Trainee's preparedness for paediatric work

Aim  Compare the opinion of paediatric consultants to paediatric Senior House Officers (SHOs) with regards their perceived level of preparedness for starting work in paediatrics.  Methods  A 5-point Likert scale questionnaire was administered to paediatric consultants and SHOs investigating how well they considered the SHO was performing and how well prepared the SHO perceived themselves for work in clinical paediatrics, respectively. Questions related to procedures, clinical examination, teamwork, history taking and OPD related activity.  Results  50 Consultants and 75 SHOs completed the questionnaire. Using a Mann-Whitney U test, both groups answered similarly to questions relating to clinical examination and history taking (p=0.51 and p=0.15). However, there were significant differences in their responses to questions relating to procedures, teamwork and OPD related activity (p Conclusion  There is a significant disparity between consultant opinion of ability and SHOs perception of preparedness for some of the same skills. More work, focusing on these specific aspects of undergraduate paediatric education needs to be carried out to improve graduate preparedness for this role</p

Neonatal abstinence syndrome: a national survey

Aim  Neonatal units have differing approaches to the management of Neonatal abstinence syndrome (NAS) and the resources allocated to this. A survey from 2009 showed this within the UK and Ireland. The aim of this project was to conduct a national survey to assess current management of NAS throughout Ireland.  Methods  The survey was conducted online via email in April 2022. A 30 question survey was developed in consultation with neonatologists, ANPs and pharmacy in Rotunda Hospital.  Results  All 21 units responded to the survey. 7/21(33%) of infants are monitored for the recommended 5 days. 21/21(100%) of units use modified Finnegan scoring however only 10/21(48%) receive training. 16/21(66%) had a non-pharmacological treatment plan. All units used oromorph as first-line agent however frequency and dosing varied significantly. 15/21(71%) use phenobarbitone as second-line. 12/21(57%) didn’t have a different approach for non-opioid NAS 12/21(57%) encouraged breastfeeding and only 5/21(24%) of units had a specific parental education program for these families. 1/21(5%) had a transitional care unit.  Discussion This national survey shows wide discrepancy in management of NAS and demonstrates the benefit that a National Guideline would have. This is a small, vulnerable population and the development of a consensus on management could standardise care and improve outcomes.</p

Minimum accepted competency examination: test item analysis

Background: To ascertain if undergraduate medical students attain adequate knowledge to practice in paediatrics, we designed the minimum accepted competency (MAC) examination. This was a set of MCQ's designed to test the most basic, 'must know' knowledge as determined by non-faculty paediatric clinicians. Only two-thirds of undergraduate students passed this exam, despite 96% of the same cohort passing their official university paediatric examination. We aim to describe the psychometric properties of the MAC examination to explore why there was a difference in student performance between these two assessments which should, in theory, be testing the same subject area. We will also investigate if the MAC examination is a potentially reliable method of assessing undergraduate knowledge. Methods: The MAC examination was sat by three groups of undergraduate medical students and paediatric trainee doctors. Test item analysis was performed using facility index, discrimination index and Cronbach's alpha. Results: Test item difficulty on the MAC between each group was positively correlated. Correlation of item difficulty with the standard set for each item showed a statistically significant positive relationship. However, for 10 of the items, the mean score achieved by the candidates did not even reach two standard deviations below the standard set by the faculty. Medical students outperformed the trainee doctors on three items. 18 of 30 items achieved a discrimination index > 0.2. Cronbach's alpha ranged from 0.22-0.59. Conclusion: Despite faculty correctly judging that this would be a difficult paper for the candidates, there were a significant number of items on which students performed particularly badly. It is possible that the clinical emphasis in these non-faculty derived questions was juxtaposed with the factual recall often required for university examinations. The MAC examination highlights the difference in the level of knowledge expected of a junior doctor starting work in paediatrics between faculty and non-faculty clinicians and can identify gaps between the current curriculum and the 'hidden curriculum' required for real world clinical practice. The faculty comprises physicians in employment by the University whose role it is to design the paediatric curriculum and deliver teaching to undergraduate students. Non-faculty clinicians are paediatric physicians who work soley as clinicians with no affiliation to an educational institution. The concept of a MAC examination to test basic medical knowledge is feasible and the study presented is an encouraging first step towards this method of assessment.</p

Neonatal abstinence syndrome: a national survey

Aim  Neonatal units have differing approaches to the management of Neonatal abstinence syndrome (NAS) and the resources allocated to this. A survey from 2009 showed this within the UK and Ireland. The aim of this project was to conduct a national survey to assess current management of NAS throughout Ireland.  Methods  The survey was conducted online via email in April 2022. A 30 question survey was developed in consultation with neonatologists, ANPs and pharmacy in Rotunda Hospital.  Results  All 21 units responded to the survey. 7/21(33%) of infants are monitored for the recommended 5 days. 21/21(100%) of units use modified Finnegan scoring however only 10/21(48%) receive training. 16/21(66%) had a non-pharmacological treatment plan. All units used oromorph as first-line agent however frequency and dosing varied significantly. 15/21(71%) use phenobarbitone as second-line. 12/21(57%) didn’t have a different approach for non-opioid NAS 12/21(57%) encouraged breastfeeding and only 5/21(24%) of units had a specific parental education program for these families. 1/21(5%) had a transitional care unit.  Discussion This national survey shows wide discrepancy in management of NAS and demonstrates the benefit that a National Guideline would have. This is a small, vulnerable population and the development of a consensus on management could standardise care and improve outcomes.</p

