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BackgroundIn the UK setting, where neonatal jaundice treatment is required, it is largely carried out in hospitals. However, it is possible to safely administer home phototherapy (HPT).ObjectiveTo report on our centre’s experience of HPT and its potential benefits.DesignRetrospective observational study performed as a service evaluation.PatientsInfants ≥35 weeks corrected gestational age with a weight of 2 kg and serum bilirubin ≤50 µmol/L above treatment thresholds. Controls were a matched group of infants who received inpatient phototherapy (IPT).SettingThe catchment area of two neonatal intensive care units, one special care unit and a birth centre at four different hospitals that is covered by a single neonatal community outreach nursing team in Birmingham, UK.InterventionHPT was started either in the community or as a continuation of IPT. Controls received IPT.Main outcome measuresThe rate of bilirubin reduction, hospital readmission rates and parental satisfaction.Results100 infants received HPT while 50 received IPT. No infant showed a progressive rise of serum bilirubin level while receiving HPT. The rate of bilirubin reduction was similar in both HPT and IPT groups (2.4±1.9 and 2.5±1.6 µmol/L/hour, respectively, MD=−0.1, 95% CI −0.74 to 0.53, p=0.74). Readmission rate was 3% in the HPT group. 97% of parents stated that the overall experience was good and 98% would choose HPT if they had their time all over again.ConclusionOur programme suggests that HPT for neonatal jaundice can be carried out in a select group of infants. It helps in providing holistic family-centred care and is viewed positively by families.

Correspondence to Dr Sarah Louise Williamson; sarahlouise.williamson@nhs.net Summary Preterm birth is the biggest cause of infant mortality and morbidity in the UK.1 Evidence has shown that optimal cord management (OCM), defined here as deferring cord clamping for at least 60 s following delivery, can reduce the risk of death in preterm babies by nearly one-third, reduce the need for blood transfusion by 10% and encourage haemodynamic stability, therefore reducing the need for inotropic support following delivery.2–4 OCM is a British Association of Perinatal Medicine quality standard, recorded as part of the National Neonatal Audit Programme (NNAP) and is an essential part of perinatal optimisation now included in the Newborn Life Support course.5–7 Problem NNAP data published for 2021 identified our neonatal intensive care unit (NICU) as a national outlier for OCM. BAPM, British Association of Perinatal Medicine; MW, midwives; NICU, neonatal intensive care unit; NLS, Newborn Life Support; OCM, optimal cord management; QI, quality improvement. Table 1 Demographs of infants born <34 weeks between 2022-2024 2022 2023 2024 Number of deliveries<34 weeks 199 210 124 Demographics Gestational age in weeks—median (range) 31 (22–33) 31 (22–33) 30 (21–33) Birth weight in g—median (range) 1475 (500–3480) 1447 (455–2795) 1365 (425–2725) Plurality  Singleton 139 (70%) 142 (68%) 96 (77%)  Multiple 30 (30%) 68 (32%) 28 (23%) OCM Number achieving OCM 112 (56%) 157 (75%) 80 (65%) Documented contraindication or concern 32 (16%) 47 (22%) 41 (33%) No OCM without documented reason 55 (28%) 6 (3%) 3 (2%) Successful OCM by Location  Delivery suite 44/63 (69%) 47/58 (81%) 28/41 (68%)  Theatre 87/130 (67%) 109/148 (74%) 49/78 (63%)  Other 0/6 (0%) 1/4 (25%) 3/5 (60%) OCM, optimal cord management. Table 2 Average annual unit rates of OCM and in-range admission temperature in babies (<34 weeks unless stated) OCM Admission temperature in range 2021* 20%* 80%* 2022 56% 85%* 2023 74% 89% 2024 65% 83% *Data reported for babies <32 weeks as per NNAP criteria.

Background Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK. Method A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups. Results A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008). Conclusion There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors.

BackgroundRapid exome and genome sequencing in acutely unwell children has become increasing available worldwide over the last five years. The diagnostic rate is variable; however most relevant literature highlights the importance of the effect of a genetic diagnosis on the management in acute neonatal (NICU) and paediatric intensive care (PICU) settings.NHS England published the National Genomic Test Directory to integrate and embed genomic testing into mainstream medicine. The test directory lists genetic testing for different disorders and ‘R14’ was allocated to the rapid exome sequencing service for acutely unwell babies and children with a potentially monogenic disorder. R14 service was launched by NHS England on 1st October 2019.The service is delivered by the Exeter Genomics Laboratory, South West Genomic Laboratory Hub, running in collaboration with clinical genetics units. The main aims are to provide rapid genetic diagnosis to influence acute management and provide equity of access.ObjectivesThis study is a retrospective service evaluation and analysis of all cases recruited during the first year of the R14 service in England from 1st October 2019 until 30th September 2020. The primary and secondary outcomes focus on assessing turn-around-time (TAT), diagnostic rate and management impact of a rapid genetic diagnosis.MethodsA standardised proforma was created and eligible patients were identified through the electronic database at the Exeter Genomic Laboratory. The proformas were pre-populated with the molecular findings, circulated to the 17 regional clinical genetics centres and completed using patient notes. Anonymised data were collated and analysed using Microsoft Excel.Results361 acutely unwell children were included. 53%(192/361) were male. Patient age groups were neonates 40%(144), infants 40%(143), children 20%(72), two unknown. 50%(182) were recruited from NICU, 26%(93) PICU, 24%(86) ward or home. 91%(329/361) were trio samples.The median TAT was 11 days from receipt of the DNA samples in the Exeter laboratory to the final report. The majority(331/361, 92%) received a final report within the 21-day TAT standard. 14/30 were delayed to allow additional testing where preliminary results were re-classified to diagnoses.The diagnostic rate was 38%(141/361). The result influenced management in 94%(133/141) of these patients.Impact of diagnosis on managementIn 75%(100/133), the diagnosis directly influenced management for the proband or family members. In a further 25%(33/133), diagnosis was helpful solely for discussing precise recurrence risk and prenatal diagnosis offered if indicated.32%(43/133) were referred to a specialist for the condition; 16%(23/133) informed re-orientation and palliative care. Current management and prognosis were supported in 16%(22/133) and specific treatment such as transplant or medication was provided in 13%(19/133). Specific screening was arranged in 5%(7/133).ConclusionsThis is the first NHS-based diagnostic service which provides rapid genetic diagnoses in acutely unwell children and the largest reported cohort of patients undergoing rapid exome sequencing. It demonstrates that this innovative and transformational national service has successfully provided rapid results while maintaining a high diagnostic rate. Most importantly, diagnoses have influenced both acute management in intensive care settings and long term management for children and their immediate and extended family members.

