Aims: To study the relation between the use of parent reported home smoking bans and smoke exposure among children aged 18-30 months. Methods: A total of 309 smoking households with children aged 18-30 months, who were part of the Coventry Cohort study, consented to participate in this cross-sectional survey. Results: Although parents in almost 88% of smoking households reported using harm reduction strategies to protect their toddlers from smoke exposure, only 13.9% reported smoking bans in the house. Mean log urinary cotinine:creatinine ratio was significantly lower for those children whose parents reported no smoking in the house (1.11, 95% CI 0.64 to 1.49) compared with none/less strict strategies (1.87, 95% CI 1.64 to 2.10). In linear regression models fitted on log cotinine:creatinine ratio, no smoking in the house was independently associated with a significant reduction in cotinine:creatinine ratio (B = 20.55, 95% CI 20.89 to 20.20) after adjusting for mother's and partner's average daily cigarette consumption, housing tenure, and overcrowding. The final model accounted for 44.3% of the variance. Conclusions: Not smoking in the house was associated with a reduction in mean urinary cotinine:creatinine ratio in children aged 18-30 months; the relation persisted after adjustment for levels of mother's and partner's daily cigarette consumption and sociodemographic factors. Results suggest that home smoking bans in this age group have a small but significant effect on smoke exposure independent of levels of parental tobacco consumption. P assive inhalation by young children of environmental tobacco smoke (ETS) is associated with an increased risk of a range of adverse outcomes.1-3 The WHO report estimates that globally 700 million children, half the world's children, breathe air polluted by tobacco smoke and that ETS is causally related to increased risks of respiratory infections in the first years of life, chronic respiratory illness in school aged children, middle ear disease, and sudden infant death. 3ETS has also been associated with learning difficulties, behaviour problems, and language difficulties in childhood although further work is needed to clarify whether these associations are causal or related to the social patterning of smoking. 3In addition to the health impact, the economic burden is considerable: the estimated annual cost of ETS in the first year of life in Hong Kong was over 2.1 million US dollars. 4 Smoking cessation by parents of young children might be expected to reduce these risks but parental smoking habits during and after pregnancy appear resistant to health education messages to stop smoking. 5 An alternative approach might be to encourage parents and other household members who feel unable to stop smoking in the short term to change their smoking habits by avoiding smoking in the presence of their children. Observational studies of smoking bans within the home suggest that these may be effective in reducing children's exposure to ETS. In a previous paper on the effects of harm r...

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SUMMARYWe describe an unusual case of an intra-abdominal teratoma with massive bleeding presenting as sudden cardiovascular collapse immediately after birth. The infant required massive volume and blood product transfusion, alongside emergent tumour resection, in order to obtain haemostasis and haemodynamic stabilisation. Haemorrhage of a sacrococcygeal teratoma is a known entity, but we are not aware of a previous report of massive intra-abdominal haemorrhage due to a teratoma, immediately after birth. This case emphasises the need to consider intra-abdominal pathology, including a teratoma, in the differential diagnosis of any newborn with early hypovolaemic shock and abdominal distention. BACKGROUND

Table 1: Pre and Post re-intubation ventilator setting, FiO2, pH and PCO2The incidence of chronic lung disease (CLD) ranges from 7 to 52% and is highest among extremely premature neonates. Background: CLD increases the risk of developing pulmonary hypertension (PH) secondary to altered angiogenesis and post natal lung growth, and abnormal vasoreactivity. PH especially in the infants requiring prolonged mechanical ventilation contributes to their morbidity and mortality; moreover the management of PH is still being refined. A goal to maintain normal CO and alkalotic pH to decrease PVR, may 2 lead to invasive ventilation and promote other invasive interventions such as tracheostomy, gastrostomy and heavy sedation.We present 4 extreme preterms (GA 26wks in 3 and 24wks in one) with PH associated with CLD. All had severe RDS and Case series: required prolonged ventilation (46, 104, 46 and 85 days respectively), but successfully weaned off to either nasal cannula or CPAP. All had severe pulmonary hypertension diagnosed by ECHO, treated with combination of iNO, Sildenafil, Bosentan and Prostacyclin targeting the 3 pathways of PVR (cGMP, Endothelin and cAMP). All electively re-intubated for invasive ventilation to keep PCO in targeted low range to 2 decrease PVR (day of life at re-intubation 165, 181, 189 and 161 respectively). The institution of mechanical ventilation lead to later escalation of ventilatory support, ventilatory dependency and tracheostomy without significant improvement in PCO , worsening PH and 2 oxygenation. (table1) NICU course was protracted (244, 344, 240, and 315 days). Currently 2/4 are still in chronic care facility, 3 are still ventilator dependent with tracheostomies with chronological age of 1, 2, 1.5 and 5.5 years.Current management of CLD includes permissive hypercapnea and permissive hypoxia, but when associated with PH, Discussion: management is still debated. Animal Studies by Malik and Marshall have shown that PVR is affected by pH alone rather than independent changes in PaCO CLD patients have chronic compensated respiratory acidosis keeping pH close to normal. Combinations of 2. supplemental therapies targeting the PVR have shown to be beneficial.Elective mechanical ventilation in preterm infants with PH associated with CLD should be avoided as it may trigger Conclusion: pulmonary hypertensive crisis with all attendant aforementioned morbidities. The management should be guided by pH in conjunction with medications that alter vascular reactivity and the provision of optimal nutrition to assure adequate somatic/lung growth. Cases with such severe presentation may warrant lung biopsy to exclude developmental lung anomalies. This abstract is funded by: None