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REaSoN 2016 Abstracts

Monday 4th & Tuesday 5th July 2016University of Warwick, Coventry, CV4 7AL, UK

Platinum Sponsors:

2016

Neonatal Meeting

(in alphabetical surname order)

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Name: Dr. Topun AustinJob Title: Consultant Neonatologist at Cambridge University Hospitals NHS Foundation TrustTitle of talk: Shining light on the newborn brain

Abstract:

Brain injury in the newborn remains a major cause of death and serious lifelong disability, with alterations in cerebral perfusion and oxygenation implicated in the pathophysiology of injury in both preterm and term infants. Near-infrared light shows a strong absorption dependency on oxygenation state and provides a safe, non-invasive means of monitoring cerebral function at the cotside. Improved quantification in newer generation instruments are an important step in developing clinically useful monitors. Multi-channel systems allow images of the haemodynamic response to brain pathology, for example seizures, to be investigated, as well as the maturation of functional networks.

The presentation will provide a background to biomedical optics, and review the clinical application in studying both haemodynamics as well as neurovascular coupling in the developing brain.

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Name: Julie-Clare Becher Job Title: Consultant NeonatologistTitle of talk: Quality Improvement: Introduction and setting the scene

Biographical Sketch:

Julie-Clare Becher is a Consultant Neonatologist and a Senior Lecturer in Child Life and Health at the University of Edinburgh. Within the Neonatal Service locally she has established the Newborn Care Collaborative, which provides a strategic and unified vision for improvement and safety of clinical services across Lothian. Her national Quality roles include Neonatal Advisor to the Maternity and Children’s Quality Improvement Collab-orative of the Scottish Patient Safety Programme, Neonatal Representative on the Scottish Child Death Review Steering Group, Chair of the Scottish Cooling Group, and within the British Association of Perinatal Medicine, she is the Deputy Scottish Representative and a member of the Neonatal Mortality Review Group and the BAPM Quality Forum.

Lecture Abstract:

Quality improvement is often seen as quick and dirty research without the quality control and rigour required of the research process. However the value of QI is about delivering immediate and sustained improvement in healthcare and should be a necessary and integral activity for all medical institutions. Improving quality is about making healthcare safer, more effective and patient-centred.

With a specific focus on neonatology, the national and international quality landscape will be reviewed, as well as the aim of this Reason meeting in highlighting examples of excellent quality improvement practice.

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Name: Prof. Daniele De Luca, MD, PhDJob Title: Medical Director, Associate Professor of neonatologyTitle of talk: Lung ultrasound in NICU care: an useful reality

Biographical Sketch:

Dr Daniele De Luca received his MD license from the Catholic University of the Sacred Heart in Rome, Italy in 2001. Dr De Luca completed his Master’s degrees at the same university in Paediatric Emergencies in 2003 and Neonatal Pulmonology in 2005. He received a Fellowship in Paediatrics and Neonatal Critical Care from the same university in 2007. Dr De Luca is now the Medical Director of the Division of Paediatrics and Neonatal Critical Care at South Paris University, “A.Beclere” Medical Centre, and Associate Professor of neonatology at the South Paris University. He is also the Contract Affiliate Professor of Neonatal and Paediatric Critical Care Catholic Uni-versity of the Sacred Heart in Rome, Italy.Dr De Luca has published approximately 100 papers for journals with an impact factor > 250, an H-Index of 16, and has been a referee for several major paediatric and general journals. He has been a referee for international grants and research quality programs in Canada, France, Italy, Netherlands, Germany, France and South Africa. Dr De Luca is the Deputy Chair, Respiratory Section, European Society for Paediatric and Neonatal Intensive Care (ESPNIC) and the Scientific Content Manager of the European Society for Pediatric Research (ESPR).

Lecture Abstract:

Lung ultrasound has been thought to be impossible for many years. Actually research has demonstrated that just the artefacts interpretation may allow collecting very useful information and now lung ultrasound is a reality. It has been demonstrated to be useful to diagnose several neonatal respiratory conditions and even guide thera-peutic choices. The lecture will go over these different points touching the most recent relevant literature and explaining all the advantages of lung ultrasound over traditional chest X-rays.Multimedia files will be extensively used.

References:

Lung Ultrasonography Score to Evaluate Oxygenation and Surfactant Need in Neonates Treated With Continuous Positive Airway Pressure.Brat R, Yousef N, Klifa R, Reynaud S, Shankar Aguilera S, De Luca D.JAMA Pediatr. 2015 Aug;169(8):e151797.

Lung ultrasound findings in meconium aspiration syndrome.Piastra M, Yousef N, Brat R, Manzoni P, Mokhtari M, De Luca D.Early Hum Dev. 2014 Sep;90 Suppl 2:S41-3.

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Name: Jan DeprestJob Title: Professor of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium & UC London, London, UKTitle of talk: In utero surgery for spina bifida

Biographical Sketch:

Jan Deprest is a Professor of Obstetrics and Gynaecology at the KU Leuven (Belgium) and UC London (UK). He established the Eurofoetus consortium,dedicated to the development of instruments and techniques for minimally invasive fetal and placental surgery. The group demonstrated that laser surgery in identical twins with “twin-to-twin transfusion syndrome” yields the best outcome. The Leuven pioneered minimally invasive antenatal treatment of congenital diaphragmatic hernia, which is currently being evaluated in a randomized clinical trial (www.TOTALtrial.eu). In 2012 his group started a program for open fetal surgery for spina bifida. He currently is the academic chair of the Department of Development and regeneration (KU Leuven), and heads the fetal therapy group. In 2015 he became part time appointed at the Institute for Women’s Health at UCL (London, UK) and is part of the fetal therapy team at UCLH. He has published over 415 scientific papers.

