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AbstractsArch Dis Child 2013;98(Suppl 1):A1-A117 A95Objective There is conflicting evidence on the association between television viewing in childhood and cognition. No recent UK and few worldwide studies have looked at the longer-term effects of television viewing in childhood. This study investigates the association between verbal and non-verbal cognitive outcomes at 7 years and television habits at 3, 5 and 7 years. Method The study comprises longitudinal and cross-sectional analysis of the United Kingdom Millennium Cohort Study based on 8,148 children with complete data on variables of interest, maternal reports of television viewing and scores from objective tests of cognitive ability (British Ability Scales Second Edition) collected when cohort members were 3, 5 and 7 years. Mean ability scores were converted into the equivalent progress expected in a child at each age group using existing age equivalents derived for the cohort study population. Linear regression was used to estimate the relationship between each subscale and categories of television viewing (in relation to a reference group who watched between 1-3 hours of television a weekday) after adjustment for co-variates.Results Children who did not watch television at 3 years had verbal ability scores at 7 years approximately 7 months behind the reference group (p < 0.05); their non-verbal ability skills were approximately 18months delayed (p < 0.05). Children who watched less than 1hour a weekday had delayed non-verbal skills of approximately 2 months (p < 0.05).There was no significant association between television viewing at 5 and verbal or non-verbal ability at 7 years.Children who did not watch television at 7 years had verbal ability scores approximately 3 months ahead of the reference group (p < 0.05). Those who watched less than 1hour a weekday were approximately 1month ahead (p < 0.05). Children who watched over 3 hours of television a weekday had delays of more than 1month (p < 0.05). There was no significant association between television viewing at 7years and non-verbal ability. Conclusion There was a positive association between television viewing at 3 years and verbal and non-verbal cognition at 7 years in this cohort but a negative association between television viewing at 7 years and verbal skills at 7 years. This may influence potential guidance on television viewing. Possible explanations are the type of programmes watched or accumulation of viewing hours.

Aims Prolonged jaundice in babies is common and usually harmless but a very small number of cases have serious pathology, such as biliary atresia, in which early detection is vital. Many “well” babies with prolonged jaundice undergo extensive investigations with a very low yield of important positive results. Our aim was to assess the safety, efficiency and cost effectiveness of a nurse-led prolonged jaundice clinic which has been in operation at our district general hospital for ten years, performing minimal investigations compared to standard practise. Methods We collected data retrospectively for all babies <3months of age in whom a conjugated bilirubin level was measured at ≥14 days of age (term) or ≥21 days (preterm) from January-August 2011, excluding babies on the neonatal unit. We reviewed clinic proformas completed for each baby seen with prolonged jaundice, medical notes and hospital results system to establish whether the baby was managed in the nurse led prolonged jaundice clinic or elsewhere by doctors, investigations undertaken and clinical outcomes. Results 91% (176) of 194 babies were managed in the nurse led prolonged jaundice clinic; 5.6% (10) had additional investigations which identified one case with significant pathology. Of the 9% (18) of babies seen elsewhere by doctors (A&E/outpatients/inpatients/daycare), 77% (14) had additional investigations. 3 babies had serious pathology including one case of biliary atresia which presented late (48 days old). Conclusion For the last ten years we have managed the vast majority of babies with prolonged jaundice in our nurse-led clinic, successfully avoiding unnecessary, time-consuming and expensive investigations for well babies whilst promptly identifying cases with serious pathology. Our district general hospital has recently merged with two local community health services to form an Integrated Care Organisation, providing a unique opportunity to move the nurse-led prolonged jaundice clinic into the community. Based on our well established model, such clinics could be conducted in local health centres by midwives or community paediatric nurses, supervised by a consultant paediatrician. This would allow further cost savings and be more convenient for families.

Results From the start of the first lockdown 23rd March 2020 until the easing of restrictions on 15th June 2020 we discharged 23 long stay patients. The length of stay prior to discharge varied from 19-866 days. The median time to discharge in this group was 22 days from the start of lockdown. The barriers to discharge varied from need for housing and care provision to social care support. Apart from improvement in length of stay we also were able to solve problems innovatively by working together. Cots and white goods were sourced through social care funds and ordered on amazon by our occupational therapists. Donated housing capacity was identified by our covid command structure facilitated families moving there temporarily instead of staying in hospital. A local hospice was able to provide care for the most complex of our patients whilst awaiting onwards placements in social care and carer training. The feedback from stakeholders following discharge was used to refine processes. There were no adverse outcomes or readmissions. Conclusions This period of global health crisis has been devastating for many. In amongst the tragedy, there are glimmers of learning that would not have been achieved without this unprecedented challenge. This rapid discharge process is one such glimmer. It demonstrates that by working together across agency boundaries, thinking innovatively and putting the children and families at the heart of what we do, we can effect rapid change. We now need to harness and retain this learning to be able to continue sending children home