This review highlights the importance of clinical information on prescriptions and that incomplete or poor documentation may contribute to prescribing errors. It also emphasises the importance of pharmacists in the identification and correction or resolution of potential prescribing errors. There is a need to develop a well-validated measure to assess the severity of prescribing errors that will better address their clinical significance and risk.

Adequate nutrition during therapeutic cooling for ischaemic injury in the newborn is important in minimising long-term neurological morbidity.1 National TOBY guidelines suggest enteral feeds may be ‘cautiously introduced’ during cooling following the correction of biochemical and metabolic disturbances.2 However, it has been suggested that neonates exposed to hypoxic injury are at increased risk of developing necrotizing enterocolitis (NEC) and so feeds should be withheld until re-warming.3 A national survey was performed to gain insight into current approaches towards enteral feeding during therapeutic cooling. Methods Hospitals were contacted by telephone and asked standardised questions about nutritional practice during cooling. 42 of the 47 units to provide cooling in the UK supplied information. Results 67% of hospitals had no guidelines or had guidelines that failed to provide information with regards to starting enteral feeds during cooling. 79% do not give enteral nutrition during cooling. Of these, 24% of guidelines cited risk of NEC/GI complications as justification. 70% offered no reasoning for the recommendation. In these units, 45% began patients on TPN (± lipids), while 55% provide only IV fluids. No units give full enteral nutrition, however 21% of units provide trophic feeds, preferentially using expressed breast milk most frequently at a rate of 1 mL 1–4 hly, with supplemental IV fluids and no adjunctive TPN. Conclusion This survey concludes that there is no uniform approach to nutrition during therapeutic cooling in neonates within the UK. Further research and subsequent guideline development is essential to ensure optimal treatment is given to this patient group. References 1 JY Ting, D Manhas, SM Innis, S Albersheim, Elevated Triglycerides Levels in Two Infants With Hypoxic-ischemic Encephalopathy Undergoing Therapeutic Hypothermia and Receiving Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2013 Jul 26, Epub ahead of print 2 The UK TOBY Cooling Register – Clinician’s Handbook Available: Accessed: 07/04/2014 3 R Mosalli, Whole Body Cooling for Infants with Hypoxic-Ischemic Encephalopathy, J Clin Neonatol. 2012 Apr-Jun; 1(2): 101–106

Introduction Congenital Cytomegalovirus (CCMV) infection is the most common intrauterine infection. We present three cases of babies and compare their symptoms and subsequent management. Treatment of CMV is with antivirals. The aim is to avoid end-organ damage. We highlight the difficulties in recognising and managing CCMV which is refactory to first line treatment. We identify the issues of differentiating between CCMV complications and side-effects of antivirals. Results All babies were diagnosed postnatally, from day 2–42 of life. One baby was diagnosed due to symmetrical intrauterine growth retardation, another following tests for petechiae/thrombocytopenia. The last baby was diagnosed following a clinical decline; thought to be infection. Babies were treated with platelet transfusions (average of 1 unit/week). All three babies received an eight week treatment of ganciclovir; with viral loads subsequently falling. One of the babies deteriorated a fortnight after the end of ganciclovir with increased viral loads. Second-line antiviral (Foscarnet) was commenced. Signs of bone marrow suppression were found during treatment, it was unclear whether this was secondary to resurgent CCMV or Foscarnet. End organ damage was evident in two of the three patients; both have a ‘moderate’ degree of unilateral hearing loss, one of these two has changes on MRI scan consistent with polymicrogyria. Conclusion CCMV infection has a varied presentation and can be resistant to first line antiviral agents. Little literature exists in use of Foscarnet in the neonatal cohort and difficulties in identifying causes of complications makes management difficult.

