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ObjectivesJaundice is the main cause (22.3%) of all hospital readmissions in near-term and term babies.1 Home phototherapy (HPT) offers a safe, effective, and practical option for treatment of jaundice and reduces the need for inpatient phototherapy (IPT).2 Furthermore, HPT aligns with British Association of Perinatal Medicine’s (BAPM) family- integrated care (FiCare) core principle of empowering parents to be primary caregivers.3 The HoPE project evaluated the uptake of HPT and its impact on neonatal readmission rates in the West Midlands.MethodsA two-part mixed-methods service evaluation was conducted. Part 1 involved an online survey of regional HPT services completed by local hospital project leads. Part 2 was a retrospective analysis in which the clinical records of babies ≥ 35 weeks gestation, over 48hours but less than 2 weeks old, weighing > 2 kg who received phototherapy for treatment of physiological jaundice were assessed over a four-month period. Parental views on HPT were collected from two of the tertiary neonatal units.ResultsAll 14 (100%) neonatal units in the region participated in the online survey, and 13 (93%) in the retrospective service evaluation. HPT was introduced in the West Midlands in April 2018, and as of February 2023, a total of 1232 infants have received HPT.Currently, 8 (57%) units offer HPT, 2 (14%) units plan to start, and 1 (7%) unit ceased due to inadequate staffing. In three (21%) of the units, HPT is provided to their service users through a different unit. The eligibility criteria for HPT were similar across the units. The main challenges faced by units that have not yet set up HPT services are staffing and funding. The main challenges faced by units providing HPT services are non-compliance with guidelines, insufficient awareness, staffing, and delays in getting serum bilirubin results.The retrospective service evaluation included 594 babies. Of these, 302 (51%) were treated in centres without HPT and 292 (49%) in centres with HPT. The readmission rate was 39% (117/302) in centres without HPT compared to 27% (80/292) in centres with HPT (see tables 1a, 1b and 2).Abstract 6275 Table laCharacteristics, duration of phototherapy in days and readmission rates of babies treated for neonatal jaundice inwith HPT and without HPTAbstract 6275 Table lbSubgroup analysis of centres with HPTAbstract 6275 Table 2Parental satisfaction survey (n = 108)ConclusionHPT is underutilised as only 21% (62/292) of babies were treated exclusively with HPT and 26% (77/292) of babies received a combination of HPT and IPT. HPT uptake could be improved by increased awareness, improved testing turnaround time, adequate funding, recruitment and retention of staff for the service. Furthermore, we recommend the development of a West Midlands perinatal network HPT guideline.ReferencesBattersby C, Michaelides S, Upton M, Rennie JM. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open May 29 2017;7(5):e016050.Pettersson M, Eriksson M, Albinsson E, Ohlin A. Home phototherapy for hyperbilirubinemia in term neonates—an unblinded multicentre randomized controlled trial. Eur J Pediatr 2021;180(5):1603–1610.Family integrated care: a framework for practice. British Association of Perinatal Medicine 2021:10–4.

Background To undertake a systematic review of studies describing the proportion of children admitted to a paediatric intensive care unit (PICU) for respiratory syncytial virus (RSV) and/or bronchiolitis who were born preterm, and compare their outcomes in PICU with children born at term. Methods We searched Medline, Embase and Scopus. Citations and references of included articles were searched . We included studies published from the year 2000 onwards, from high-income countries, that examined children 0–18 years of age, admitted to PICU from the year 2000 onwards for RSV and/or bronchiolitis. The primary outcome was the percentage of PICU admissions born preterm, and secondary outcomes were observed relative risks of invasive mechanical ventilation and mortality within PICU. We used the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies to assess risk of bias. Results We included 31 studies, from 16 countries, including a total of 18,331 children. Following meta-analysis, the pooled estimate for percentage of PICU admissions for RSV/bronchiolitis who were born preterm was 31% (95% confidence interval: 27% to 35%). Children born preterm had a greater risk of requiring invasive ventilation compared to children born at term (relative risk 1.57, 95% confidence interval 1.25 to 1.97, I 2  = 38%). However, we did not observe a significant increase in the relative risk for mortality within PICU for preterm-born children (relative risk 1.10, 95% confidence interval: 0.70 to 1.72, I 2  = 0%), although the mortality rate was low across both groups. The majority of studies ( n  = 26, 84%) were at high risk of bias. Conclusions Among PICU admissions for bronchiolitis, preterm-born children are over-represented compared with the preterm birth rate (preterm birth rate 4.4% to 14.4% across countries included in review). Preterm-born children are at higher risk of mechanical ventilation compared to those born at term.

