Royal Belfast Hospital for Sick Children

ObjectiveTo determine the prevalence of invasive bacterial infection (IBI) in a UK cohort of febrile infants aged 90 days and younger with positive urinalysis (PU) results.DesignA planned secondary analysis of data from the Febrile Infant Diagnostic Assessment and Outcome study, a prospective multicentre observational cohort study.Setting35 paediatric emergency departments and assessment units across the UK and Ireland, between 6 July 2022 and 31 August 2023.PatientsFebrile infants aged 90 days and younger presenting to emergency care.Main outcome measuresIBI rates, namely bacterial meningitis or bacteraemia, among febrile infants with PU results were compared with those with negative urinalysis (NU) results.Results1480 of 1821 infants underwent urinalysis testing. 549 infants had PU results and 931 had NU results. 42/549 (7.7%) and 20/931 (2.2%) infants had IBI in the PU and NU groups, respectively. Of the IBI cases within the PU group, 5/549 (0.9%) were bacterial meningitis and 39/549 (7.1%) were bacteraemia, with two concomitant cases. Of the IBI cases in the NU group, there were 4/931 (0.4%) cases of bacterial meningitis and 18/931 (1.9%) cases of bacteraemia, with two concomitant cases. There were no bacterial meningitis cases in infants over 60 days of age or those with confirmed urinary tract infection (UTI).ConclusionsThe prevalence of bacteraemia was high (7.1%) among PU infants, while the prevalence of bacterial meningitis was low (0.9%), with PU or NU. These findings support existing data that older infants with suspected UTI are at low risk of bacterial meningitis.

Abstract Aim Idiopathic Toe Walking (ITW), a common gait abnormality in children, leads to functional limitations and psychosocial challenges. However, the lack of robust evidence to guide treatment results in varied clinical practice. This study aimed to evaluate the clinical and kinematic outcomes of children with ITW one year postoperatively and assess whether these align with patient and parent satisfaction. Method A retrospective review (2012–2023) assessed children diagnosed with ITW who underwent bilateral Tendon Achilles Lengthening (TAL). Clinical assessment and 3-dimensional gait analysis were used to assess kinematic parameters, generating a movement analysis profile (MAP) and gait profile score (GPS). Follow-up evaluations occurred one year post-operatively, supplemented by satisfaction surveys for a sub-cohort of patients. Results 39 patients (22 boys/17 girls) and 35 patients (20 boys/15 girls) had complete pre and postoperative data for clinical assessment and 3-dimensional gait analysis respectively. Age at the time of operation averaged 11.3 years. Postoperative follow-up averaged 1.3 years. Autism spectrum disorder was diagnosed in 23% of patients. Daytime pain reduced significantly from 72% preoperatively to 15% postoperatively, while nighttime pain, reported in 10%, resolved entirely. Improvements were observed in ankle dorsiflexion and several MAP variables, suggesting better alignment with normative gait patterns. Additionally, GPS trends decreased postoperatively across the cohort. Patient and parent satisfaction outcomes were reported as excellent in 67% of responses. Conclusions The data suggests that TAL demonstrates efficacy in improving clinical and kinematic outcomes in ITW patients, reducing pain and achieving high levels of satisfaction among patients and parents.

This cohort study evaluated the risk of invasive bacterial infection among infants aged 61 to 90 days and whether clinical appearance was associated with invasive bacterial infection risk in this population.

Special low-protein foods are essential in the dietary treatment of phenylketonuria (PKU). In the UK, these are available on prescription through the General Practitioners (GPs) and distributed via nutritional home delivery companies or pharmacies. A 58-item online non-validated semi-structured questionnaire was emailed to British Inherited Metabolic Disease Group (BIMDG) dietitians and dietetic support workers (DSW)/administrators working in PKU to ascertain the main system issues and errors with the supply of low-protein prescription foods (LPPF). 73% (n = 53/73) of dietitians and 72% (n = 18/25) of DSW/administrators responded. A total of 80 questionnaires (representing 44 paediatric and 36 adult PKU centres) were completed. A total of 50% (n = 40/80) of respondents reported patient/caregiver problems accessing LPPF at least weekly. The most common problems were unavailable products (82%), missing LPPF in deliveries (79%), and delayed deliveries (66%). For 64% of respondents, >25% of their patients had recurring problems accessing LPPF, and 69% of respondents spent ≥1 h/week and 11% >5 h/week correcting LPPF patient supply issues. The most common foods patients experienced supply issues with were bread (96%), pasta/rice (41%) and milk replacements (35%). This was associated with GP prescription errors (65%), LPPF prescriptions sent to incorrect dispensers/suppliers (60%), and manufacturer supply issues (54%). Problems with patients/caregivers included not ordering LPPF in a timely way (81%), not responding to messages from home delivery companies (73%) and poor understanding of the ordering process (70%). The majority (93%) of respondents reported that prescription issues impacted their patients' blood Phe control. Suggestions for improving access to LPPF included centralisation of the system to one supplier (76%) and apps for ordering LPPF (69%). The supply of LPPF for PKU in the UK is problematic; it may adversely affect the ability of patients to adhere to dietary management, and a review investigating patient access to LPPF is urgently required.