Lecture Abstract:

Deprest J, Van Calenbergh F, Janssen K, Naulaers G, De Catte L, Timmerman G, Baeck S, Henrotte N, Lewi L, Devlieger R. Prenatal surgery for spina bifida aperta. In utero spina bifida surgery team, University Hospitals Leu-ven, Leuven, Belgium. – : Jan.Deprest@uzleuven.beThe prenatal diagnosis of neural tube defects (NTD) allows parents to consider all prenatal options. Though NTD can be diagnosed in the first trimester [1], the majority of cases of spina bifida are still being picked up in the second trimester. In a recent series of 167 patients we assessed patients referred to for suspected NTD at a median of 19 wks [2]. Cranial lesions were diagnosed significantly earlier than spinal lesions. Of the open spinal lesions, 77% were isolated. Only 22% were managed expectantly, in line with high termination rates elsewhere in Europe. There was no correlation between parental prenatal management decisions and disease specific severity markers. Since 2012, we also offer open fetal surgery for selected cases of spina bifida aperta. We started our program after combined in house and exported training in collaboration with the Children’s Hospital of Philadelphia [3]. By 2016 we operated over 20 cases, with an outcome comparable with the results obtained in the Management Of Myelomeningocoele Study [4]. In that randomized trial (n=183), the number of children needing a ventriculo-peritoneal-shunt, who were operated in utero, was half what was observed the postnatal repair group (40% instead of 82% at 12 month). Also motor development at 30 months of age in prenatally operated children was better. The number of children that could independently walk doubled from 20 to 40% in the fetal surgery group. Drawbacks are the maternal morbidity, but mainly a high risk for preterm rupture of the membranes and preterm delivery. In patients operated on before birth, gestational age at delivery was 34±3,1 wks compared to 37,3±1,1 wks in the unoperated group. Further follow up of the MOMS cohort showed persistently lower shunt rates, yet more benefit in fetuses with normal ventricles [5] and partial improved lower urinary tract function [6].Practically, the intervention is preferably performed between 24 and 26 weeks (because of lower membrane rupture rates [7]). It requires combined loco-regional and maternal anesthesia, maternal laparotomy and hysterotomy [8].

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Though the majority of contacts so far were initiated by patients, we aim to set up as early as possible a communication channel with the referring team as early as possible. We do ask for upfront local counseling by fetal medicine specialist, neonatologist, pediatric neurosurgeon and/or – neurologist about all options. To avoid needless travel we have made an easy checklist for referring physicians, a standardized letter for the patient insurance and provide upfront a quotation. Within Europe so far not a single referral was denied financial coverage. Actually, in the USA it has been shown that fetal surgery reduces management costs [9]. The latter, together with the objective level I evidence of the benefit of fetal surgery, it is hard to imagine that this surgery should be denied to parents requesting it. Though most centers in the USA require patients to stay on campus and deliver at the fetal surgery site, we have adhered to a pragmatic policy of offering patients to return to their own tertiary institute, used to managing newborns with spina bifida – given the maternal fetal medicine specialists agree to the further management during pregnancy and elective cesarean delivery at around 37 weeks, and that outcomes will be provided to us. So far we do not offer the maternally better acceptable fetoscopic approach, as the procedure remains associated with a higher membrane rupture rate and other technical limitations, questioning it being a valid alternative [10, 11]. We have a research program which is dedicated to the development of fetoscopic techniques that allows exact replication of the open procedure, or alternatives which have been shown to be equally effective (www.gift-surg.ac.uk), a collaboration between UCL and KU Leuven, and supported by the Wellcome Foundation.

References:

1. Engels AC, Joyeux L, Brantner C, De Keersmaecker B, De Catte L, Baud D, Deprest J, Van Mieghem T: Sono-graphic detection of central nervous system defects in the first trimester of pregnancy. Prenat Diagn 2016.2. Ovaere C, Eggink A, Richter J, Cohen-Overbeek TE, Van Calenbergh F, Jansen K, Oepkes D, Devlieger R, De Catte L, Deprest JA: Prenatal diagnosis and patient preferences in patients with neural tube defects around the advent of fetal surgery in Belgium and Holland. Fetal Diagn Ther 2015, 37(3):226-234.3. Cohen AR, Couto J, Cummings JJ, Johnson A, Joseph G, Kaufman BA, Litman RS, Menard MK, Moldenhauer JS, Pringle KC et al: Position statement on fetal myelomeningocele repair. Am J Obstet Gynecol 2014, 210(2):107-111.4. Adzick NS, Thom EA, Spong CY, Brock JW, 3rd, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN et al: A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011, 364(11):993-1004.5. Tulipan N, Wellons JC, 3rd, Thom EA, Gupta N, Sutton LN, Burrows PK, Farmer D, Walsh W, Johnson MP, Rand L et al: Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neu-rosurg Pediatr 2015:1-8.6. Brock JW, 3rd, Carr MC, Adzick NS, Burrows PK, Thomas JC, Thom EA, Howell LJ, Farrell JA, Dabrowiak ME, Farmer DL et al: Bladder Function After Fetal Surgery for Myelomeningocele. Pediatrics 2015, 136(4):e906-913.7. Moldenhauer JS, Soni S, Rintoul NE, Spinner SS, Khalek N, Martinez-Poyer J, Flake AW, Hedrick HL, Peran-teau WH, Rendon N et al: Fetal myelomeningocele repair: the post-MOMS experience at the Children’s Hospital of Philadelphia. Fetal Diagn Ther 2015, 37(3):235-240.8. Bebbington MW, Danzer E, Johnson MP, Adzick NS: Open fetal surgery for myelomeningocele. Prenatal diagnosis 2011, 31(7):689-694.9. Werner EF, Han CS, Burd I, Lipkind HS, Copel JA, Bahtiyar MO, Thung SF: Evaluating the cost-effectiveness of prenatal surgery for myelomeningocele: a decision analysis. Ultrasound Obstet Gynecol 2012, 40(2):158-164.10. Joyeux L, Engels AC, Russo FM, Jimenez J, Van Mieghem T, De Coppi P, Van Calenbergh F, Deprest J: Feto-scopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes. Fetal Diagn Ther 2016.11. Flake A: Percutaneous minimal-access fetoscopic surgery for myelomeningocele - not so minimal! Ultra-sound Obstet Gynecol 2014, 44(5):499-500.

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Name: Dr Jon DorlingJob Title: Clinical Associate Professor, University of NottinghamTitle of talk: ‘The Speed of Increasing Feeds Trial; An Update’

Biographical Sketch: After studying medicine in Dundee, Jon trained in Paediatrics and Neonatology in East Anglia and the East Midlands. He completed his MD in Leicester studying methods for predicting outcome in early infancy for sick newborn infants.

Jon is an Academic Neonatologist who enjoys helping to answer important questions about care for newborn infants. He is the Chief Investigator of The Speed of Increasing Feeds Trial (SIFT) in the UK & Eire. This trial has recruited over 2800 infants from 56 neonatal units to assess the benefits and harms of increasing milk feeds at 30ml/kg/day v 18ml/kg/day. He is also part of other teams assessing deferring cord clamping beyond 2 minutes, lactoferrin supplementation, antibiotic impregnated long lines and ursodeoxychlic acid for pregnancy related cholestasis.

Lecture Abstract:

Unfortunately, due to outstanding data that has not been submitted or is being queried it is not possible to provide the results for the SIFT trial at this talk. Jon will describe the progress of The Speed of Increasing Feeds Trial and present some data from the group as a whole. He will also put the trial in context from currently available data and propose potential implications of the possible trial results. He will aim to motivate people to get the last bits of data sent into NPEU by 22nd July 2016 so that outcomes for patients can be included in the trial analysis. The arrangements for obtaining the data at 2 years of age will also be described.