Background Survival following extreme preterm birth has improved, potentially increasing the number of children with ongoing morbidity requiring intensive care in childhood. Previous single-centre studies have suggested that long-stay admissions in paediatric intensive care units (PICUs) are increasing. We aimed to examine trends in long-stay admissions (≥28 days) to PICUs in England, outcomes for this group (including mortality and PICU readmission), and to determine the contribution of preterm-born children to the long-stay population, in children aged <2 years. Methods Data was obtained from the Paediatric Intensive Care Audit Network (PICANet) for all children <2 years admitted to National Health Service PICUs from 1/1/2008 to 31/12/2018 in England. We performed descriptive analysis of child characteristics and PICU outcomes. Results There were 99,057 admissions from 67,615 children. 2,693 children (4.0%) had 3,127 long-stays. Between 2008 and 2018 the annual number of long-stay admissions increased from 225 (2.7%) to 355 (4.0%), and the proportion of bed days in PICUs occupied by long-stay admissions increased from 24.2% to 33.2%. Of children with long-stays, 33.5% were born preterm, 53.5% were born at term, and 13.1% had missing data for gestational age. A considerable proportion of long-stay children required PICU readmission before two years of age (76.3% for preterm-born children). Observed mortality during any admission was also disproportionately greater for long-stay children (26.5% for term-born, 24.8% for preterm-born) than the overall rate (6.3%). Conclusions Long-stays accounted for an increasing proportion of PICU activity in England between 2008 and 2018. Children born preterm were over-represented in the long-stay population compared to the national preterm birth rate (8%). These results have significant implications for future research into paediatric morbidity, and for planning future PICU service provision.

ScenarioWhile working on a neonatal unit, you look after a baby born at 28 weeks gestational age, who required umbilical venous catheter (UVC) insertion following birth. During a routine echocardiogram examination to assess the patent ductus arteriosus, an incidental finding of an echogenic, non-occlusive thrombus was identified in the left portal vein. This was thought to be secondary to the UVC placement.You wonder how many preterm babies who have UVCs inserted in the neonatal unit develop portal venous thrombosis and who have complications from this.Structured clinical questionWhat is the prevalence of portal vein thrombosis following UVC insertion in preterm neonates born ≤32 weeks or very low birthweight infants (<1500 grams)? What is the prevalence of long-term significant complications of this?

ObjectiveTo quantify the characteristics of children admitted to neonatal units (NNUs) and paediatric intensive care units (PICUs) before the age of 2 years.DesignA data linkage study of routinely collected data.SettingNational Health Service NNUs and PICUs in England and WalesPatientsChildren born from 2013 to 2018.InterventionsNone.Main outcome measureAdmission to PICU before the age of 2 years.ResultsA total of 384 747 babies were admitted to an NNU and 4.8% (n=18 343) were also admitted to PICU before the age of 2 years. Approximately half of all children admitted to PICU under the age of 2 years born in the same time window (n=18 343/37 549) had previously been cared for in an NNU.The main reasons for first admission to PICU were cardiac (n=7138) and respiratory conditions (n=5386). Cardiac admissions were primarily from children born at term (n=5146), while respiratory admissions were primarily from children born preterm (<37 weeks’ gestational age, n=3550). A third of children admitted to PICU had more than one admission.ConclusionsHealthcare professionals caring for babies and children in NNU and PICU see some of the same children in the first 2 years of life. While some children are following established care pathways (eg, staged cardiac surgery), the small proportion of children needing NNU care subsequently requiring PICU care account for a large proportion of the total PICU population. These differences may affect perceptions of risk for this group of children between NNU and PICU teams.

