, the role of endoplasmic reticulum stress was underestimated in the pathogenesis of diabetes. It is becoming increasingly clear that endoplasmic reticulum stress is an important etiological factor in the development of monogenic and polygenic diabetes. In this article, we aim to define the etiology of pediatric monogenic β-cell dysfunction and provide guidance on the investigation and management of children presenting with monogenic β-cell dysfunction.