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ObjectivesA retrospective analysis of relationship between pulse oximetry, lactate and fluid balance during first five post operative days and patient outcomes after Norwood stage 1MethodsA retrospective, single centre analysis of etiometric data during a 5 year period (Jan 2016- Dec 2020) was performed on children undergoing Norwood stage 1 procedure. SpO2 (minute by minute data), arterial lactate (229 total readings at various timepoints) and daily fluid balance was collected for the first five post operative days . The studied outcomes are listed in table 1.Results32 patients were identified. Four were excluded due to lack of access to etiometric data. Patient demography and surgical characteristics are demonstrated in table 1. Outcome parameters studied are demonstrated in table 2The ICU and hospital stays were higher in the children who died (23.5 and 62.5 days) as compared to the survivors (10.75 and 34 days) although not statistically significantly different [p=0.19 (los_icu), p=0.37 (los_hosp)]Median percentage of time pulse saturations (SpO2) remained < 75% was 22.4 + 12.3; >85% was 11.7 + 8.8 and within targeted range of 75%-85% was 62.8+ 9.4.No statistically significant correlation was found between the percentage of time saturations were l<75% or >85% or daily fluid balance with any of the studied outcomes. They were also not able to significantly predict any of the listed outcomes. However, lactate at 42 hr and beyond demonstrated moderate to strong association with los_icu (r=.55,p=.01). Lactate at 42 hr was also able to significantly predicted los_icu, F(1, 19) = 8.1, p =.01 accounting for 29.9% (R2) of the variation in los_icu (adjusted R2 = 26.3%) (figure 1). Multiple regression model(s) including lactate , fluid balance, cardiopulmonary bypass times and pulse oximetry times were not good.ConclusionOnly persistent hyperlactatemia at 42 hours showed an association and predicted increased length of ICU stay. Limitations of a single centre, retrospective nature and small sample size prevent generalization of these results. A larger prospective study alongside analysis of data from a larger single ventricular registry could provide more information about the utility of bedside etiometry data in studying patient journey and outcomes.Abstract 7970 Figure 1Linear regression model for lactate at 42 hours post operatively and ICU length of stay[Image Omitted. See PDF.]Abstract 7970 Table 1Patient demography and surgical characteristics[Image Omitted. See PDF.]Abstract 7970 Table 2Outcome parameters[Image Omitted. See PDF.]ReferencesPrimeaux J, Salavitabar A, Lu JC, Grifka RG, Figueroa CA. Characterization of post-operative hemodynamics following the norwood procedure using population data and multi-scale modeling. Front Physiol. 2021;12:603040. Published 2021 May 13. doi:10.3389/fphys.2021.603040Wasaki T, Takeuchi M, Taga N, Oe K, Shimizu K, Morita K. Masui. 2004;53(9):1008–1013.

IntroductionMost paediatric intensive care units (PICU) currently use a traditional bespoke weight-based method for calculating the concentration of intravenous infusion using complex and highly variable approaches. There are big variation in preparation methods across PICUs in the UK with over 150 methods identified,1 which can potentially increase the risk of error and subsequently impact patients’ safety. Approximately 46% of the errors that occur in PICUs are related to administration errors,2 and IV medication errors represent about 54–56% of all administration errors.3 Standard concentrations of Infusions (SCI) is part of a global strategy to improve intravenous medication safety since it has been shown to potentially eliminate up to 27% of medication errors.4 AimWe aimed to explore and investigate the current approach and extent of the impact on the patients‘ safety. The objectives were to identify the numbers and types of errors reported in PICU specifically with regards to the weight based infusions. Furthermore, to assess the adherence of nurses to the local infusions policy and the time it takes for nurses to prepare infusions.MethodA secondary analysis was carried out for all medication errors gathered retrospectively from 1 September 2012 to 30 May 2022 in a PICU using the conventional weight based infusions method. Additionally, nine nurses were observed during the preparation of continuous infusions and observational data gathered using a data collection tool. A total of ten infusions were observed.ResultsA total of 378 errors were identified during the study period, and 16 errors were directly attributed to weight based infusions, including four types of errors. Calculation and wrong setting of pumps were the highest number of errors (n=5 each; 31.3%), followed by preparation errors involving inaccuracy of withdrawn volume (n=4; 25%). Most of these errors (n=14, 87%) were considered no harm and two (13%) were considered low harm. These two errors required observation, monitoring and minor treatment of patients. Half of the errors identified (8 errors) were as a result of higher concentrations and the other half, lower concentrations. Furthermore, 19% (n=3) of errors were prescription related errors. The mean time to prepare infusions as directly observed in preparation of ten infusions was 12 minutes ranging between 7 and 29 minutes. ConclusionsThe risk of medication errors due to the complex and highly variable weight based concentrations of infusions has demonstrated to have a negative impact on patient safety. Furthermore, the nature of errors that weight based concentrations is associated with, such as ten-fold higher or lower than the prescribed concentration, can lead to significant undesirable consequences. Implementation of the standard concentrations of infusions could be a potential solution to complement continuous education in reducing medication errors.ReferencesOskarsdottir T, Harris D, Sutherland A, et al. A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom. J Pharm Pharmacol 2018;70:1324–1331.Santesteban E, Arenas S, Campino A. Medication errors in neonatal care: a systematic review of types of errors and effectiveness of preventive strategies. Journal of Neonatal Nursing 2015;21:200–208.Ross LM, Wallace J, Paton JY. Medication errors in a paediatric teaching hospital in the uk: five years operational experience. Archives of Disease in Childhood 2000;83:492–497.Howlett M, Butler E, Lavelle KM, et al. The impact of technology on prescribing errors in paediatric intensive care: a before and after study. Appl Clin Inform 2020;11:323–335.

BackgroundAlveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare, fatal, congenital lung disorder involving abnormal development of the capillary vascular system around the alveoli of the lungs, which clinically presents as persistent pulmonary hypertension of the newborn (PPHN) refractory to treatment. It has been linked to the gene FOXF1 on chromosome 16q24.1–q24.2. Histopathological examination by lung biopsy is the gold standard for diagnosis.Materials and methodsWe present four cases of ACD/MPV who were referred for ECMO support with a diagnosis of PPHN with no apparent congenital anomalies.ResultsAll the newborns had an overwhelming course, with PPHN and hypoxemia refractory to treatment. The diagnosis of ACD/MPV was established by ante-mortem lung biopsy in all cases. Intensive care treatment was withdrawn post diagnosis, with none of the four surviving.ConclusionsEarly lung biopsy for a histological diagnosis allows expensive and ineffective treatment to be avoided. Lung biopsy can be performed with low risk and high-diagnostic yield for alveolar capillary dysplasia.

Pulmonary haemorrhage is an uncommon symptom in paediatrics with the etiology varying among the series by age, location, and the diagnostic tests employed. Once airway protection and volume resuscitation are ensured, localization of the anatomic site of bleeding, isolation of the involved airway, control of haemorrhage and treatment of the underlying cause of becomes essential. In localized persistent bleeding, airway control may be achieved by lung isolation with double lumen endotracheal tube and synchronous independent lung ventilation.