Preterm infants often develop a postural deformation of the legs with wide hip abduction and external rotation giving a 'frog leg' posture. It has been shown that the deformation persists at the age of3-45 years and the use of postural techniques aimed at reducing the deformation is recommended. (Arch Dis Child 1993; 69: 597-598)

Background:In the United Kingdom, the new NHS contract for primary care mandates that practices use the Electronic Frailty Index (EFI) to screen for frailty and apply clinical judgment, based on knowledge of the patient, to decide whether they have a diagnosis of frailty. EFI has not yet been validated for this purpose. Many primary care clinicians would agree that although not formally investigated, there seems to be a strong association between being housebound or in institutional care and having a diagnosis of frailty. Although being housebound or in institutional care is not commonly coded in primary care computer record systems (IT), this cohort of patients do require home visits if they become unwell. Home visits are coded and it is simple to run a search on primary care IT to generate a list of older people who have received a home over given period.Aim:This study assessed whether being housebound and requiring home visits could form a new screening tool for frailty.Design and Setting:Retrospective cohort study from 1/3/15 to 29/2/16. Primary care, South Devon.Method:Medical records of 154 patients over 65 years of age were evaluated. Patients were divided into two groups: a group (n = 82) that had received a home visit and a second group consisting of a randomized sample of patients (n = 72) with similar baseline characteristics who had not. Patient records were analyzed by two clinicians to determine whether a frailty syndrome was present. Researchers were blinded to each other's results. An arbitrator determined the frailty status on disagreement.Results:Home visits have a sensitivity of 87.23% [95% confidence interval (CI): 74.35%–95.17%] and specificity of 61.68% (95% CI: 51.78%–70.92%). For frailty, Cohen's Kappa showed fair interobserver reliability.Conclusion:This study suggests that home visits are a good screen for frailty; the data are easy to retrieve from primary care IT and could be used as a valid screening tool to assist with identifying frailty in primary care.

Main outcome measures: Hospital course, discharge, and 3-year post-tracheostomy outcomes were compared between preterm infants <29 weeks gestation and infants with congenital anomalies.Results: Forty-three infants were identified; seven were lost to follow-up and excluded. Of the 36 analyzed, 86% survived to discharge. At discharge, 13% were decannulated, 36% required no mechanical ventilation, and 52% required mechanical ventilation. Median hospitalization was 295 days. At 3 years post-tracheostomy, 97% were alive. Proportions of infants with tracheostomy in situ was 80%, 73%, and 60% at 1, 2, and 3 years post tracheostomy. Tracheostomy incidence was 2.7% for preterm infants <29 weeks gestational age with 55% for subglottic stenosis. All preterm infants received postnatal steroids. Preterm infants underwent tracheostomy at later chronological age (123 vs. 81 days, p < 0.001), but similar corrected gestational age (42 + 5 vs. 51 + 2 weeks, p = 0.095). Preterm infants had more intubation attempts (17 vs. 4, p < 0.001), total extubations (8 vs. 2, p < 0.001), and days on ventilation before tracheostomy (100 vs. 78, p < 0.001).Conclusions: Infants who underwent tracheostomy in a Canadian public healthcare setting demonstrated decreasing tracheostomy dependence and high survival post tracheostomy, despite prolonged hospitalization. Preterm infants had more intubation and extubation events which may have contributed to airway injury.

Background Children with a Fontan operation represent a unique form of congenital heart disease (CHD) that requires multiple cardiac surgeries and procedures with an uncertain long-term outcome. Given the rarity of the types of CHD that require this procedure, many children with a Fontan do not know any others like them. Methods With the cancelation of medically supervised heart camps due to the COVID-19 pandemic, we have organized several physician-led virtual day camps for children with a Fontan operation to connect with others in their province and across Canada. The aim of this study was to describe the implementation and evaluation of these camps via the use of an anonymous online survey immediately after the event and reminders on days 2 and 4 postevent. Results Fifty-one children have participated in at least 1 of our camps. Registration data showed that 70% of participants did not know anyone else with a Fontan. Postcamp evaluations showed that 86% to 94% learned something new about their heart and 95% to 100% felt more connected to other children like them. Conclusion We have demonstrated the implementation of a virtual heart camp to expand the support network for children with a Fontan. These experiences may help to promote healthy psychosocial adjustments through inclusion and relatedness.

AimsPreterm infants requiring small bowel resection may receive a temporising enterostomy to divert the faecal stream and allow optimisation of their clinical condition and nutritional status prior to restoration of intestinal continuity.Facilitating growth in the presence of an enterostomy can be challenging, and may require adjuvant parenteral nutrition in addition to enteral feeds. There remains no consensus regarding the optimal timing of stoma closure.We aimed to determine the stoma-related complication rate in preterm neonates undergoing small bowel resection and enterostomy formation to help inform discussions about the timing of stoma closure.MethodsWe retrospectively identified all infants<32 weeks gestation who underwent small bowel resection and enterostomy formation between January 2012 and June 2017, from our surgical procedures database. Information including basic demographics, indication for enterostomy, timing of formation and closure and associated complications were extracted from case records. Local Caldicott Guardian approval was obtained.Results34 neonates were identified with a median gestational age and birth weight of 27+3 weeks (range 23+2–31+6) and 933 grams (range 480–2050) respectively. Indications for enterostomy formation were necrotising enterocolitis (NEC) in 16 (47%) infants, spontaneous intestinal perforation in 9 (26%) and ‘other’ in 9 (26%).The overall median age at stoma formation was 26 days (range 3–97); with a median age of 44 days (range 6–71) in infants with NEC, compared to 15 days (range 3–97) for all other infants. Median age at stoma closure was 105 days (range 27–394).27 neonates (79%) required adjuvant parenteral nutrition via central venous access and 14 (51%) of these developed a central line associated complication. There were 7 stoma-related complications comprising 3 stoma prolapse, 1 wound dehiscence and 3 superficial wound breakdown.ConclusionsComplications directly related to an enterostomy, or due to a requirement for central venous access and parenteral nutrition are common in preterm infants. These data should inform multidisciplinary discussion regarding the risks and benefits of persevering with an enterostomy versus early closure.