References:

https://www.npeu.ox.ac.uk/sift

Morgan J, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD001241. DOI: 10.1002/14651858.CD001241.pub6.

SIFT Investigators Group. Early enteral feeding strategies for very preterm infants: current evidence from Co-chrane reviews. Arch Dis Child Fetal Neonatal Ed. 2013 Nov;98(6):F470-472.

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Name: Elspeth FergusonJob Title: Specialty Trainee Year 6 in Paediatric Diabetes and EndocrinologyTitle of talk: Adult growth attainment and pubertal timing in a cohort of preterm infants

Biographical Sketch:

Having qualified as a doctor in 2006, I have worked as a paediatric trainee in South Yorkshire since 2008. I am due to commence specialist training in paediatric diabetes and endocrinology on return from maternity leave in February 2017.

The work to be presented was completed as part of my MSc in Child Health at the University of Leeds.

Lecture Abstract:

BackgroundMost premature infants are born with an appropriate birth weight for their gestation (AGA), however growth failure is often seen in the days and weeks following delivery, particularly amongst those infants born at the extremes of prematurity or experiencing significant morbidity(1).

Children born at term and small for gestational age (SGA), undergo catch-up growth during infancy and childhood and may have an earlier onset of puberty(2). They have an increased risk of being short as adults. (3, 4). Periods of catch-up growth and pubertal timing (in particular the onset of adrenarche), may play a role in determining their risk of the metabolic syndrome in adult life(5, 6).

Similarities have been drawn between the growth patterns of children born SGA and those born prematurely. To date however, few studies have followed the growth or pubertal development of infants born prematurely through to adulthood and those which have, have focused on groups of infants classified by birth weight resulting in disproportionate numbers of SGA infants(7-12).

This study aimed to determine whether preterm born children reach their expected adult height when compared to term controls and whether there is any difference in pubertal timing.

MethodologyThis prospective longitudinal cohort study recruited 204 preterm children born at a tertiary neonatal unit during 1994 and a group of fifty matched controls. Growth parameters have been assessed annually until the completion of growth and from ten years of age the children have self-staged pubertal status.

ResultsThere was no significant difference in the final height standard deviation score (SDS) of children born at term (n=30) and those born prematurely (n=80) (0.45 term vs 0.22 preterm). Catch-up growth however, continued throughout the whole of childhood. When the difference between final height SDS and mid-parental height SDS were compared, there were again no significant differences (0.13 term vs 0.03 preterm).

Proportions of girls and boys reporting pubertal development having commenced at 10 and 13 years were similar between the preterm and term cohorts as were ages at menarche and pubertal growth spurts.

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ConclusionAs a whole the preterm population achieve their height potential and advance through puberty at a similar time to children born at term.

References:

1. Bertino E, Coscia A, Mombro M, Boni L, Rossetti G, Fabris C, et al. Postnatal weight increase and growth velocity of very low birthweight infants. Archives of disease in childhood Fetal and neonatal edition. 2006;91(5):F349-56.2. Ibanez L, Potau N, Francois I, de Zegher F. Precocious pubarche, hyperinsulinism, and ovarian hyper-androgenism in girls: relation to reduced fetal growth. The Journal of clinical endocrinology and metabolism. 1998;83(10):3558-62.3. Hokken-Koelega AC, De Ridder MA, Lemmen RJ, Den Hartog H, De Muinck Keizer-Schrama SM, Drop SL. Children born small for gestational age: do they catch up? Pediatric Research. 1995;38(2):267-71.4. Jaquet D, Collin D, Levy-Marchal C, Czernichow P. Adult height distribution in subjects born small for ges-tational age. Hormone Research. 2004;62(2):92-6.5. Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. 2000;320(7240):967-71.6. Monteiro PO, Victora CG. Rapid growth in infancy and childhood and obesity in later life--a systematic review. Obesity Reviews. 2005;6(2):143-54.7. Wehkalampi K, Hovi P, Dunkel L, Strang-Karlsson S, Jarvenpaa A-L, Eriksson JG, et al. Advanced pubertal growth spurt in subjects born preterm: the Helsinki study of very low birth weight adults. Journal of Clinical En-docrinology & Metabolism. 2011;96:525-33.8. Hack M, Schluchter M, Cartar L, Rahman M, Cuttler L, Borawski E. Growth of very low birth weight infants to age 20 years. Pediatrics. 2003;112(1 Pt 1):e30-8.9. Saigal S, Stoskopf B, Streiner D, Paneth N, Pinelli J, Boyle M. Growth trajectories of extremely low birth weight infants from birth to young adulthood: a longitudinal, population-based study. Pediatr Res. 2006;60(6):751-8.10. Peralta-Carcelen M, Jackson DS, Goran MI, Royal SA, Mayo MS, Nelson KG. Growth of adolescents who were born at extremely low birth weight without major disability. Journal of Pediatrics. 2000;136(5):633-40.11. Saigal S, Stoskopf BL, Streiner DL, Burrows E. Physical growth and current health status of infants who were of extremely low birth weight and controls at adolescence. Pediatrics. 2001;108(2):407-15.12. Powls A, Botting N, Cooke RW, Pilling D, Marlow N. Growth impairment in very low birthweight children at 12 years: correlation with perinatal and outcome variables. Archives of Disease in Childhood Fetal & Neonatal Edition. 1996;75(3):F152-7.

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Name: David FieldJob Title: Professor of Neonatal MedicineTitle of talk: Measuring the Quality of Neonatal Care: What does it mean and who is it for?

Lecture Abstract:

The need to consider care quality is now embedded within all medical specialties across the developed world. Neonatal care, at some level, has been conscious of the need to measure care quality almost from the time it emerged as a specialty and in that sense has been at the forefront of the process. Early concerns were about survival and neurodevelopmental outcome and ensuring that all services performed to a broadly comparable standard with regard to these particular outcomes. However over time a range of other measures have emerged as a means of reflecting the performance of perinatal and neonatal services. During this time during which an increasing range of measures have been monitored we may have lost focus in terms of why we are measuring and recording various aspects of neonatal care and equally important who are we measuring it for?

In this talk I would like to discuss some of the fundamental issues we should consider in our attempts to assess quality.

In particular:

1) The background issues and difficulties of measuring quality in relation to neonatal care2) What question are we trying to answer?3) Who are we measuring quality for?4) How do we decide what to monitor?5) How should findings be presented?6) What / who should we compare with what / who?

