Omalizumab is a monoclonal antibody which targets immunoglobulin E. It is approved as an add‐on therapy for children with severe allergic asthma. Assessment of endotype and phenotype is necessary in order to correctly identify those patients who are most likely to respond to omalizumab. Children with severe asthma represent a complex heterogeneous group. This report outlines the background, management, and outcomes for two children initiated on omalizumab for severe allergic asthma in Children's Health Ireland at Tallaght. It demonstrates the difficulties faced by this cohort and the positive impact targeted biological therapy can have. Given the substantial cohort of children with asthma attending our tertiary center, it also indicates that comprehensive stepwise care can achieve adequate control in the vast majority of cases without the requirement for additional therapies.

Developmental disorders in children are common. Associated demanding co-morbidities that include sleep problems are prevalent in this group. In turn, these are linked to daytime performance issues, reduced developmental and academic growth, and considerable familial psychopathology. Behavioral modification measures are and should be the first line approach to management. Medications for sleep disorders have an important role in addition to behavioral modification therapy. This literature review looks into the occurrence and severity of sleep problems in children with developmental disorders. The probable advantages of using medications, mainly focusing on the neurohormone melatonin (a sleep inducer), are also explored.

Exercise induced bronchoconstriction (EIB) may complicate childhood asthma. Leukotriene receptor antagonists (LTRAs), such as montelukast, may be beneficial in protecting against EIB. Our aim was to systematically review the role of LTRAs in the treatment of asthmas complicated by exercise induced bronchoconstriction and to assess various clinical factors which may influence the therapeutic outcome. Electronic searches were performed in the following databases: PubMed, CENTRAL, and the US National Institutes of Health Clinical Trial database. Following selection according to clearly defined inclusion and exclusion criteria and in accordance with the PRISMA statement; 5 double-blind, randomized, placebocontrolled trials of montelukast as monotherapy or addon therapy in childhood asthma and 2 review articles were analysed in this systematic review. Treatment with LTRAs provides protection from EIB, when used as both monotherapy and add-on therapy. However, disease variables and aetiological factors may impact on the extent of clinical improvement. Genetic variability may influence leukotriene production and subsequent response to LTRAs. This issue could be addressed in further studies.

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Results: Of 1761 children studied 8.5% were malnourished according to z score P / E, 21.6%, according to E / I. The analysis of z score P / E revealed that 58.4% were male and 66.7% female. The mean age was 8.9 years. The z score of E / I 53.4% were male and 56.5% female. The risk of malnutrition was higher among boys: 59.7% for the index P / E and 53.9% for E / I. There was no statistically significant difference between the schools, gender and school year. Among nutritional status, period (P < 0.0001) and students grade (p = 0.0105), we observed statistical significance. Conclusion:Malnutrition is still continuing between the low-income population and males had a higher percentage of malnutrition. From the analysis in the region, one can consider that the nutritional assessment of school -the anthropometric technique in particular -is an extremely important tool for understanding the dynamics of child nutrition and development. 1428LITERATURE REVIEW ON LEAD POISONING E. Neary, O. Ahmareen, F. Sharif Department for Paediatrics, Midland Regional Hospital, Mullingar, IrelandThe adverse affects of high blood levels of lead are well established. There is now data emerging which looks at lower blood levels of lead associated with poor cognition and other developmental concerns. The authors undertook a literature review to examine the causal effect of low lead level and impaired cognitive function. The plausibility of including lead screening as part of developmental delay workup in Ireland is also explored. This review concludes that there is an adverse relationship between increasing level of lead and cognition. Children with developmental delay would be at an increased risk to the cognitive impairment associated with low levels of lead. Given that there are preventative and therapeutic options to minimise the effects of lead, we argue that this group of children should be routinely screened for lead. Currently there is lack of prevalence data in Ireland. The authors are working in conjunction with British Paediatric Surveillance Unit Project to undertake active surveillance of lead poisoning in Ireland. CORRELATION BETWEEN INTRADELTOID INJECTION AND DELTOID FIBROSIS T.T. Tu General Pediatrics Department, National Hospital of Pediatrics, Ha Noi, VietnamAim: To investigate a correlation between intradeltoid injection and deltoid fibrosis (DF) Material and methods:A case-control study based on a community population was conducted. Cases included patients from 1-20 years of age suffering from DF in three communes. The diagnosis criteria included 293 children.Controls included healthy individuals matched with cases by age and sex. Two controls were selected for one case. Results:There is an evident correlation between injection of antibiotic into Deltoid muscle and DF with OR= 27.2;P< 0.001. The degree of correlation decreased with an increase in age OR= 3.8; P< 0.001 when antibiotic injection was done in newborn period, OR= 2.1, p< 0.01 in children from 1 month to 5 years old.There was also correlation between intrade...