Abstracts
Arch Dis Child: first published as 10.1136/archdischild-2022-rcpch.300 on 17 August 2022. Downloaded from http://adc.bmj.com/ on September 13, 2023 at UNICEUMA - Universidade
their choice of agent on findings from neonatal
echocardiography.
1203 LUNG ULTRASOUND COULD BE USED AS A SCREENING
FOR HEMODYNAMICALLY SIGNIFICANT PATENT
DUCTUS ARTERIOSUS (HPDA) – PROSPECTIVE STUDY
1
Amelie Cyr, 2Prosanta Mondal, 1Veronica Samedi, 1Sibasis Daspal. 1Royal University
Hospital; 2University of Saskatchewan, Saskatoon
10.1136/archdischild-2022-rcpch.299
Aims Determining whether a PDA is hemodynamically signifi-
cant or not (non-hsPDA) is clinically relevant to evaluate the
risk of associated morbidities and to determine subsequent
management courses such as the need for intervention. A
known consequence of hsPDA is pulmonary edema.
The aim of the study is to evaluate whether the assessment
of pulmonary edema by lung ultrasound is a reliable sono-
graphic indicator of hsPDA. Lung ultrasound could then be an
accessible bedside tool used to evaluate if a PDA is hemody-
namically significant and to assist with decision-making regard-
ing its management along with other clinical and
echocardiographic indicators.
Methods We conducted a prospective study of 20 infants in
the Neonatal Intensive Care Unit at the Jim Pattison Child-
ren’s Hospital, Canada, between July 2019 to October 2020.
Inclusion criteria were very preterm infants (gestational age
less than 32 weeks) with low birth weight (less than 2500
grams) who had an echocardiogram and a bedside lung ultra-
sound assessment within their first two weeks of life.
The infants were divided into two groups based on their
echocardiogram findings: infants with a non-hsPDA (no PDA
or non-hsPDA) and infants with a hsPDA. Differences in clini-
cal characteristics, echocardiogram findings, and lung ultra-
sound scores were evaluated.
A bedside lung ultrasound was done on the same day as
the echocardiogram to assess for the presence of pulmonary
edema. Lung ultrasound scoring was used to evaluate oxygena-
tion needs.
Results The echocardiographic and lung ultrasound scores of
infants included in this study are summarized in table 1. Six
patients (6/20) did not have a PDA (2/6) or had a non-
HsPDA (4/6) while 14 patients (14/20) had an HsPDA based
on echocardiogram findings.
LUS score was significantly higher (10.6) in the HsPDA
group compared to the non-HsPDA group ( 6.0), and these
indices correlated with echocardiographic parameters.
Abstract 1203 Table 1
Conclusion • This study demonstrates that LUS scoring can be
used as a sonographic indicator of hsPDA.However, given sig-
nificant limitations – further studies with a larger population
size are required.
Arch Dis Child 2022;107(Suppl 2):A1–A537
1226 PARENTAL EXPERIENCE INTERVIEWS: PART OF A
DIRECT NICU TO PCCU TRANSFER SERVICE
IMPROVEMENT PROJECT
Shil Patel, Catarina Silvestre, Phoebe Kigozi. Nottingham University Hospitals NHS Trust
10.1136/archdischild-2022-rcpch.300
Aims As part of a service improvement project, we aimed to
ascertain parental experiences when transitioning between the
Neonatal Intensive Care Unit (NICU) and the Paediatric Crit-
ical Care Unit (PCCU).
Methods In this study, parents of infants hospitalised at the
Nottingham University Hospitals (NUH) tertiary NICU and
directly transferred to PCCU were enrolled.
Parents were invited for an interview by a family care team
administrator who also plays a key role in the NICU parental
support group.
Parents who agreed to an interview were then contacted at
their convenience and verbally consented by Dr Shil Patel.
The interviews were performed using a semi-structured for-
mat to establish the background summary of their case, infor-
mation received about the transfer and opinions on some
suggested interventions. Open questions were used to elicit
their personal experiences.
The interviews were not recorded but indirect quotations
were recorded with key themes noted.
Ceuma. Protected by copyright.
Results Four parent interviews were undertaken, representing
10% of NICU to PCCU transfers at NUH over the last 10
years. Two were ex-preterm current PCCU patients, with one
awaiting a tracheostomy and one weaning tracheostomy venti-
lation. Two were children who had surgical airways and were
two years post discharge.
6 key themes emerged including clarity/amount of informa-
tion received, differences in care approaches, expectations
around parental involvement and outcomes, pre-transfer tours,
available support for parents and finally the perceptions
around transfer. Figure 1.
Key quotes outlined in table 1.
Parents wanted more information, seeking information else-
where, and felt that it was ‘empowering when more informa-
tion is given’.
They noticed the ‘culture’ difference between the two units,
even minor aspects like the number of bedside toys. They
also struggled to understand why the approach to management
was so different ‘when the child is the same’.
The expectation of the plan prior to transfer was also a
key talking point, with all parents having the expectation
of going to PCCU to wean respiratory support and go
home.
Perception of the transfer was also key as many felt the
day of transfer was rushed and due to ‘bed pressure’.
The parents who received tours before transfer greatly
appreciated them. One stating that they still remember the
doctor and nurse who conducted them.
Parents overall felt more supported on NICU. They found
it difficult to relate to other parents on PCCU and got much
of their support outside of the units, through social media
and groups.
A187
 Abstracts