Introduction Sildenafil is increasingly used to treat PPHN secondary to chronic lung disease in neonates. Severity of PPHN has been linked to increased mortality at two years.1 There is no national guideline advising clinicians on dosage or weaning schedules for use of Sildenafil in neonates. Methods A telephone survey of tertiary level neonatal units in England and Wales (n = 48) was conducted in December 2013 and January 2014. Neonatal consultants were contacted to ensure robust data. In the event a consultant was not available, staffs employed by the unit for at least 24 months (Specialist registrar, Advanced Neonatal Nurse Practitioner (ANNP) or nursing sister) were surveyed. Results The response rate was 90% (n = 43/48). Sildenafil was used frequently (>5 patients per year) in 12% (n = 5), infrequently, (1–5 patients per year) in 23% (n = 10) and rarely (<1 per year) in 51% (n = 22). Majority of units had used Sildenafil within the last 6 months 49% (n = 21). 60% (n = 26) used Sildenafil only after discussion with Cardiologists, 35% (n = 15) commenced Sildenafil after discussion with neonatal colleagues. No unit had fixed indications for commencement of Sildenafil. Amongst those with a guideline (n = 6); the initial dose varied between 250–300 mcg/kg commenced between 4 and 12 hourly. Guidelines on two units were unclear on rate of increase of Sildenafil. No guideline stipulated weaning/stopping practice. Conclusion Sildenafil is infrequently used in NICU, however only 6 units did not use Sildenafil in the past 24 months. Variability in practice amongst units mirrors the need for a national consensus guideline.

Aims Pneumococcal vaccination (PnV) was introduced into the UK immunisation schedule in 2006. This paper reviews presentation, diagnosis, management and outcomes of children with pneumococcal meningitis from a tertiary children’s hospital before and following the introduction of the PnV. The study evaluated differences in outcome between patients in the hospital’s catchment area (internal) and those transferred from another hospital (external). Method Retrospective case note audit of patients admitted with a diagnosis of pneumococcal meningitis. The audit covered six years before and following the introduction of PnV. Results Sixty two case notes were audited, 37 in the pre-PnV and 25 in the post PnV group. Forty-four patients (71%) were internal and 18 were transferred in from another hospital (external). Mean age was 2.2 years (median 11 months, range <1 month – 15 years) (M:F 1.5:1). No statistically significant difference was found between the two groups in time from symptoms to presentation, presenting symptoms, laboratory indices, duration of admission or management. The mean time from presentation to diagnosis was twice as long in the post-vaccination (0.72 days), compared to the pre-vaccination group (0.33 days). 5 patients died, 4 (80%) in the pre-vaccination group. The average number of neurological sequelae in survivors was just over 1 in the pre-vaccination and under 0.5 in the post-vaccination group (i.e. for every two patients in this group one would be expected to have neurological sequelae). All of the patients who died were internal. There was an average of one neurological sequelae per patient in the external group. Conclusion There were fewer patients in the post-PnV group, mortality was less and on average fewer patients had neurological sequelae in this group. This may reflect a reduced population of pathogenic serotypes following vaccination. Time to diagnosis was longer on average in the post-PnV group, which could suggest that as pneumococcal meningitis has become less common it takes longer to make the diagnosis, the small number of patients (62) precludes definitive conclusion. Management and duration of admission were similar. Internally-derived patients were less likely to die but slightly more likely to have neurological sequelae. These findings require confirmation with a nationally-conducted audit. Abstract G327(P) Table 1 Total mean (%) [sd] Pre vaccination mean (%) [sd] Post vaccination mean (%) [sd] P value Total n = 62 n = 37 n = 25 N/A Age in years 2.2 [3.3] 2.26 [2.85] 2.15 [3.89] 0.89 Male gender n = 39 (63) n = 24 (65) n = 15 (60) N/A Received Pneumococcal Vaccination* 13 (21.7) 0 (0) 13 (56.5) N/A Days from symptomatic to date of seeking medical advice (in days) 1.44 [1.7] 1.58 [1.66] 1.2 [1.78] 0.44 From seeking medical advice to diagnosis (in days) 0.5 [1.54] 0.33 [1.21] 0.72 [2.03] 0.36 Hours after presentation – Antibiotics begun 5.54 [18.79] 7.7 [24.02] 2.34 [3.73] 0.27 Temperature on presentation (degrees centigrade) 38.3 [1.06] 38.3 [0.95]...