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Name: Egbert HertingJob Title: Prof DrTitle of talk: Less Invasive Surfactant Administration (LISA)

Biographical Sketch:

Egbert Herting is 57 years old, Professor in Paediatrics and Director of the University Children´s Hospital in Lü-beck, Germany. He studied medicine in Münster, Germany, and Cardiff, Wales, UK and graduated in 1984.He started his professional carreer in the Paediatric District Hospital of Minden, Westphalia, Germany, before he became a research fellow at Göttingen University in Northern Germany in 1985. Following the board qualification in Paediatrics he trained in paediatric subspecialities and was board approved for neonatology, paediatric intensive care, paediatric infectious diseases and paediatric pulmonology.In 1991 he was awarded with the Doctor of Medicine (Promotion) for a study dealing with single versus multiple doses of Curosurf, a porcine surfactant preparation, became a lecturer (Habilitation) with a thesis on surfactant treatment of secondary respiratory distress syndrome (e.g. meconium aspiration syndrome) in 1997 and was appointed as an extraordinary professor in Göttingen University in 2002. In 2004 he was elected as professor and became the head of the University Children´s Hospital in Lübeck, Schleswig-Holstein, Northern Germany. His main field of research interest is surfactant deficiency and neonatal pulmonary and infectious disease. From 1992 to 1994 he received a grant from the German Research Council (DFG) and worked as a research fellow with Prof. Bengt Robertson, one of the pioneers in surfactant research, at the Karolinska Institute, Stockholm, Sweden. In 1999 he defended his PhD thesis (Surfactant and neonatal pneumonia) at the Karolinska. He is the author of various research and book articles especially on the topics of neonatal pulmonary disease, surfactant replacement therapy, and neonatal infections. He is a member various national and international societies, the past president of the German Association for Neonatology and Pediatric Intensive Care (GNPI) and current member of the Board of the German Society for Pediatrics (DGKJ). In addition, and serves as expert for the German Research Council (DFG).

Lecture Abstract:

Recently, there is a strong interest in non-invasive respiratory support for premature neonates. However, treatment failure many occur when CPAP (continuous positive airway pressure) or NIPPV (nasal intermittent positive pressure ventilation) is applied. CPAP failure in premature infants is often due to RDS (respiratory distress syndrome) and surfactant deficiency. Thus, for more than 2 decades neonatologists tried to develop techniques to deliver surfactant without endotracheal intubation or mechanical ventilation. INSURE (INtubate SURfactant Extubate) has been described more than 20 years ago in Scandinavia. The INSURE method reduces the transferral rate of prematurely born infants to tertiary centres and the rate of mechanical ventilation. However, the technique still needs classical endotracheal intubation and sedation and analgesia. LISA (Less Invasive Surfactant Administration) has been in use in our unit in Lübeck for more than 10 years. The baby is kept on PEEP (positive endexpiratory pressure) and a thin catheter is placed in the trachea while the baby is continuously spontaneously breathing with CPAP-support. Several studies indicate that LISA reduces the rate of mechanical ventilation and seems to improve survival without complications. In most cases, LISA can be done without sedation. Few studies exist that compare LISA with INSURE. There is tendency from 2 small studies that LISA may be superior to INSURE, but clearly more evidence is needed from larger well designed clinical trials. Recently, there has been a renewed interest in the technique of surfactant delivery by aerosol, but clinical attempts have been rather disappointing so far, probably due to low deposition rates.

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References:

1. Verder H, Robertson B, Greisen G et al.; Danish-Swedish Multicenter Study Group. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. N Engl. J Med. 1994;331(16):1051-1055.2. Kribs A, Pillekamp F, Hünseler C et al. Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ≤ 27 weeks). Pediatr Anaesth. 2007; 17(4):364-369.3. Göpel W, Kribs A, Ziegler A et al. German Neonatal Network. Avoidance of mechanical ventilation by surfac-tant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011 Nov 5;378:1627-34.4. Herting E. Less Invasive Surfactant Administration (LISA) - Ways to deliver surfactant in spontaneously breath-ing infants. Early Human Development 2013; 89(11): 875–880.5. Fischer H, Bührer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analy-sis. Pediatr 2013;132 (5): e1351 -e1360.6. Kanmaz HG, Erdeve O, Canpolat FE. Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatr. 2013;131(2):e502-e509.7. More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants: a meta-narrative review. JAMA Pediatr. 2014 Oct;168(10):901-8.8. Kribs et al, Nonintubated Surfactant Apllication vs Conventional Therapy in Extremely Preterm Infants: A Ran-domized Clinical Trial. JAMA Pediatr. 2015 Aug;169(8):723-309. Pillow JJ, Minocchieri S., Innovation in surfactant therapy II: surfactant administration by aerosolization. Neo-natology. 2012;101(4):337-4410. Finer NN et al, An open label, pilot study of Aerosurf© combined with nCPAP to prevent RDS in preterm neo-nates. J Aerosol Med Pulm Drug Deliv. 2010 Oct;23(5):303-9

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Name: Dr Kevin IvesJob Title: Consultant Neonatologist and Honorary Senior Clinical Lecturer in Paediatrics, John Radcliffe Hospital, Oxford. Contact: kevin.ives@nhs.net Title of talk: Nasal High Flow: dos and don’ts, and don’t knows.

Biographical Sketch:

Kevin Ives was born in Norwich and is proud to be considered ‘Normal for Norfolk’. He trained in Cambridge, Brighton and at King’s College, Guy’s and University College Hospitals in London. He has been a Consultant Neonatologist in Oxford since 1991; deported temporarily to Monash Medical Centre, Melbourne for a sabbatical in 1992. An Action Research Fellowship funded his MD Thesis on ‘Bilirubin transport and toxicity in the central nervous system.’ He has been chapter author on Neonatal Jaundice in Roberton and Rennie’s Textbook of Neonatology (1999, 2005, 2012), and was a contributor to the NICE Guideline on Neonatal Jaundice (2010).

Over the last decade Kevin has been an unashamed crusader for nasal High Flow Therapy and has received invitations to share his experience in Europe and the USA. He is a co-author of the largest retrospective study of nHFT published to date5, and is a contributing author of an ‘International Consensus Document on the use of nHFT in Neonatology’, that is currently being submitted for publication.

Kevin is well aware that his conviction that nHFT will replace nCPAP on all Neonatal Units over the next ten years will get up some peoples’ noses.

