Results 77 UASC were seen in clinic, 91% were male, median age was 16 years (range 11-18). They came from 14 different countries; 31 were from Afghanistan, 15 from Eritrea and 10 from Albania. All were tested for TB. 51 were tested for hepatitis B, of whom four (8%) were positive. 51 UASC tested negative for HIV and hepatitis C. Of 24 children tested for schistosomiasis four (16.6%) were positive. Of 74 asymptomatic UASC, 17 (23%) had LTBI. Three UASC with active tuberculosis were referred following presentation at emergency departments, all originally from Afghanistan. Two had been symptomatic for over four months. The median length of time between arriving in the UK and infection screening was 10 months (range 1-60 months; data available on 37 children). Conclusion We demonstrate clinically important rates of detection of treatable infections. Patients were offered testing as recommended by RCPCH guidance but there was significant delay due to high non-attendance and delays in IHA Intensive liaison work by specialist Table 1: Outcomes within each domain for the Core Outcome Set (COS) during each Delphi round nurses is ongoing to improve the time to testing, with promising results. We recommend that timely and tailored infection screening be offered to all UASC, by informed consent following expert counselling about their individual risk More data are needed to inform best practice and develop consistent guidance.

Methods Staff from simulation and paediatric metabolic medicine collaborated to devise multi-professional metabolic emergency scenarios. Cases highlighted specific aspects of underlying inborn errors of metabolism and general clinical principles and protocols. Simulation sessions involved medical and nursing staff from all levels. Participant feedback focused upon session utility and applicability to the clinical environment. Analysis of simulation data was retrospectively performed of all metabolic emergency simulation data. Results Between January 2017 and September 2018, there were 7 metabolic simulation sessions involving 56 members of staff. Scenarios involved inherited metabolic conditions with complications assessing generic skills including: an allergic reaction to enzyme replacement therapy in a child with Hunter's syndrome; sepsis in a child with methylmalonic acidaemia and seizures in a child with a decompensated urea cycle defect. Participant feedback was positive with high session utility reported and applicability to clinical practice. Conclusions Participants in simulated metabolic emergencies report this training as a valuable opportunity to practise team working and clinical skills. Scenarios incorporating common emergencies in rare conditions can meet generic and sub-speciality specific training needs. Further work is planned to devise syllabus based metabolic scenarios and contribute to training in this neglected field.

Aims The Emergency, Triage, Assessment and Treatment plus Admission (ETAT+) course has incorporated the World Health Organization’s (WHO) 10 steps for the management of malnutrition.1 2 The ETAT+ course was implemented in two urban Rwandan hospitals. A tertiary hospital from October 2010 and a district hospital from March 2011. The aim of this audit was to assess if the teaching and implementation of the ETAT+ course has successfully reduced mortality rates in in children (between 2 months and 5 years of age) with malnutrition. Methods The medical records, discharge summaries, and death certificates of all the 429 children with malnutrition, admitted to these two hospitals between March 2008 and November 2011 were retrospectively reviewed and analysed using SPSS. Results We reviewed the notes of 337 children pre ETAT+ of whom 37 died (11%) compared with 84 post-ETAT of whom 2 died (2.4%). Abstract G150(P) Table 1Mortality rates pre and post ETAT training Pre-ETAT+ Post-ETAT+ Deaths (%) Total no patients Deaths (%) Total no patients Tertiary 20 (14.6%) 137 2 (3.4%)* 58 District 17 (8.5%) 200 0 (0%)* 26 (Pearson Chi-squared, p = 0.03, though this has reduced power due to values of less then 5 in the boxes marked with *) Conclusions Though these results are limited by the relatively small number of children in the post-intervention group and the lack of a control hospital (without ETAT+ intervention) they do provide evidence that the mortality rate in children with malnutrition has reduced since the implementation of the ETAT+ course.

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Aims Neonates who require transfer to a higher level of care need optimal sharing of clinical information to maintain adequate continuity of care at the receiving hospital. Therefore, we sought to identify the core clinical information (CCI) that should be provided to a referral center when transferring a neonate in a resource-limited setting. Methods A three-round modified Delphi-consensus study. Participants were clinicians with experience in neonatal care in resource-limited settings. Results In Round-1, a literature and internet search identified 16 pre-existing Neonatal Referral Forms (NRFs). These 16 NRFs contained a total of 101 individual items. Ten items were removed as they were not relevant to our setting (e.g. cooling). Ninety-one items met the pre-defined consensus, of being present in two or more NRFs, and were therefore included in Round-2. Each NRF contained a mean of 34 items (min=11, max=52). Thirty-three were present in more than half of the 16 NRFs demonstrating the need for consensus.For Round-2 and Round-3, there was a response rate of 32 (25%) and 33 (27%) participants, respectively. Participants were clinicians from East Africa, USA, and the UK. In Round-2, 6 of 12 new suggested items met the pre-defined consensus. None of these items were specific to the resource-limited setting. 57 items, grouped into eight domains, met the final consensus criteria (Table 1). Conclusion Our CCI of 57 items is larger than the range of 11-52 items that were present in the 16 NRFs of Round-1. This CCI can now be used to create a standardized Neonatal Referral Form tailored to use in resource-limited settings.Abstract G298(P) Table 1 Delphi-rounds for CCI items