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ObjectivesHypoglycaemia is a cause of morbidity and mortality in neonatal populations. Identification of at-risk groups and timely management is key to improving outcomes. Our local guideline categorises infants as Red, Amber or Green depending on different risk factors. ‘Red’ infants should automatically receive pre-feed blood glucose monitoring, and treatment for hypoglycaemia differs between categories: <2.6mmol/L for ‘Red’ and ‘Amber’ and <2.0 mmol/L for ‘Green’ infants.We retrospectively audited: a) frequency of hypoglycaemic infants b) compliance against local guidelines for: initial risk assessment, completion of 3 pre-feed blood glucoses in high-risk infants; and c) time to prescription and administration of hypoglycaemia treatment.MethodsWe used Badgernet to identify infants born on site between 27 July – 27 September 2023. All blood gas results were collected from the post-natal ward (PNW) machine for the study period. Data was collected from the following sources: 1) Badgernet lists (Mothers with diabetes, hypertension or pre-eclampsia; babies under observation) and 2) Electronic patient records (oral glucose gel prescription and administration). Finally, full review of badger notes for risk factors was undertaken for all infants with hypoglycaemia and 50 infants selected through random number generation.Results672 infants were born over the 2-month period. Table 1 shows the frequency of infants with hypoglycaemia stratified by risk category.Abstract 6752 Table 162.8% ‘Red’ infants had 3 or more blood gases taken, the first of which was on average 6 hours 53 minutes from birth. 35% of hypoglycaemic episodes in ‘Red’ babies were treated, and on average, across all categories, there were 22.5 and 34.5 minutes from measured hypoglycaemia to prescription and administration of treatment, respectively. 85.3% of infants sampled were correctly categorised.ConclusionOur results demonstrate poor local compliance with infant risk assessment, hypoglycaemia monitoring and treatment. Furthermore, we are not meeting latest BAPM1 guidance for first blood glucose measurement: 2–4 hours after birth. A limitation is our inclusion of only PNW blood gas data, which may miss a minority of initial blood gases undertaken on Labour Ward or data for infants not on PNW. Improvement is planned through departmental training and use of recently adopted electronic record system.ReferenceIdentification and Management of Neonatal Hypoglycaemia in the Full Term Infant (Birth – 72 hours). A BAPM DRAFT framework for practice, British Association of Perinatal Medicine 2023.

ObjectivesRespiratory insufficiency is a significant cause of mortality and morbidity amongst infants with exomphalos and usually is ascribed to the increased intraabdominal pressure after surgical closure. We determined if infants with exomphalos also had abnormal antenatal lung growth as indicated by lower chest radiographic thoracic areas (CRTA) on day one compared to ventilated, term-born controls without respiratory pathology and whether the CRTA could predict the development of bronchopulmonary dysplasia (BPD).MethodsInfants with exomphalos cared for between January 2004 and January 2023 were included in the study. The control group consisted of term, newborn infants admitted because of poor perinatal adaptation or hypoxic ischemic encephalopathy without concomitant respiratory pathology. The infants were ventilated for absent respiratory drive at birth and had no supplemental oxygen requirement by six hours of age. The study was registered with the Clinical Governance Department. The radiographs were imported as digital image files by Sectra PACS software (Sectra AB, Linköping, Sweden). Free-hand tracing of the perimeter of the thoracic area as outlined by the diaphragm and the rib cage was undertaken and the CRTA was calculated by the software. The chest radiograph with the highest CRTA in the first 24 hours after birth for each infant was included in the analysis.ResultsSixty-four infants with exomphalos and 130 controls were included. Infants with exomphalos had a lower median (IQR) CRTA [1983 (1657 – 2471) mm2] compared to controls [2547 (2153 – 2932) mm2, p<0.001]. Infants with exomphalos had a lower median (IQR) gestational age [38.1 (35.8 – 39.0) weeks] and birth weight [3.06 (2.43 – 3.33) kg] compared to controls [39.5 (38.0 – 41.0) weeks and 3.34 (2.98 -3.69) kg, p<0.001 for both] and a lower incidence of male sex (42% versus 59%) p=0.032).Following multivariable regression analysis, infants with exomphalos had significantly lower CRTAS compared to controls (p=0.001) after adjusting for differences in gestational age and male sex. In the exomphalos group, the CRTA was lower in infants with exomphalos who developed BPD [n=14, 1530 (1307 – 1941) mm2] compared to those who did not [2168 (1865 – 2672), p<0.001]. Following multivariable regression analysis, the CRTA was significantly associated with BPD development [p=0.021] after adjusting for male sex and gestational age.ConclusionThe lower CRTA on day one in the exomphalos infants compared to the controls and its association with BPD development suggests the exomphalos infants may have had abnormal antenatal lung development.

