Aims The role of behavioural skills in the provision of safe and effective neonatal care is well recognised.1 Behaviour Assessment Tool (BAT) has been validated for use in simulated neonatal and paediatric environment to assess resuscitation skills.2 The aim of this study was to develop a modified version of the tool and validate it to assess trainee’s performance in stabilising an acutely unwell newborn. Methods Ethical approval was gained to study the performance of paediatric trainees. The modified Delphi method was used to develop a weighted scoring tool. Video recording of the performance of two trainees was used to train four assessors in use of the tool. Performance of a further sixteen trainees was recorded and was assessed by these assessors. Assessors were blinded to trainee’s identity and their years of experience. Results The scoring tool showed good interrater reliability (ICC = 0.80, CI: 0.58 – 0.92). Mean of the scores achieved by junior trainees was 34.03 (±5.42) compared to senior trainees 38.84 (±1.71). Results of the Independent Samples Mann-Whitney U Test demonstrated a statistically significant difference (P = 0.015) in the distribution of scores achieved by junior and senior trainees. Discussion The study demonstrates that reliable and valid measurements of behavioural skills can be obtained from simulated neonatal environments using this scoring tool. It is recognised that human factors such as lack of clear leadership, teamwork and communication rather than technical failures represent the greatest threat to complex systems like healthcare.3 In order to provide robust feedback and training in this area, it is important to have tools to assess behavioural skills in a valid and reliable manner. We feel that our tool can help to assess doctors in training and support the development of a robust training programme for the doctors of the future. References The Joint Comission. Sentinel event alert. Preventing infant death and injury during delivery. Adv Neonatal Care 2004;4:180–1 Anderson JM, Yaeger KA. The development of a behavioral scoring tool for neonatal resuscitation. In: Society for Medical Simulation Meeting. San Diego, CA. 2006. Reason J. Understanding adverse events: human factors. Qual Health Care 1995;4:80–9

Aim There is developing consensus regarding routine use of pulse-oximetry. Studies have shown that pulse-oximetry screening can substantially reduce the postnatal diagnostic gap in critical congenital heart disease (CHD)1. Aims of this study were firstly, to determine local antenatal detection rates for critical CHD, and secondly, to benchmark these diagnosis rates as part of the introduction of routine neonatal pulse-oximetry screening in the trust. Methods A retrospective review was performed to identify all infants with an antenatal diagnosis of critical CHD with an estimated date of delivery between March 2009 and March 2013. In addition, local and regional paediatric cardiology databases and the local child death database were reviewed to identify any further cases of critical CHD. Results 31 live births were identified. Data for termination of pregnancy was only available for one year, showing a rate of 39%. Of 31 live births, 23 (74%) were alive at time of study, 5 had died (16%) – 4 of these deaths were picked up at routine screening – and outcome was unknown in 3 cases. 18 cases (58%) were diagnosed antenatally, with a further 6 (19%) diagnosed prior to discharge home from postnatal ward. The remaining 7 (23%) were diagnosed after discharge. TOF, TGA and CoA were the most common lesions (70%). Conclusions Prevalence of critical CHD locally was around 1.3 per 1000 births which is comparable to previously published data2, but the antenatal diagnosis rate was higher (58%) compared to national average (35%, CCAD 2011–12). Despite this, 23% (n = 7) were missed by current antenatal and postnatal screening programmes. Routine postnatal pulse-oximetry would likely have identified 5 of these 7, and the introduction of this in the trust will be monitored and reviewed to assess improvement in diagnostic yield. References Riede FT, et al. Effectiveness of neonatal pulse-oximetry screening for detection of critical congenital heart disease in daily clinical routine -results from a prospective multicenter study. Eur J Pediatr. 2010;169(8):975–81. Wren C, et al. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed. 2008;92:F219-224