Aims To evaluate the incidence of line infections in a UK paediatric oncology centre and assess the efficacy of biopatch (a chlorhexidine impregnated exit site patch applied at line insertion) at reducing infections. Introduction Central venous access is an essential component of paediatric oncology care however line insertion requires general anaesthesia and infections can be life threatening. Novel strategies to reduce line infections therefore merit evaluation. Methods We audited the incidence of line infections before and after the introduction of biopatch. Data was collected retrospectively from electronic theatre records and hospital results systems over an 18 month period and each line was followed up for 6 months. We also investigated whether neutropaenia at insertion was associated with infection (chi-square test). Results First six months (before biopatch): 45 patients had 64 lines inserted (1.42 per patient). 12 lines (19%) were removed due to proven infection. There were 9 exit site infections (0.14 per line) and 1 line was removed due to exit site infection alone. There were 33 blood culture positive infections (0.52 per line). Second six months (before biopatch): 47 patients had 52 lines inserted (1.11 per patient). 7 (13%) were removed due to proven infection. There were 18 exit site infections (0.35 per line) and 2 were removed as a result of this alone. There were 19 blood culture positive infections (0.37 per line). Third six months (post biopatch introduction): 45 patients had 52 lines inserted (1.15 per patient). 15 (28%) were removed due to proven infection. There was 1 exit site infection (0.02 per line) and no lines were removed on the basis of this alone. There were 37 blood culture positive infections (0.71 per line). In all time periods there was no association between neutropaenia (<0.5 x 109/L) at the time of insertion and subsequent line infection (P = 0.71). Conclusion Introducing biopatch reduced the number of exit site infections. There was no reduction in blood culture positive infections. There was no association between neutropaenia at the time of line insertion and subsequent line infection.

Aims To determine the most reliable method for a nutritional assessment in a child with cerebral palsy with a GMFCS level IV-V. Methods The review is in four parts: 1. A review of the reasons behind this vulnerable group being susceptible to malnutrition, looking at the causative factors affecting nutrition, and potential adverse effects. 2. A literature review by searching Embase and Medline databases to review the evidence behind the most effective way to assess nutrition in children who are predominantly using a wheelchair. 3. An audit reviewing children with cerebral palsy who were referred for gastrostomy placement, how their nutritional status was assessed and comparing against NICE standards for nutritional assessment in children and young people with cerebral palsy (https://www.nice.org.uk/guidance/ng62) 4. A survey of 16 acute and community paediatricians as well as dieticians to review current practice, and establish opinion on what would be acceptable and feasible to do in clinic as well as explore potential barriers to implementing a change in practice.The information obtained from above was used to create a clinic proforma, along with a user guide, designed to standardise our assessments and bring them in line with current NICE guidance. Results Literature review: 92 articles were identified through Embase and Medline. These were reviewed using Critical Appraisal Skills Programme (CASP) and the American National Institute for Health appraisal tool, and the most relevant evidence was summarised.Audit: 82 patient notes were reviewed electronically, 11 met audit criteria. 56% had their height and weight measured; 0% had further anthropometric measurements done if basic height and weight measurements were not performed.Survey: 21% feel their current practice gives an adequate reflection of nutritional status. 100% of respondents routinely measured weight; 79% height, 36% head circumference; 50% Body Mass Index. 21% request blood tests; 7% perform knee height if actual height is not possible; 43% look for physical signs of malnutrition. Concerns were highlighted over lack of appropriate equipment and training. Conclusions There is wide variation in our practice and an evidence based approach to standardising practice is essential to ensure the most effective assessment. Potential barriers of lack of funding, education and training in anthropometry must be overcome.

groups and differing degrees of myelosuppression, as marked by ANC levels. Methods A retrospective cohort study was conducted on 97 patients who were initiated on hydroxycarbamide between 2005-2017 at a tertiary haemoglobinopathy centre in London, UK. The primary measure of outcome was the burden of acute SCD-related complications, as defined by the annualised rates of A and E attendances and hospital admissions. Secondary outcomes included haematological, biochemical, liver, renal and Transcranial Doppler velocity status. Comparative analysis was performed upon stratification via dose (<20 mg/ kg/day, 20-24 mg/kg/day and !25 mg/kg/day) and sustained ANC values (ANC<4×10*9/L and ANC!4×10*9/L). Results Clinical outcomes were not predicted by dose or ANC values. Whilst laboratory indices between dose groups were also non-statistically significant, patients maintained on ANC<4×10*9/L were shown to achieve superior responses in haemoglobin, haemoglobin F, absolute reticulocyte count and liver function. Toxicities occurred idiosyncratically, with minimal reports of transient neutropenia and thrombocytopenia. Conclusion Sufficient clinical responses may be achievable without intensive dose escalation. The implications of enhanced physiological responses achieved with greater myelosuppression remain to be investigated in prospective studies.