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ObjectivesRespiratory distress is the commonest cause of term admission to Neonatal Unit. However, two-thirds were only admitted for less than 48 hours.1 The audit as outlined in the ATTAIN SOP: Avoiding Term Admissions in Neonatal Units – Respiratory Management of Term infant in the First Hour Following Birth and analyse the outcome for babies in whom ‘Trial of PEEP’ is attempted. In this audit trial of PEEP was performed in new-borns > 37 weeks’ gestation who requiring respiratory support immediately after birth. PEEP was given at 6cm H2O for 30 minutes. [figure 1] The outcomes were then analysed to identify potential avoidance of term admission and rooms for improvement in practice.Abstract 6048 Figure 1MethodsPatient samples were collected between March and June 2023. Initial collection in March to May was not effectively collected with missing information, prompting a creation of specialized form and allocation to colleagues in May to June. Additional data on babies undergoing ‘trial of PEEP’ was identified. Excel was used for analysis, focusing on descriptive analysis.ResultsIn this study, a total of 19 patients were included, but 4 of them were excluded because positive end-expiratory pressure (PEEP) was applied more than 1 hour after birth. Among the new-borns who received a PEEP trial at birth, 40% successfully avoided admission to the Neonatal Unit (NNU). [figure 2] Impressively, 83% of these new-borns did not require septic screens or antibiotics, underscoring the effectiveness of PEEP. Additionally, 66% of the babies admitted to NNU only needed high-flow oxygen support for less than 8 hours. Notably, three infants received PEEP for less than 30 minutes and were immediately admitted to the NNU due to ongoing respiratory distress, while three others with similar PEEP durations were observed in the postnatal ward after their respiratory effort normalized. Prolonged rupture of membrane (PROM) was identified in three patients who developed respiratory distress at 5 hours, 6 hours and 1 hour with significant meconium and failed the ‘Trial of PEEP’.Abstract 6048 Figure 2ConclusionThe initial findings suggest that employing the ‘Trail of PEEP’ during delivery benefits term and late-preterm infants experiencing respiratory distress at birth. This approach appears to lower admissions to the Neonatal Nursing Unit (NNU), promoting maternal-infant bonding, reducing antibiotic usage, and potentially saving costs by averting NNU admissions. However, it’s important to note that patients with Premature Rupture of Membranes (PROM) may have a distinct respiratory distress mechanism and may not respond as effectively to PEEP.ReferenceReducing harm leading to avoidable admission of full-term babies into neonatal units, NHS Improvement, February 2017.

Vulvar lichen sclerosus is a chronic inflammatory skin condition that leads to scarring and an increased risk of squamous cell carcinoma. It presents clinically as atrophic white patches or plaques, often with associated fissures, erosions, hyperkeratosis, purpura or ecchymoses. The chronic inflammation in vulvar lichen sclerosus leads to permanent scarring, resulting in pain syndromes and genitourinary complications. While diagnosis is often made clinically, skin biopsies are considered the gold standard for diagnosis. Additionally, biopsies are often required throughout the course of the disease to monitor for the development of malignancy. Thus, there is a need for noninvasive, high‐sensitivity, real‐time imaging to evaluate vulvar lichen sclerosus changes. This study presents a proof‐of‐concept evaluation of a 1.7‐μm optical coherence tomography (OCT)/OCT angiography (OCTA) system with enhanced penetration depth and high resolution for characterizing the structural and microvascular features of VLS. The primary objective was to evaluate the feasibility of using this imaging technology to quantitatively measure vulvar epithelial thickness and vascular changes across different anatomical sites (labia majora, labia minora, and interlabial sulci) in both VLS patients and healthy controls. By leveraging the increased penetration depth of the 1.7‐μm OCT system, we aimed to provide a deeper understanding of VLS‐associated tissue alterations and explore its potential as a non‐invasive alternative to biopsies for disease assessment and monitoring. Optical Coherence Tomography Angiography in the Assessment of Vulvar Lichen Sclerosus

BackgroundKangaroo mother care (KMC) is a proven intervention for intact survival in preterms. Despite evidence, its adoption has been low. We used a point of care quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies from a baseline of 1.5 hours/baby/day to above 4 hours/baby/day through a series of plan-do-study-act (PDSA) cycles over a period of 53 weeks.MethodsAll babies with birth weight <2000 g not on any respiratory support or phototherapy and or umbilical lines were eligible. The key quantitative outcome was KMC hours/baby/day. A QI collaborative was formed between six centres of Karnataka mentored by a team with a previous QI experience on KMC. The potential barriers for extended KMC were evaluated using fishbone analysis. Baseline data were collected over 3 weeks. A bundled approach consisting of a variety of parent centric measures (such as staff awareness, making KMC an integral part of treatment order, foster KMC, awareness sessions to parents weekly, recognising KMC champions) was employed in multiple PDSA cycles. The data were aggregated biweekly and the teams shared their implementation experiences monthly.ResultsA total of 1443 parent–baby dyads were enrolled. The majority barriers were similar across the centres. Bundled approach incorporating foster KMC helped in the quick implementation of KMC even in outborns. Parental involvement and empowering nurses helped in sustaining KMC. Two centres had KMC rates above 10 hours/baby/day, while remaining four centres had KMC rates sustained above 6 hours/baby/day. Cross-learnings from team meetings helped to sustain efforts. Extended KMC could be implemented and sustained by low intensity training and QI collaboration.ConclusionsFormation of a QI collaborative with mentoring helped in scaling implementation of extended KMC. Extended KMC could be implemented by parent centric best practices in all the centres without any additional need of resources.