There is increasing evidence reflected in both UK 2019 NICE and European guidelines suggesting that less invasive surfactant administration (LISA) reduces the need for mechanical ventilation and reduces the combined outcome of death or bronchopulmonary dysplasia, and is now the optimal method for surfactant delivery in spontaneously breathing babies. Despite this, uptake in England has been slow compared with Europe. This quality improvement project outlines the process of implementing LISA in a neonatal intensive care unit over a 2-year period, the barriers and challenges which were encountered, and how they were overcome.

BackgroundThe SARS-Cov2 pandemic impacts postgraduate medical training in all specialties, including paediatrics. However, those advised to ‘shield’ or stringently socially distance have been particularly affected personally and professionally. Despite the emerging situation, trainee voices must be heard to provide valuable contributions to local and national processes affecting them.ObjectivesWe describe the model used and outcomes from the Supported Return to Training programme (SuppoRTT) Shielding Trainee Advisory Group (S-STAG) in collaboration with Health Education England (HEE) to design and implement pathways and resources for these trainees.MethodsLed by HEE fellows, the group was recruited from varied specialties, providing broad representation of community and hospital-based, medical and craft specialties, including paediatrics. The group met virtually fortnightly during the first wave of the pandemic. Collaborative work was completed using shared documents online.Trainee challenges and experiences raised within the group and via wider trainee networks allowed a targeted approach to providing resources and guidance. Good practice from different regions, Royal College guidance and advocacy of displaced trainees was shared across multiple platforms.Results272 live attendees of four webinar episodes represented all HEE regions and Northern Ireland. 96% found the series ‘useful’ with 86% rating the psychological support sessions as ‘useful’ or ‘very useful’. Recorded sessions continue to be viewed.ResourcesA pathway was designed to help trainees and supervisors navigate their new circumstances and identify learning contributing to training progression despite significant changes to clinical roles. We designed a nationally available toolkit, freely available via the national/regional HEE SuppoRTT websites including: suggested activities, resource signposting, peer-support models, trainers guidance and advice on returning to face-to-face working.Four recorded webinars were delivered with country-wide involvement of professionals including a clinical psychologist, exploring the impact of shielding on identity and purpose. Bringing people experiencing similar challenges together developed support and a framework to understand the emotional impact of shielding and negotiate the challenges of abrupt changes. Peer-support groups were set up in many regions.Collaboration continues to inform further guidance as the situation evolves.Information DisseminationStrong connections developed with SuppoRTT Regional offices and HEE national communication teams assisted in identifying, receiving feedback from and disseminating information to affected trainees whilst maintaining confidentiality. Utilising social media, formal publication in journals and digital media facilitated rapid dissemination of resources.ChallengesThe pandemic presents unique challenges: Trainee occupational health is provided by the employer, not HEE or a training body, resulting in potential disconnect and lack of institutional awareness. Each trainee has individual circumstances requiring a bespoke approach. Formal national guidance and resources were not immediately available, constantly changing case rates in different geographies impaired making guidance universally available and appropriate. S-STAG is aware that for some, these resources were not prompt enough, despite best efforts. In future, these resources could be adapted and earlier advocacy initiated.ConclusionsOur group has successfully demonstrated a collaborative approach between trainees from a broad range of specialties and educational leaders with an interest in welfare and trainee support, working in a rapidly changing environment to produce a range of relevant resources.

Women with homoplasmic variations in mitochondrial DNA are at high risk for having affected biologic children. This study tests a new method to subvert the transmission of mitochondrial disease from mother to offspring.

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.

Pseudohypoaldosteronism (PHA) due to obstructive uropathy, urinary tract infections and congenital urogenital malformations has been reported in the literature; however, there are no reports of PHA associated with hydrometrocolpos due to a common urogenital tract. Hydrometrocolpos is a condition resulting in distension of the vagina and uterus due to accumulation of secretions (other than blood), caused by increased oestrogenic stimulation and vaginal outflow obstruction. We report on a neonatal case of PHA caused by recurrent hydrometrocolpos presenting with vomiting and poor weight gain. There was significant hyponatraemia, hyperkalaemia, and anaemia requiring medical stabilisation prior to surgery. The mechanism by which PHA occurs in obstruction involves renal tubular dysfunction due to pressure from hydronephrosis and the release of intrarenal cytokines. In addition, there is an immature or resistant renal tubular responsiveness to aldosterone during infancy. Clinicians should be aware of this uncommon but serious presentation.