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The practices and support for delivery of Neonatal Parenteral Nutrition (PN) in Northern Ireland were audited against standards derived from the ESPGHAN guidelines, NCEPOD Report on PN and the NICE Quality Standards for Specialist Neonatal Care. Method The records of the first 40 babies consecutively admitted to 5 neonatal units in Northern Ireland after 1st April 2012 were audited (~10% of all NI admissions). Results 100% have a policy for PN and access to MDT nutritional expertise; 80% had access to standard PN. Infant characteristics were gestation median (range) 34 (24–41) weeks; birthweight median (range) 2.24 (0.6–4.97) kg. PN commenced at a median (range) age 9 (1–96) hrs; Individual unit medians ranged from 2–24 hrs. Overall 48% initially commenced standard PN. This varied between units with a range of 15–95% Access used for PN delivery was; 75% peripheral, 19% UVC, 6% long line. 2% (4 babies) had complications with central access. 1 accidental removal, 1 extravasation and 2 sepsis of which 1 CoNS and 1 staph epidermis. 100% of chart entries regarding IV access had doctor’s name, grade, date, time and catheter type, 95% documented tip position. PN duration median (range) was 3 (0–89) days. EN commencement median (range) was 1 (0–74) days. Full EN was reached median (range) 4 (0–21) days. Conclusions There is significant variation in practice for PN administration and probable overuse. A regional guideline may assist with ensuring each infant receives care determined by regional consensus ‘best practice’.

The practices and support for delivery of Neonatal Enteral Nutrition (EN) in Northern Ireland were audited against standards derived from the NICE Quality Standards for Specialist Neonatal Care. Method The records of the first 40 babies consecutively admitted to 5 neonatal units in Northern Ireland after 1st April 2012 were audited (~10% of all NI admissions). Results All units have breastfeeding policies and 80% EN progression guidelines Infant characteristics were gestation median (range) 34 (24–41) weeks; birthweight median (range) 2.24 (0.6–4.97) kg. EN commencement median (range) was 1 (0–74) days. Full EN was reached median (range) 4 (0–21) days. Initial milk used was; 48% expressed breast milk (EBM), 35% formula, 14% donor EBM (DEBM) and 3% never received EN. 63% of all babies received some EBM; 27% received DEBM. Milk at full EN was; 36% formula, 30% EBM, 14% EBM + formula, 9% DEBM, 7% none. On discharge 55% were on formula, 28% EBM. Median (range) of corrected age at discharge was 37 (28–44) weeks with weight median (range) 2.47 (0.8–4.97) kg. Patient outcomes; 75% home, 19% transferred, 4% postnatal ward, 2% died. Conclusion Despite increasing evidence of the benefits of maternal breast milk for preterm infants, rates of EBM use fell from 48% on initiation to 28% at discharge. Only 63% of neonatal admissions in Northern Ireland ever received maternal breastmilk. A Quality Improvement Initiative should commence supporting mothers breastfeeding and expressing milk for their infants.

Coagulase negative staphylococcal (CoNS) bloodstream infection rates are a common cause of late onset sepsis in the neonatal population. Our unit, which is a 31 bedded tertiary neonatal intensive care, had high CoNS rates as part of its benchmarking activities with the Vermont Oxford Network. Method A multidisciplinary quality improvement team was established, with the aim of reducing the incidence of central line associated CoNS blood stream infections. The team have examined areas of practice potentially contributing to nosocomial infection. Initiatives undertaken include revision of staff teaching and induction programmes, audits and regular monitoring of practice. Specific interventions included; Hand washing training using ultraviolet light and GloGerm® with random peer audit. Training and audit of the implementation of aseptic non touch technique and personal protective equipment. Training and audit of parents and grandparents hand washing practices. Revision of skin cleansing guidelines to introduce a more concentrated alcohol based chlorhexidine solution. Revision of feeding guidelines expediting full enteral feeds by 1–3 days facilitating earlier removal of central lines. Introduction of a high impact intervention tool on blood culture technique. Results Figure. Abstract PC.48 Figure Conclusion Through a multidisciplinary quality improvement team, the culture within NICU that nosocomial infection is acceptable or inevitable has been challenged, and a reduction in infection rates has been achieved. This is difficult to consistently maintain and all staff must remain motivated and enthusiastic to ensure improvements continue.

Background and aims: Pulse oximetry is not routinely used in term neonates. However, current research argues strongly towards introduction as infants with critical congenital heart disease may be detected who are otherwise discharged undiagnosed. Delayed diagnosis and treatment can result in higher mortality, increased hospital stay and incidence of significant complications. This audit aimed to determine feasibility of local screening by quantifying potential false positives thus achieving a perception of workload, unnecessary distress and cost-effectiveness. Method: Data collection upon 100 infants in postnatal wards and delivery suite involved documentation of hours of age and SpO 2 as assessed. With verbal parental consent the pulse oximeter was placed on the infant's left foot and the reading taken after 30 seconds good trace. Suggested criteria from research are; on initial screening; saturations ≥95% can be discharged, 90-94% repeat screen 6hrs later and saturations < 90% refer for further investigation +/-Cardiology opinion and echocardiography. Results: Results correlate with current research showing 5% potential false positives. All of these babies were rechecked 6 hours later and had SpO 2 ≥95%. Consequently of these 100 babies none would have required referral to cardiology based on the above criteria.