Developmental dysplasia of the hip (DDH) is common and is a source of potentially avoidable morbidity through childhood and adult life. Despite progress over the past century, there is a wide variation in policy, practice and outcomes between countries. This review considers information from a geographically wide range of locations to evaluate the impact of these variations and understand how these variations arise. The aim is to help clinicians and policymakers adopt the best practices for their population. There is a lack of randomized controlled trials to guide decisions on screening. Given the large numbers to treat and preexisting practices, it is unlikely that such trials of sufficient statistical power will be performed. However, many whole population studies are becoming available from different countries that allow an assessment and comparison of the impact of their strategies. Standardizing metrics in studies and defining late diagnosis would improve comparisons across studies. The general trend appears to favour universal screening to reduce the risk of late diagnosis, the need for surgery and the subsequent poorer outcomes. Notably, resource-constrained countries like Mongolia have successfully implemented universal screening, showing that effective strategies can be adopted regardless of resources.

Aims and ObjectivesThis study aimed to explore the impact of respiratory viral testing on the prevalence of invasive bacterial infections (IBI) in febrile infants up to ninety days of age. Infants in this age group are at high risk for bacteraemia and meningitis, collectively termed IBI, and tend to present with non-specific symptoms making risk assessment challenging. The study is novel in its focus on SARS-CoV-2, Influenza, and Respiratory Syncytial Virus (RSV) due to their availability as point-of-care tests (POC) and therefore their potential influence on the diagnostic pathway within the emergency care setting.Method and DesignThis secondary analysis used data from the Febrile Infant Diagnostic assessment and Outcome (FIDO) study, a prospective observational cohort study conducted across 35 sites in the UK and Ireland under the PERUKI network. Infants aged ≤90 days with a fever ≥38°C were included. The results of commercially available tests for SARS-CoV-2, Influenza, and RSV were compared against the presence of IBI, defined as a pathogen identified in blood or CSF by culture or molecular testing. Analysis was conducted with descriptive statistics (SPSS version 23).Results and ConclusionOf 1821 infants recruited to FIDO, 1395 underwent respiratory viral testing; 339 (24.3%) tested positive. Infants with a positive viral test had significantly lower IBI rates compared to those with a negative test (1.5% v 3.8%, p=0.034). In infants aged 29-90 days, those with a positive viral test had an IBI rate of 0.7% versus 3.2% for negative tests (p=0.015).These findings indicate that young febrile infants with a positive respiratory viral test for SARS-CoV-2, RSV or Influenza are at lower risk of IBI. Infants over 28 days of age with a positive test represent the lowest-risk cohort. Respiratory viral POC tests may therefore hold potential to streamline management by reducing painful procedures, decreasing admission rates or length of stay and enhancing antimicrobial stewardship.

