Conclusion Incidence of chest pain presenting to our ED was 1%. The commonest recorded cause was musculoskeletal. Fewer than 1% had a possible cardiac aetiology for chest pain. ECG is a useful test for children presenting with chest pain. Very few patients with mild ST elevation had cardiac enzyme levels checked. Aims The antenatal diagnosis of congenital heart diseases (CHD) is crucial for fetal and perinatal management; however, there is little in literature regarding the pharmacologic intervention for fetal CHD in Egypt. Therefore, we attempted to detect fetal cardiac structural or functional abnormalities using fetal echocardiography and plan fetal pharmacologic intervention without endangering the mother's life. Methods Cases fulfilled inclusion criteria were diagnosed using detailed fetal Echocardiographic examinations and antenatal treatment was described if indicated after a written consent. Cardiovascular profile score (CVPS) was used to assess the response to treatment. Postnatal transthoracic Echo was done to confirm diagnosis with follow up till the end of neonatal period to determine outcome. Results Fetuses fulfilled inclusion criteria were 143 with a mean gestational age at diagnosis 27.59 ± 5.41 weeks, mean maternal age at diagnosis was 26.64 ± 5.428 years, the most frequent cause of referral was family history of CHD (34.1%). Twenty fetuses (14%) received antenatal therapy. Fetuses with heart failure due to structural cardiac defects (n = 4) and functional non arrhythmic heart failure (n = 8) received digoxin while cases with fetal tachyarrhythmia (n = 6) received digoxin and/or sotalol or flecainide and fetuses with immune mediated fetal heart block (n = 2) received dexamethazone. Success in tachyarrhythmia was statistically significant regarding CVPS (p = 0.038) and heart rate changes (p = 0.002) but statistically insignificant regarding CVPS in structural defects (p = 0.102) and nonarrhythmic functional heart failure (p = 0.343). Conclusion Antenatal cardiac pharmacologic intervention is possible with hydrops fetalis reversal in fetal tachyarrhythmia and resolution of first degree immune mediated atrioventricular block. On the contrary, no response to antenatal digoxin use in fetal structural heart failure and limited response in non-arrhythmic functional heart failure. G168(P)ANTENATAL G169(P) EXPLORING ETHNIC VARIATION IN INFANTS WITHCONGENITAL HEART DEFECTS UNDERGOING PAEDIATRIC CARDIAC SURGERY Introduction North American researchers have reported ethnic differences in the prevalence and short-term outcomes of congenital heart defects (CHDs), which may reflect genetic variation, environmental exposures or healthcare access. It is unclear whether ethnic differences in CHD frequency and outcomes also exist in the UK population and healthcare system. Aim To examine national paediatric cardiac surgical audit data for ethnic differences in the frequency of different CHD subtypes, associated comorbidities and short-term outcomes for infants operated in the first year of life. Methods Individual...

community patients were admitted to the acute inpatient setting. We therefore audited the standards relating to inpatient care which included the need to record the cause of neurodisability on admission, on daily ward rounds and at discharge, recording of a child's mobility, communication and if a child had a handheld patient record (or if one was recommended). Methods We retrospectively audited 30 children admitted over a 1 year period, randomly selecting 10 elective admissions, 10 emergency admissions with short stay spells (<24 hours) and 10 longer term emergency admissions (>24 hours). Baseline data is shown in the table 1. Our short-term interventions following baseline data collection included delivering teaching to all ward doctors about the children with neurodisability & why these aspects of care were important to record and attaching a prompt sheet to notes trolleys. A re-audit of 10 patients over the next 2 months (limited numbers due to reduced summer admissions) showed improvement in all areas. Results Conclusions Our short term intervention, which did not require any hospital committee approval or funding, showed significant improvement in our documentation towards the NCEPOD standards allowing us to better support these families. We have also designed a proforma for medical notes which is in the process of going through health records approval and will be re-audited once introduced.

Aims 1) To identify risk factors for death or unplanned readmission within one year following hospital discharge after cardiac intervention for congenital heart disease. 2) To characterise patient groups at highest risk who would benefit from targeted intervention. Methods Records in the national congenital cardiac surgical audit (NICOR) pertaining to UK infants who had a cardiac surgery or intervention aged under 12 months between 01/01/2005 and 31/12/2010 were matched with intensive care admission records in Paediatric Intensive Care Audit Network (PICANET); linked records with known life-status were obtained for 7634 infants. Outcome measures were: Outcome 1 – death within 1-year following discharge; Outcome 2 – Outcome 1 or emergency readmission to PICU within 1-year following discharge. Potential risk factors available from either dataset were pre-specified and univariate and multivariate logistic regression used to investigate the effects of these on each outcome. Classification and regression tree (CART) analysis was used to identify distinct patient groups differentiated by risk of Outcome 2, each defined by a set of patient characteristics. Results 3.2% (246/7643) and 6.7% (514/7643) of infants experienced Outcome 1 and 2 respectively. Fitted multivariate models for both outcomes were robust in risk factor selection (Outcome 1 - ROC AUC = 0.78, 95% CI [0.75, 0.82]; Outcome 2 - ROC AUC = 0.78 [0.75, 0.80]). Risk factors significant in the multivariate Outcome 2 model were: age at procedure, weight z-score, cardiac procedure, cardiac diagnosis, non-cardiac congenital anomaly, neurodevelopmental condition, prematurity (<37 weeks gestation), ethnicity, and length of stay in specialist centre (LOS). Clinical deterioration was additionally significant to Outcome 1 whilst neurodevelopmental condition and acquired diagnoses were not. Key defining characteristics of infants in the patient groups identified as higher risk were [% Outcome 2]: (1) neurodevelopmental conditions [24%]; (2) Hypoplastic left heart, single ventricle or pulmonary atresia [15%]; (3) Congenital anomalies and LOS > 1 month [24% risk]; (4) No congenital anomalies and LOS > 1 month [9% risk]. Conclusions Understanding patient risk groups should inform recommendations for improving services, support development of interventions to mitigate each profile of risk and facilitate evaluation of the priority and feasibility of targeting each group.

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