Arch Dis Child: first published as 10.1136/archdischild-2022-rcpch.300 on 17 August 2022. Downloaded from http://adc.bmj.com/ on September 13, 2023 at UNICEUMA - Universidade
Documentation should include indication for insertion, site,
number of attempts, batch number, expiry date, length of use
& reason for removal.
Review any complications after insertion e.g., infection,
thrombosis, extravasation.
Methods A total of 33 cases identified over 6 months period.
Review of cases included gestational age, birth weight and
indication for long line insertion. Other areas reviewed
included, grade of clinician performing procedure, type of line
inserted, grade of assistant, x-ray confirmation of line position
and any complications following the procedure.
Type of line inserted included Premicath, UVC/UAC, Vygon,
Temena
Results In most cases, infant’s weight was < 2kg (28/33 cases)
and gestational age was equal to or less than 32 weeks‘ gesta-
tion (23/33 cases) i.e., long line insertion was required more
for the low birth weight or small gestational age infants.
TPN was the main indication for long line insertion (in 27/
33 cases) with other indications including IV fluids, medica-
tions, monitoring (figure 1).
Abstract 1226 Figure 1 Majority of lines were inserted by middle grade paediatri-
cian (21/33 cases). Check lists were completed in 16/33 cases.
Documentation in the case notes was recorded in 31 cases.
Type of line inserted; 12 cases had Premicath, in 8 cases
Abstract 1226 Table 1
Vygon was used, 9 had an umbilical line, Temena was used in
one case (figure 2). In 3 cases, not clearly documented. All

Ceuma. Protected by copyright.

cases had an x-ray to confirm long line placement.

Conclusion In a limited number of parent interviews, we

observed that families struggle with transition periods, whether
that is admission, step downs or transfers.
Children transferred directly from NICU to PCCU make
up a very low number of patients. However, they occupy dis-
proportionate resources. They frequently go on to require fur-
ther support in the community. The parents need to be
supported to look after their children who have complex
needs in hospital and perhaps beyond.
These results are informing our local improvement plan for Abstract 1228 Figure 1 Indications for long or central line insertion
the transition of care pathways between NICU and PCCU;
and should be considered by other units with similar patients.

1228 A REVIEW OF LONG LINE INSERTION AT A LEVEL TWO

NICU IN A DGH, ENGLAND, UK: FOLLOWING BEST
PRACTICE IN PERFORMING PROCEDURE, AFTERCARE
AND DOCUMENTATION
1
Khairy Gad, 2Maged Amin. 1Consultant Paediatrician, Health and Social Care, UK;
2
Paediatrician, UK

10.1136/archdischild-2022-rcpch.301

Aims Long line insertion is aseptic procedure.

A checklist should be completed after the Long Line is Abstract 1228 Figure 2 Type of long or central line
inserted.

A188 Arch Dis Child 2022;107(Suppl 2):A1–A537