ObjectivesThe COVID-19 pandemic response saw child health services undergo rapid reform to improve care provision.1 2 However, perhaps the greatest success story of the pandemic was the improvement in access to paediatric healthcare education for over 1800 whole time equivalent of GPs in Northern Ireland (NI). The foundations which were built, and the partnerships formed through an innovative, regional multidisciplinary education program endure today as it enters its tenth successive series. In it’s a wake, a community of practice between primary, secondary, and tertiary healthcare professionals prevails, and the pathway for the first primary care paediatric conference was paved.3 4MethodsWe conceived, co-designed, co-delivered, evaluated, and embedded an exciting partnership between primary, secondary, and tertiary healthcare professional education bodies across Northern Ireland- RBHSC SimEd, GPNI, and NIMDTA. Using the established GPNI virtual platform, we designed and delivered nine live and recorded-format interactive webinars (figure 1). The sessions have been led by a range of healthcare professionals including paediatric consultants, nurse practitioners, pharmacists and dieticians. To build on this success in the post pandemic era, an inaugural regional child health conference was established to empower primary care colleagues with evidence based practical solutions which facilitate optimal management in primary care through interactive workshops, debates and patient panel discussions.ResultsParticipation and feedback from virtual sessions has been excellent with over 1,800 attendees to date. Sessions have been accessed by GPs, foundation doctors, paediatric trainees, specialty consultants, nurses and pharmacists. Our face-to-face Primary Care Paediatrics Conference saw over 140 healthcare professionals from across the region share in a collaborative event of networking, panel discussions and practical workshops. Key comments include: ‘Thoroughly enjoyed the practical insights from paediatrics’. ‘I will continue to attend the series as I find them very relevant to primary care’. ‘Before I would have sent these cases to ED as I don’t think I could have reassured the family.’ConclusionAligned with the RCPCH 2040 vision, we have demonstrated innovation by embedding regional interprofessional educational sessions aimed at helping colleagues support clinical decision making, sharing knowledge, guidance, and research.5 Building on its success, we delivered the first regional Primary Care Paediatric Conference which continues to strengthen links and address the gap- specifically the significant number of primary care physicians with limited paediatric experience. We demonstrate a successful interprofessional initiative, whereby upon learning from each other, we can enhance care for children and young people across NI.ReferencesBrocard E, Antoine P, Mélihan-Cheinin P, Rusch E. COVID-19′s impact on home health services, caregivers and patients: lessons from the French experience. The Lancet Regional Health – Europe. 2021 Sep;8:100197.Haines A, de Barros EF, Berlin A, Heymann DL, Harris MJ. National UK programme of community health workers for COVID-19 response. The Lancet. 2020 Mar.Wegner E, McDermott R, Snyder WM. ‘Cultivating communities of Practice’ (Hardcover). 1st ed. Harvard Business Press, 2002.Klaber R, Blair M, Lemer C, Watson M. Whole population integrated child health: moving beyond pathways. Archives of Disease in Childhood, 2016;102(1):5–7.Paediatrics 2040- https://www.rcpch.ac.uk/resources/paediatrics-2040.

BackgroundThe preparation for critically ill children involves calculating drug and fluid volumes using the commonly taught WETFLAG (weight, energy, endotracheal tube, fluids, lorazepam, adrenaline, glucose) acronym. While smartphone applications (apps) are increasingly used for these calculations in clinical practice, limited studies have explored their accuracy and safety.AimTo assess the accuracy of three calculation methods for paediatric emergency drug doses and fluid volumes: a smartphone app, reference charts and traditional calculation methods. The secondary aims were to investigate the effect on the time taken and self-reported stress levels.MethodsA convenience sample of healthcare professionals from four hospitals contributed. Participants calculated drug and fluid doses for fictional patients using the three different methods. The method and case order were randomised centrally. The study recorded the number of errors made during the calculations, healthcare professionals’ self-reported stress levels on a scale of 0 (no stress) to 10 (maximum stress) and the time taken for each case. The app was developed at the direct request of the study team.ResultsNinety-six participants calculated values for six fictional cases, resulting in 576 calculations. Traditional calculation methods showed a statistically significant higher rate of error compared with the use of a smartphone app or reference charts (mean=1, 0, 0, respectively). The smartphone app outperformed both traditional calculation methods and reference charts for time taken and user-reported stress levels.ConclusionsTraditional methods of ‘WETFLAG’ drug and fluid calculations are associated with a statistically significant increased risk of error compared with the use of reference charts or smartphone app. The smartphone app proved significantly faster and less stressful to use compared with traditional calculation methods or reference charts.

ABSTRACT Purpose Feasibility and pilot outcomes of a new community-based program for families of children with acquired brain injury (ABI) are presented. Interventions, delivered by home-visiting and teletherapy, were underpinned by problem-solving therapy, narrative meaning making, goal-directed interventions and community system psychoeducation. Methods Eighty-three families of children, who had sustained an ABI before 12 years of age, had an average of 13 sessions of the ‘Family First’ (FF) intervention. A mixed-methods prospective design was employed. Feasibility was evaluated through measures of accessibility and acceptability. Goal attainment scaling and pre-post changes on standardized questionnaires assessed changes in psychosocial adjustment and quality of life. Results Feasibility analyses suggested engagement and retention of often hard to reach families and children with high psychosocial needs. Qualitative analyses suggested themes related to the accessibility of a unique service (‘Nothing else like this out there’ and ‘Accessible and flexible’) which facilitated ‘Empowerment’ within a family context (‘A family affair’). Promising changes on standardized scales of behavior problems, competencies and child and family quality of life were discerned. Increased goal attainment scores were observed. Conclusion The FF program showed feasibility and promise. It impacted positively on the lives of children and families and improved capacity in supporting systems.