Lecture Abstract:

Over the past 12 years nasal High Flow Therapy (nHFT) has replaced nasal continuous positive pressure (nCPAP) on the Neonatal Unit in Oxford as the first line choice for non-invasive respiratory support. This occurred against a backdrop of minimal research evidence, but has been vindicated by recent RCTs 1 2, 3 and the Cochrane Review meta-analysis 4, which conclude that nHFT is a safe effective alternative to nCPAP in preterm infants after extubation. Reassurance regarding the safety of this transition in practice in Oxford was gained from large comparative cohorts of the Vermont Oxford Network5.The use of nHFT as a primary non-invasive mode in respiratory distress has evolved from confidence gained in the context of post-extubation support. This is extending to early stabilisation in the delivery suite, as we have just heard6. Recent trial evidence on primary treatment is contradictory, and may challenge the use of nHFT in this context for babies below a certain gestation and when adopting the trial protocol dictated for a specific delivery device.

This lecture will cover some of the speaker’s admittedly biased thoughts on ‘the dos, don’ts and don’t knows’ of nHFT, and will hopefully generate even more in discussion. The Dos: Do provide adequate training and follow manufacturers’ guidance in the use of nHFT.Do consider using nHFT as an alternative to nCPAP in the majority of newborns requiring non-invasive respiratory support. Do focus on dead space washout rather than the unmeasured pressure.

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Do consider the case for improved quality of care beyond the issue of nasal trauma.Do recognise and utilise the ease of oral feeding whist a baby is on nHFT.Do have a policy for weaning from nHFT and for escalating therapy. Do consider developing intra and inter-hospital transport using nHFT.Do consider whether the trials relate to your own babies and use of equipment.Do audit your own practice against treatment measure outcomes from the trials.

The Don’ts: Don’t exceed a flow rate of 8L/minute in neonatology.Don’t use the wrong size of cannula.Don’t forcibly close a baby’s mouth if they are receiving nHFT.Don’t be concerned about pressure if the three points above are complied with. Don’t mix different manufacturers’ cannulas with different delivery devices.Don’t leave babies on unnecessarily high flow rates.Don’t forget to wean.Don’t enter the mind-set that considers nCPAP to be a rescue mode for nHFT.

The Don’t knows:We don’t know when starting treatment what the initial gas flow should be. We don’t know how best to wean nHFT, or the point at which to discontinue. We don’t know if certain devices or cannula interfaces are superior to others. We know little of the health economics of nHFT versus other non-invasive support. We don’t know if nHFT is suitable for initial delivery room stabilisation.We don’t have much information on the use of nHFT during neonatal transport.We don’t know if variation in the success of nHFT reflects nursing experience 7. We don’t have much evidence for safety and efficacy of nHFT in ELBW infants.We don’t know the efficacy of nHFT in other neonatal lung disorders, such as meconium aspiration, pneumonia and pulmonary hypoplasia. We don’t know (at the time of writing) whether the UK will remain in the European Union.

References: 1. Manley BJ, Owen LS, Doyle LW, Anderson CC, Cartwright DW, Pritchard MA, Donath SM, Davis PG. High-Flow Nasal Cannulae in Very Preterm Infants after Extubation. N Engl J Med 2013;369:1423-33.2. Collins CL, Holberton JR, Barfield C, Davis PG.A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airways pressure postextubation in premature infants. J Pediatr 2012;162(5):949.e1-954.e1.3. Yoder BA, Stoddard RA, Li M, King J, Dirnberger DR, Abbasi S. Heated, Humidified High-Flow Nasal Can-nula Versus Nasal CPAP for Respiratory Support in Neonates. Pediatrics 2013;131(5):e1482-904. Wilkinson D, Andersen C, O’Donnell CPF, De Paoli AG, Manley BJ. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database of Systematic Reviews 2016;2:CD006405. 5. McQueen M, Rojas J, Sun SC, Tero R, Ives K et al. Safety and Long Term Outcomes with High Flow Nasal Cannula Therapy in Neonatology: A Large Retrospective Cohort Study. J Pum Respir Med 2014;4:2166. Reynolds P, Leontiadi S, Lawson T, Otunla T, Ejiwumi O, Holland N. Stabilisation of premature infants in the delivery room with nasal high flow. Arch Dis Child Fetal Neonatal Ed 2016 Jan 5 [Epub ahead of print].7. Roberts T C, Manley B J, Dawson J A, Davis P G. Nursing perceptions of high-flow nasal cannulae treat-ment for very preterm infants. Journal of Paediatrics and Child Health 2014. doi:10.1111/jpc.12636

2016

15

Name: Rod KellyJob Title: Neonatal Transport FellowTitle of talk: Going viral: Volunteering in the Ebola outbreak

Biographical Sketch:

I’m currently working as a Neonatal Transport Fellow for ScotSTAR (the Scottish Specialist Transport and Retrieval Service) and I’m a member of the UK International Emergency Medical Register.

Lecture Abstract:

The Ebola epidemic in West Africa was described by the World Health Organisation as the “most severe acute public health emergency seen in modern times” (1). Mortality rates in children were high: 90% in infants under 1 year and 80% in children between the ages of 1 and 4 years, compared to 65% for children older than 15 and adults(2). Over 12,000 children were left orphaned in Sierra Leone(3). Despite the high mortality rates and high incidence of child safeguarding issues, doctors and nurses with paediatric experience were under-represented in those volunteering for deployment(4). As part of the NHS response organised by UK-Med on behalf of DFID (Department for International Develop-ment), I was deployed to Save the Children’s Ebola Treatment Centre (ETC) in Kerry Town, Sierra Leone. This case report describes the clinical course of a 6 year old boy with Ebola virus disease, to illustrate the chal-lenges encountered when working in the ETC and in survivor clinics in a resource deplete setting, as well as some of the positive aspects of volunteering.

References:

1. WHO Ebola situation assessment. September 2014 Accessed at: http://www.who.int/mediacentre/news/ ebola/26-september-2014/en/ 2. Agua-Agam J et al. (2015) Ebola Virus Disease among children in West Africa N Engl J Med. 372:1274-7.3. Street Child. Ebola orphan report. Accessed at: http://www.street-child.co.uk/ebola-orphan-report/ 4. UK International Medical Register figures

2016

16

Name: Jo KirbyJob Title: Neonatal Outreach Lead and Family Support SisterTitle of talk: Neonatal Outreach: Reducing the Length of Stay for the Moderate and Late Preterm Infant

Biographical Sketch:

I have been a neonatal nurse for nearly 26 years. I have always had an interest in the on-going care of the growing preterm infant and supporting the family both on the neonatal unit and when home, including bereavement support. I have worked as a senior sister on the neonatal unit for over 10 years now and 6 years ago set up the neonatal outreach service in Plymouth.