Structured clinical question In neonates requiring intubation (population), is there a better sedative/analgesic (intervention) than the most common premedications (fentanyl or morphine, with atropine and suxamethonium) to reduce patient distress, reduce cardiovascular instability, and either increase success rates or improve conditions for intubation (outcome)? Summary Commentary It is now accepted that premedication should be used to reduce pain and marked physiological changes caused by awake intubation of neonates. 4 In the UK opioid sedatives are commonly used, most frequently morphine or fentanyl, with atropine and suxamethonium. 5 6 There is some evidence that these regimens increase ease of intubation. 7-9 However morphine has a long onset time of 5-15min, which may lead to delay or inappropriately early laryngoscopy, 10 11 and has prolonged effects on neonates for up to 24hours 12 ; fentanyl is faster acting but can cause chest wall rigidity and laryngospasm, treated with naloxone 13 or muscle relaxant. 4 Table 1 shows randomised controlled trials (RCTs) of other agents whose control arms use common premedication regimens, comparable with practice in the UK, with key outcomes. Citation Study group Study type (evidence level) Outcome Key result Comments Norman et al 20 Thirty- four neonates <37weeks, nasal intubation; 17 glycopyrrolate/thiopentone/ suxamethonium/remifentanil vs 17 morphine/atropine Blinded, age-stratified RCT (1b) Intubation conditions Score 'good conditions' 16/17 vs 1/17; p<0.001 Insufficiently powered, 39 randomised, 34 in analysis; two administration errors in study group. Pain scores No significant difference in scores up to 6hours Observations Study group heart rate and MAP more stable;...

Specific support requested by trainees to facilitate research involvement included supervisory and methodological support.Table 1 Results from thematic analysis of responses to motivators and barriers around research Motivators/benefits to research Example quotes Clinical care ‘I feel it can benefit so many more children than I am able to see clinically on an individual basis. The TRN recognises the positive impact of signposting all trainees to relevant support systems when developing research or quality improvement studies.3 Without appropriate exposure to high-quality research while in training, we risk compromising evidence-based care. Contributors Survey review, analysis of data, drafting and review of article—TR, HM, FM, LP, ELW, CWC, CJ and the RCPCH Trainee Research Network Working Group.

Correspondence to Dr Tim J van Hasselt, Neonatal Intensive Care Unit, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; t.vanhasselt@nhs.net The Kaiser Permanente Sepsis Risk Calculator (KP-SRC) was developed to predict early-onset neonatal sepsis (EOS), using continuous variables (local EOS incidence rates, maternal factors, infant well-being) to guide decision making.1 KP-SRC has been adopted in Plymouth and Wales, reducing antibiotic use by up to 84%2 3 compared with using National Institute for Health and Care Excellence (NICE) guidelines. [...]a small group of infants initially recommended observations by KP-SRC can have high CRP or bacteraemia. [...]emphasis on close observation, early recognition of deterioration and timely escalation is vitally important. TJvH, HM; supervision, project design, manuscript review: PS, AKE; local lead, data collection, manuscript: RE, LM, NM, SS, MJ, OA, CC, BM; data collection, manuscript: MN; data analysis, manuscript: RJ.

Near hanging refers to survival following suspension by the neck. This is a devastating injury which can lead to mortality or serious long-term morbidity. Children and young people present to emergency departments following accidental or deliberate near hanging. This article describes the patterns of injury, the initial management and important prognostic factors.

Retrospective virtual application of the National Institute for Health and Care Excellence (NICE) guidelines for neonatal infection 2021 compared with Kaiser Permanente Sepsis Risk Calculator (KP-SRC) and previous NICE guidelines 2012. NICE 2021 may reduce this to 4.4% and KP-SRC may reduce it to 2.7%, treating those recommended both culture and antibiotics.Table 1 Estimated percentages of live births >34 weeks receiving antibiotics in postnatal settings, following virtual application of NICE 2021 guidelines and KP-SRC Live births total January–February 2020 Current practice Abx NICE 2012 applied* KP-SRC 2/1000 Abx indicated plus NICE 2012* KP-SRC 2/1000 Abx and culture indicated plus NICE 2012* NICE 2021* KP-SRC 2/1000 Abx indicated plus NICE 2021* KP-SRC 2/1000 Abx and culture indicated plus NICE 2021* n 7833 624 572 118 306 346 103 209 % 8.0 7.3 1.5 3.9 4.4 1.3 2.7 NICE 2012: LM (1), SS (2), TvH (2), NM (2), AKE (2,3), PS (1), Paediatric Research Across the Midlands (PRAM) Network: (1) Birmingham Heartlands Hospital, (2) Birmingham Women’s and Children’s NHS Foundation Trust, (3) Institute of Metabolism and Systems Research, University of Birmingham.