BackgroundChildren and young people (CYP) with Cerebral Palsy (CP) are at risk of nutritional problems. Up to 90% experience difficulties in chewing or swallowing, and/or eating or drinking independently.It has been recognised that these children at risk of nutritional problems have an increased risk of bone demineralization and low-impact fractures.Feeding impairment also correlates with the severity of motor deficit (GMFCS level IV – V). Studies show that those within this category were 5.7 times more likely to have lower bone mineral density (LBMD) than GMFCS level I-III.The recent NICE guidelines have made recommendations that CYP with CP have regular reviews of their nutritional status and LBMD should be assessed and adequately managed.AimTo ascertain (as per the NICE guidelines)a. Whether CYP with CP (GMFCS level IV–V) seen in a tertiary neurodisability service are having regular reviews of their nutritional status.b. Whether LBMD is being assessed adequately.MethodRetrospective case note analysis of CYP with CP (level IV-V) attending between March 2015- February 2017Results24 children with GMFCS IV-V, CP, were identified. The male to female ratio was 11:1396% had their weight measured92% had their height measured75% had a nutritional review performed70% were referred to dieticians/for alternative methods of feeding.62.5% of individuals had their dietary intake of vitamin D/calcium assessed at clinic17% had investigations performedDiscussionOur findings showed that we are not achieving optimum results in mandatory areas such as measuring weight and height. Barriers identified were lack of equipment and training in mobilising a wheel chair bound child.Other areas for improvement include the need to perform regular nutritional reviews, with ongoing referrals if deemed necessary.A proforma/checklist for the service is currently being developed in order to aid clinic reviews, and a further audit will be performed in a year.

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Conclusions DAH is an uncommon, life-threatening complication of dengue Fever. A high index of suspicion and early institution of supportive treatment in form of blood component transfusion, shock management and mechanical ventilation are critical to successful management of such patients.

BackgroundCoeliac Disease (CD) is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individual. Recent NICE guidelines sets out the guidance for the diagnosis and management of CD. It recommends that all patients should be seen by a specialist, require dietician input and be annually reviewed.Children from the entire the county of Lincolnshire are referred to Lincoln County Hospital (LCH) for their diagnosis and are managed by a single consultant paediatrician with an interest in gastroenterology.Aims1) To compare our practice for the diagnosis and management of children with coeliac disease over a 5 year period from 2009 to 2014 with the current NICE guidelines.2) To look at any change in presentation/practice from the previous audit.(1999–2004)MethodsRetrospective review of the patients diagnosed with coeliac disease over a 5 year period from 2009–2014 in LCH was undertaken and compared with the previous audit (1999– 2005). Age of presentation, duration of symptoms, clinical presentation, serology, biopsy findings, management, follow-up and sibling screening data were collected and compared.Excluded diagnosed elsewhere.Results65 children (23M,42F) were diagnosed with CD in 2009–2014 vs 41 (19M,22F) in previous audit. Mean age of diagnosis 8.1 yr vs 6.1 years, Duration of symptoms was same in both 6–8months, 65% presented with gastrointestinal symptoms vs 49%, Associated disorder 5% vs 7%, Asymptomatic 7% vs nil, Latent celiac 8% vs 12%, EMA and TtG 100% vs 100% and 7% in previous audit, HLA typing 4% vs 14%, Biopsy done in 97% in both audit, Dietician reviewed 100% in both audit, Sibling screened 55% vs 100%, Follow up in Coeliac clinic 83% vs 87%, First Degree relative 21% vs 14% in previous audit. Associated conditions see included type-IDDM, Down’s syndrome, Addison’s disease, Skeletal dysplasia.ConclusionWe noted that there was a significant increase in the number of patients with CD and that they presented at a slightly older age. More patients had gastrointestinal symptoms.Only 5% less than3rd centile. 7% were asymptomatic. The incidence of CD in first degree relative was high at 21%.Our practice is compliant with the NICE guidelines and ESPHAGAN.