Lecture Abstract:

Neonatal outreach care is about promoting safe discharge home and supporting the transition from hospital to home. This talk explores how neonatal outreach support can facilitate early discharge home for infants, particularly the moderate and late preterm infant. Benefits of early discharge home include reuniting the family unit earlier and also the release of cots on the neonatal unit. The neonatal outreach service is not only about promoting early discharge home but also the provision of expert neonatal nursing support for families in the community whose needs can vary from supporting the growing moderate preterm infant in establishing full feeds at home to supporting parents to care for their term infant with a lifelong condition and the complex needs their baby might have.

References:

• Neonatal Data Analysis Unit, Imperial College London, 2014• Care in Local Communities. A new vision and model for district nursing. Department of Health Public Health Nursing, January 2013• NHS at Home. Community Children’s Nursing Services, Department of Health partnerships for Children, Families and Maternity, March 2011• Transition from Hospital to Home for Parents of Preterm Infants. Journal of Neonatal Nursing, March 2012, Vol 26 No1• Neonatal Specialist Care NICE quality standard (QS4) October 2010• Neonatal Intensive care: Feeling of Parents After Discharge of the Child, Dornasbach et al, J Nurs UFPE on line., Recife, 8(8):2660-6, Aug., 2014• It’s not a game: the very reay costs of having a premature or sick baby, Bliss, 2014• Caring for Vulnerable Babies- National Audit Office, December 2007• Toolkit for High-Quality Neonatal Services, Department of Health, November 2009• Neonatal Critical Care, NHS England Service Specification 2013

2016

17

Name: Shoo Lee, MBBS, FRCPC, PhDJob Titles: Scientific Director, Institute of Human Development, Child & Youth Health, Canadian Institutes of Health Research; Professor of Pediatrics, Obstetrics & Gynecology, and Public Health, University of Toronto; Head, Department of Pediatrics, Sinai Health System.Titles of talk: “Quality improvement in the NICU” and “Family Integrated Care – a new paradigm for care in the NICU”

Biographical Sketch:

Dr. Shoo Lee is a neonatologist and health economist. He is Scientific Directorof the Institute of Human Development, Child and Youth Health (IHDCYH) at the Canadian Institutes of Health Research; Professor of Paediatrics, Obstetrics & Gynaecology and Public Health; Paediatrician in Chief and Director of the Maternal Infant Care (MICare) Research Centre at Mt. Sinai Hospital and Senior Clinician Scientist of the Lunenfeld Tannenbaum Research Institute.Dr. Lee received his medical degree from the University of Singapore, completed his paediatric training at the Janeway Children’s Hospital in Newfoundland and neonatal fellowship training at Boston’s Children’s Hospital, and received his PhD in Health Policy (Economics) from Harvard University. As the founder and Chairman of the Canadian Neonatal NetworkTM and the International Neonatal Collaboration, Dr Lee fosters collaborative research, and he leads the CIHR Team in Maternal-Infant Care. His research focuses on improving quality of care, patient outcomes and health care services delivery.He developed Family Integrated Care model and piloted the concept at Mount Sinai Hospital. Awards for his work include the SPR Douglas K. Richardson Award for Perinatal & Pediatric Healthcare Research, CIHR Knowledge Translation Award, the Aventis Pasteur Research Award and the Distinguished Neonatologist Award from the Canadian Paediatric Society, the Premier Member of Honour Award from the Sociedad Iberoamericana de Neonatologia and Magnolia Award from the Shanghai government.

Lecture Abstract:

Quality Improvement in the NICU The Evidence based Practices for Improving Quality (EPIQ) method is an objective way of using data to drive quality improvement. It was tested in Canadian NICUs and found to be effective at improving outcomes in a large national network. It can also be adapted for international collaborations and used to examine innovation practices in other countries that can yield improvement in practices and outcomes. Examples of this strategy will be discussed, including use of breast milk feeding strategies that reduces the incidence of necrotizing enterocolitis, and changing the role of parents to be care givers in the NICU. These and other changes are driving a redesign of the neonatal care paradigm for the future.

Family Integrated Care Model – a new paradigm for care in the NICU Drawing inspiration from the Humane Care model in Estonia, we developed a Family Integrated Care Model in Canada that significantly advances the concepts of Family Centered Care. In the Family Integrated Care model, parents become an integral part of the NICU care team, and they are taught to provide all aspects of routine care for their babies, with the exception of IV and procedures. Parents routinely attend and provide reports during ward rounds, write in the medical charts, participate in daily patient care management decisions, and provide all routine care for their babies. We will share the results of a large multicentre trial in Canada, Australia and New Zealand.

2016

18

References:

Quality Improvement in the NICU1. Lee SK, Canadian Neonatal Network EPIQ Study Group. Improving the quality of care in neonates a cluster randomized controlled trial. CMAJ 2009. DOI 10.1503/cmaj.0817272. Lee SK, Aziz K, Singhal N, Cronin G, Canadian Neonatal Network. The EPIQ evidence reviews - practical tools for an integrated approach to knowledge translation. Paediatr & Child Health 2011;16:629-6303. Lee SK, Shah P, Singhal N, Aziz K, Synnes A, McMillan DD, Seshia M, Canadian Neonatal Network EPIQ Study Group. Association of a quality improvement program with neonatal outcomes in extremely preterm infants: A prospective cohort study. CMAJ 2014:DOI 10.1503/cmaj.1403994. Lee SK, Aziz K, Singhal N, Cronin CM, Canadian Neonatal Network Partnerships for Health System Improvement (PHSI) Study Group. An Evidence-based Practice for Improving Quality (EPIQ) program has greater impact on improvement of outcomes than the use of clinical practice guidelines in neonatal intensive care units. Paediatr Child Health 01/2015; 20(1):e1-9

Family Integrated Care Model – a new paradigm for care in the NICU1. O’Brien K, Bracht M, Macdonell K, McBride T, Robson K, O’Leary L, Christie K, Galarza M, Dicky T, Levin A, Lee SK. A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Preg-nancy and Childbirth 2013 DOI 10.1186/1471-2393-13- S1-S122. Bracht M, O’Leary L, Lee SK, O’Brien K. Implementing family integrated care in the NICU: A parent education and support program. Adv Neonatal Care 2013;13(2):115-1253. O’Brien K, Bracht M, Robson K, Ye X, Mirea L, Cruz M, Ng E, Monterrosa L, Soraisham A, Alvaro R, Narvey M, Da Silva O, Kei L, Tarnow-Mordi W, Lee S. Evaluation of the Family Integrated Care model of neonatal intensive care: a cluster randomized controlled trial in Canada and Australia. BMC Pediatrics 2015, 15:210. DOI: 10.1186/s12887-015-0527-04. Lee SK, O’Brien K. Parents as primary caregivers in the neonatal intensive care unit. CMAJ. 2014 Aug 5;186(11):845-7.5. Galarza-Winton ME1, Dicky T, OLeary L, Lee SK, OBrien K. Implementing family-integrated care in the NICU: educating nurses. Adv Neonatal Care. 2013 Oct;13(5):335-40.6. Macdonell K1, Christie K, Robson K, Pytlik K, Lee SK, OBrien K. Implementing family-integrated care in the NICU: engaging veteran parents in program design and delivery. Adv Neonatal Care. 2013Aug;13(4):262-9, quiz 270-1.