Why did you do this work?The Working Lives Subgroup of the London School of Paediatrics (LSP) Trainees’ Committee aims to empower trainees with the knowledge and resources to help them navigate issues that they may encounter throughout their training. Through our work with educational seminars, open forums, one to one support, and the creation of user-friendly guidance, we identified a need for further awareness, guidance and support for trainees regarding their working lives matters. We therefore designed and hosted a ‘Working Lives Study Day’ (WLSD).What did you do?The online WLSD was designed for paediatric trainees, and was also open to colleagues involved in the organisation of paediatric training including rota coordinators and consultants. The day consisted of presentations, Q&A sessions, and interactive workshops. We focused content on four key areas: payslips and salary calculations; pregnancy, maternity/paternity leave and pay; rota design and implementation; and less-than-full-time (LTFT) training. These topics are in line with NHS England’s Chief Executive Amanda Pritchard’s agenda for ‘Improving the working lives of doctors in training’, as set out in a letter to all NHS trusts in April 2024.1 Pre and post course surveys were sent to all attendees, asking them to rank their confidence level from 1–10 (1 being least confident, 10 being most confident) in the four areas, as well as encouraging open space questions and feedback.What did you find?The WLSD was attended by 45 paediatric trainees from across London. Our data demonstrates improvement in confidence levels of attendees across all four topics. Attendees’ confidence in calculating their pay and checking their payslips scored a mean of 3.5 prior to the course, which increased to 7 in the post course feedback. The mean score for understanding rights during pregnancy and parental leave before the course was 3; this improved to 7.5 following the course. Attendees ranked their confidence tackling rota related issues such as rostering and leave at a mean of 6 before the course, which improved to 8 after the course. Attendees’ confidence navigating LTFT training scored a mean of 4.5 before the course, which increased to 7.8 after the course (figure 1).Abstract 8253 Figure 1Results comparing attendee mean pre survey confidence to post attendance confidence, for four topics covered during the study day[Image Omitted. See PDF.]Most queries from the pre-course survey centred around rota and leave. The post course feedback was overwhelmingly positive: trainees expressed highlights from all the sessions, particularly with regards to understanding pay.What does it mean?The WLSD achieved an improvement in trainees’ confidence managing issues with their pay, rotas, LTFT training and parental leave. This supports the continuing need to disseminate this information through further study days to help trainees find solutions to these common issues. We feel encouraged by the success of this work, and plan to open future sessions to a national audience. Ultimately, doctors who are happy and empowered in their working lives provide better patient care.2 ReferencesPritchard A, Powis S, Evans N. Improving the working lives of doctors in training [Internet]. NHS England: United Kingdom; 25th April 2024 [Accessed 27th September 2024]. Available from: https://www.england.nhs.uk/long-read/improving-the-working-lives-of-doctors-in-training/Department of Health. NHS Health & Well-being Improvement Framework [Internet]. Department of Health: United Kingdom; 29th July 2011 [Accessed 30th September 2024]. Available from: https://assets.publishing.service.gov.uk/media/5a7c0296e5274a7318b907ab/dh_128813.pdf