Reducing-Invasive-Screening-for-Group-B-Streptococcus-GBS-in-Asymptomatic-Term-Neonates.pdf

Lette

Early Onset Neonatal E.Coli Sepsis

This was a retrospective case-control study over 14 years comparing characteristics of neonates who developed E.coli bacteraemia with matched infant controls whose mothers were colonised with E.coli on high vaginal swab but who did not develop bacteraemia. Data was obtained from maternal and neonatal charts, the laboratory data-base was analysed to identify possible risk factors for E.coli bacteraemia. 21 cases and 38 controls were identified. The data showed no difference in gender, maternal age, white cell count, or cord pH. Significant differences were found in gestation (33 vs. 39.5wks p5 days is advised.</p

The effect of patient’s body weight, infusion connection point, and infusion pump position on intravenous multi-infusion drug delivery at low infusion rates suitable for premature neonates

Introduction: Parenteral drug administration in the neonatal intensive care involves complex pharmacotherapy adjusted for the patient's weight, fluid allowance, and complex multi-infusion systems. Objectives: We investigated the delivery rate of a model drug through a multi-infusion system consisting of six intravenous infusions. Methods: Delivery rate of the model drug was determined after infusion initiation and termination. Measurements were collected spectrophotometrically in real time. Time to drug delivery and the amount of drug delivered were measured. Key findings: The longest time to drug delivery was observed for a 500 g neonate model with a distal infusion connection point and neutral pump position (337 ± 30 min, P Conclusions: Delayed drug delivery to premature neonates due to multi-infusion systems may compromise accurate drug administration and lead to dosing errors.</p

Born into direct provision: outcomes of infants born to asylum seekers

Aim  Asylum seekers in Ireland have free access to antenatal care. Our aim was to review the outcomes of liveborn infants to mothers living in direct provision centres and the antenatal care their mothers accessed.  Methods  This was a retrospective review of infants born to asylum seekers, between November 2017 and February 2020, in a tertiary neonatal unit. The results were compared to the 2018 general hospital outcomes.  Results  During this period, 81 neonates were born to 78 asylum seekers. The median booking gestation was 30+4 weeks and only 9 (12%) had an early dating scan and 30 (42%) had a complete anatomy scan. Fifteen (20%) mothers had positive serology. Ten (12%) neonates were born prematurely, 20 (25%) were admitted to NICU and there were two (2%) neonatal deaths. At discharge, only 19 (23%) were exclusively breast fed. Fifty-six (71%) infants were followed in clinic and 10 (18%) had at least one “non-attendance”. Sixteen (20%) patients used an interpreter and language barriers lead to several miscommunications.  Conclusion  Infants born to asylum seekers had significantly higher rates of NICU admission (25% v 13%), maternal blood borne infections (20% v 1.5%) and lower rates of exclusive breastfeeding (23% v 45%) compared with the general hospital population.</p

Changes in inflammatory proteins following platelet transfusion in a neonatal population

Background: Studies have demonstrated increased morbidity and mortality with platelet transfusions in the neonatal period. Platelets are as important for host immunity and inflammation as for hemostasis. Increased inflammation may explain the dose-associated increase in mortality, bleeding, and lung disease. Objective: This study aims to assess if there are any changes in inflammatory cytokines post-platelet transfusion in babies in NICU. Methods: This prospective observational study recruited babies due to receive a non-emergency platelet transfusion. Dried whole blood samples were collected prior to and 2 h post-transfusion. Samples were processed using multiplex immunoassay to enable analysis of tiny blood volumes. Statistical analysis was performed using R. Results: Seventeen babies underwent 26 platelet transfusions across two centers. Median birthweight was 1545 g (535-3960 g) and median birth gestation was 31 weeks and 1 day (23 + 1 to 40 + 5). Median pre-transfusion platelet count was 19.5 × 109/l. There was a significant increase in levels of CXCL5 (p Conclusion: The increase in the cytokines CXCL5, CD40 and TGF-β after platelet transfusion in babies in NICU could potentiate existing inflammation, NEC, lung, or white matter injury. This could potentially explain long-term harm from platelet transfusion in babies. Impact: There is a change in levels of immunomodulatory proteins CXCL5, CD40, and TGF-β after platelet transfusion in babies in NICU. Murine neonatal models have demonstrated an increase in cytokine levels after platelet transfusions. This is the first time that this has been demonstrated in human neonates. The increase in proinflammatory cytokines could potentially explain the long-term harm from platelet transfusion in babies, as they could potentiate existing inflammation, NEC, lung injury, or white matter injury.</p

Infants born to mothers with COVID-19 during pregnancy: the first four months of the pandemic

A recent UK report on COVID-19 in pregnancy found that, of the infants delivered, 25% were preterm and 5% tested positive for SARS-CoV-2, half of which required admission to NICU1. In contrast, a US study of 120 infants born to mothers with SARS-CoV-2, all tested negative for SARS-CoV-2 in the first 24 hours, and of those followed up, all remained PCR negative and asymptomatic at 14 days.</p