2016

19

Name: Nicky McCarthyJob Title: Advanced Neonatal Nurse Practitioner Title of talk: ANNP Led Neonatal Service

Biographical Sketch:

Nicky McCarthy qualified as a nurse from St Bartholomew’s School of Nursing in 2002. She entered Neonatal Nursing that same year and has worked at The Royal London Hospital, for the London Neonatal Transfer Service and is currently at Brighton and Sussex University Hospitals Trust. Professional development led her to qualify as an Advanced Neonatal Nurse Practitioner (ANNP) in 2013. In order to strengthen her extended nursing role she is about to embark on a Doctorate in Clinical Practice at Southampton University. Her current ANNP role encompasses a traditional Tier 2 medical role on both the Neonatal Intensive Care Unit at the Royal Sussex County Hospital and the Kent Surrey and Sussex Neonatal Transport Service as well as member-ship of an Advanced Nurse Practitioner team responsible for a Nurse Led Special Care Baby Unit at The Princess Royal Hospital in Haywards Heath.Her special interests have always included education and simulation training: she regularly directs Neonatal Life Support Courses, teaches on the Advanced Resuscitation of the Newborn Infant course as well as developing and running the simulation programme in Princess Royal Hospital.

Lecture Abstract:

Our nursing roles have dramatically changed and evolved in response to government initiatives, healthcare adaptations and patient requirements. Brighton and Sussex University hospitals have employed Advanced Nurse Practitioners since 2002. In 2004 due to service remodeling a stand-alone neonatal service had to be devised to provide neonatal support at The Princess Royal Hospital, Haywards Heath. After consideration of various models the decision taken was to create a nurse led SCBU. The realisation of this entailed a considerable recruitment drive as well as the successful home growing of a large team of ANNPs.Within Brighton and Sussex University Hospitals NHS Trust the department of Neonatology is based on the Trevor Mann Baby Unit (TMBU) at the Royal Sussex County Hospital and the Special Care Baby Unit at Princess Royal Hospital. In 2015 there were 3,415 deliveries at the Royal Sussex County Hospital and 2,477 deliveries at the Princess Royal Hospital. TMBU is one of three intensive care units in Kent Surrey and Sussex. It provides tertiary neonatal medical and surgical care for Brighton, east and west Sussex and special care for Brighton and mid Sussex. The Sussex neonatal transport service is based at TMBU and provides 24/7 cover in collaboration with similar services in Kent and Surrey. The SCBU in Princess Royal Hospital is staffed for 8 special care cots. Transitional care is provided on the postnatal ward. The baby unit is one of two in the UK led by a team of Advanced Neonatal Nurse Practitioners supported by consultant neonatologists. Working within well-defined service parameters, subsequent audit and review of performance reports a safe and successful delivery of care.Our ANNP team pursues areas of interest within protected non-clinical time and each of these is intended to utilize our skills as senior nurses with the aim of enhancing nurse education, championing service development and improving patient safety.This session seeks to share our local model whilst exploring ways in which ANNP roles can add value to any service providing care to the preterm and sick newborn.

References:

Department of Health (2009) Advanced Level Nursing: A Position Statement. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215935/dh_121738.pdf Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. www.nmc-uk.org/Nurses-andmidwives/The-code/The-code-in-full/ Royal College of Nursing (2010) Advanced Nurse Practitioners – An RCN Guide to the Advanced Nurse Practitioner Role, Competences and Programme Accreditation.www.rcn.org.uk/_data/assets/pdf_file/0003/146478/003207.pdf Department of Neonatology Brighton and Sussex University NHS Trust (2015) Annual Report.www.bsuh.nhs.uk/departments/neonatal-services/professionals/guidelines

2016

20

Name: Rόisίn McKeon-CarterJob Title: Advanced Neonatal Nurse PractitionerTitle of talk: Transitional Care Supporting the Neonatal Service

Biographical Sketch:

Firstly I am a nurse to my core and have 38 years nursing experience, 26 of them in neonatology. I am currently an Advanced Neonatal Nurse Practitioner (ANNP) and Clinical Director for the Neonatal Service in Derriford Hospital, Plymouth. I joined the NHS through an ENB neonatal intensive course in 1990. I worked initially as a staff nurse, then sister and was unit manager for a short time. However, neonatology was changing and there was a void in experienced medical staff to care for these babies. Therefore in 2002, I trained as an ANNP and have worked clinically on a hybrid ANNP / doctor medical rota since then including neonatal transport and prescribing medication for the neonatal populationI am passionate that all staff are enabled to undertake their work to support a streamlined patient pathway and enhance parental satisfaction. Therefore, I subscribe to an ethos of care, respect and trust. I support advancing practice skills for the multidisciplinary team and I have led on a midwifery led NIPE service in Plymouth. This saw a reduction in bed blocking in hospital and an increase in appropriate referrals especially DDH.In 2010, I took on the clinical lead nurse role for transitional care with a focus to streamline the pathway through NICU and facilitate safe discharge and reduce length of stay. I increased the bed capacity to 18 and developed clear admission criteria. This strategy has worked well and in combination with a 7 day outreach service has seen a reduced length of stay for the preterm infants. In 2012, I was awarded the Florence Nightingale Leadership Scholarship which was a great honour culminating in me being invited to ‘carry the lamp’ at the Florence Nightingale Memorial Service in Westminster Abbey in 2014.Róisín McKeon-CarterRSCN, RGN, ENB 405 & 904, City & Guilds 730(7) (adult teacher certificate), BSc Neonatal Studies. Florence Nightingale Scholar.

Lecture Abstract:

Transitional care to support and enhance early and safe discharge from hospital is not a new concept. Twenty plus years ago, Rieger et al published in 1995 espousing the merits of early discharge and a home support programme, i.e. neonatal transitional care and outreach.NHS England in their service specification (2013) has identified a neonatal population, special care with external carer, that should be cared for in a transitional care setting. The flow chart in the commissioning document, on page 19, includes TC in the pathway for managing babies born and needing additional medical management. However few TC cots are available for staff to adhere to this pathway and prevent separation of mothers and babies.The BLISS report published in 2014 advises parents that transitional care ‘means your baby still has some needs but is almost ready to go home. Most importantly, the mum becomes the main carer with support from a nursery nurse or other staff on the unit’. Therefore, there is a need to ensure that transitional care cots are available to support the neonatal service.

References:

Rieger ID, Henderson-Smart DJ. A neonatal early discharge and home support programme: shifting care into the community. J Paediatr Child Health 1995;31:33–7. NHS Commissioning Board Service Specifications Neonatal Care December 2013https://www.engage.england.nhs.uk/consultation/ssc-area-e/supporting_documents/e8aservicespec.pdfBliss baby report 2014

2016

21

Name: Dr. Peter ReynoldsJob Title: Consultant NeonatologistTitle of talk: Delivery room stabilisation in preterms using nasal High Flow

Lecture Abstract:

The use of nasal High Flow (nHF) (also termed High Flow Nasal Cannulae) in neonatal care has offered a new way to achieve non-invasive ventilation in neonatal settings. Whilst there is published evidence that nHF can be as effective as nCPAP for post-extubation respiratory support, there is much still to learn about the use of High Flow in neonatal settings, including what differences exist between the various High Flow systems available, what dif-ferences to nCPAP are important, and when to start nHF, how to wean it, and when to stop it.This presentation will describe the novel use of nHF in the delivery room during the stabilisation of preterm babies less than 30 weeks old. The observational study was conducted in a single centre with over 8 years of experience of using nHF (using the Vapotherm™ Precision Flow system™). We set out to test the feasibility of stabilising and transferring babies to the Neonatal Unit using a custom-made nHF mobile unit. We collected data for the evidence of clinical stability on admission to NICU such as admission temperature and oxygen requirement. We also recorded the subsequent need for further stabilisation (e.g. intubation and ventilation, rescue surfactant administration and use of inotropes) during the first 72 hours after birth. Staff comments were also invited.We obtained parental consent and enrolled twenty eight babies in total. We followed a standard clinical protocol in all cases which ensured a safe approach to resuscitation in the event25/28 were successfully stabilised and transferred on nHF to the Neonatal Intensive Care Unit. The average admission temperature for babies transferred on nHF was 36.9°C and the average inspired oxygen at admission was 29%. Less than half (48%) required surfactant and 60% were still on nHF 72 hours after admission, with one baby receiving inotropes.This study shows that using nHF for stabilisation and transfer of preterm infants is feasible. During the talk I will show an example video of the stabilisation of an infant, and also describe our ongoing use of the mobile nHF system.

2016

22

Name: Dr. Damian RolandJob Title: Consultant and Senior Honorary Lecturer in Paediatric Emergency Medicine Title of talk: Social Media - what can we learn? How can it make life easier for education and practice?

Biographical Sketch: Dr. Roland is an experienced Paediatric Emergency Medicine clinician who is passionate about the care of ill and injured children. He co-developed the Paediatric Observation Priority Score (POPS) an award winning system for evaluating children in emergency settings. He was also part of the team that delivered “www.spottingthesickchild.com” and has previously been named as one of the top 50 innovators in the NHS.

He is a firm believer in the power of social media as a mechanism of knowledge translation and has a visible digital presence via twitter (@damian_roland) and his own blog (rolobotrambles.com)

Lecture Abstract:

Social Media is a buzz-word. Everyone has heard of it but very few can define it. The use of social media in medicine is an uneasy alliance. There are many examples of its benefits but also significant reticence on behalf of organisations and institutions to completely adopt it. The evidence isn’t always clear but its ability to disseminate information rapidly can’t be disputed. This lecture will provide a balanced account of how social media can be beneficial to professionals and most importantly patients by aiding rapid diffusion of evidence based practice.

References:

Roland D, Truger, S, Thoma B and Chan T. FOAM helps to bridge the Knowledge Translation Gap Letter to the Edi-tor re: Pundit-Based Medicine [EPI Issue #18, page 34] http://www.epijournal.com/articles/246/foam-helps-to-bridge-the-knowledge-translation-gap

Roland D and Brazil V Top 10 ways to reconcile social media and ‘traditional’ education in emergency care. Emerg Med J 32(10):819-822 01 Oct 2015

Roland D, May N, Body R, Carley S and Lyttle M. Will Social Media make or break medical conferences? British Journal of Hospital Medicine 76(6):318-319 01 Jun 2015

Roland D, May N, Body R, Carley S and Lyttle M. Are you a SCEPTIC? SoCial mEdia Precision & uTility In Confer-ences Emerg Med J 2015;32:412-413

2016

23

Name: Professor Dominic WilkinsonJob Title: Consultant Neonatologist, Director of Medical Ethics, Oxford Uehiro Centre for Practical EthicsTitle of talk: Don’t stop now? The ethics of stopping resuscitation

Biographical Sketch:

Dominic Wilkinson is Director of Medical Ethics and Associate Professor at the Oxford Uehiro Centre for Practical Ethics, University of Oxford. He is a consultant in newborn intensive care at the John Radcliffe Hospital, Oxford. He also holds a health practitioner research fellowship with the Wellcome Trust

Dominic has published more than 100 academic articles relating to ethical issues in intensive care for adults, children and newborn infants. He is the author of ‘Death or Disability? The ‘Carmentis Machine’ and decision-making for critically ill children’ (Oxford University Press 2013). He is editor of the Journal of Medical Ethics and managing editor of the open access Journal of Practical Ethics. Twitter: @Neonatalethics

Lecture Abstract:

When newborn infants are born in very poor condition, clinicians embark on resuscitation in the hope that they will respond quickly. However, some infants fail to respond, and clinicians then must decide how long to continue resuscitation.In this paper, I will review existing resuscitation guidelines as well as recently published evidence on the outcome of infants who receive prolonged resuscitation. The central ethical questions are whether continued resuscitation would be futile (because it will not restore circulation) or would do more harm than good (because it will lead to survival with profound impairment). I argue that an Apgar score of 0 at 10 min after birth is not a good enough predictor of outcome to be used as the main basis for decision-making about ongoing resuscita- tion. In the face of uncertainty about whether resuscitation should be discontinued, clinicians should opt to provide longer resuscitation, with later consideration of withdrawal of life-sustaining treatment if the clinical course indicates that prognosis is poor. References:

Wilkinson DJ, Stenson B. Don’t stop now? How long should resuscitation continue at birth in the absence of a detectable heartbeat? Arch Dis Child Fetal Neonatal Ed. 2015 Nov;100(6):F476-8. doi: 10.1136/archdis-child-2015-308602.