Background Observational studies suggest high prenatal vitamin D intake may be associated with reduced childhood wheezing. We examined the effect of on wheezing in an interventional study. Methods randomised 180 pregnant women at 27 weeks gestation to either no D, 800 IU ergocalciferol daily until delivery or single oral bolus 200,000 cholecalciferol, ethnically stratified, controlled trial. Supplementation improved but did not optimise status. Researchers blind allocation assessed offspring...

To use cardiac MRI techniques to assess ventricular function and systemic perfusion in preterm term newborns, compare echocardiographic methods, obtain initial reference data.Observational magnetic resonance imaging study.Neonatal Unit, Queen Charlotte's Chelsea Hospital, London, UK. Patients 108 newborn infants with median birth weight 1627 (580-4140) g, gestation 32 (25-42) weeks.Mean (SD) flow volumes assessed by phase contrast (PC) 28 stable were left output (LVO) 222 (46), right (RVO)...

Management of preschool wheeze is based predominantly on symptom patterns.To determine whether personalizing therapy using blood eosinophils or airway bacterial infection results in fewer attacks compared with standard care.A proof-of-concept, randomized trial to investigate the prescription inhaled corticosteroids (ICS) guided by eosinophils, targeted antibiotics for infection, unscheduled healthcare visits (UHCVs) care. Children aged 1-5 years ≥2 previous year were categorized as episodic...

Background Some observational studies have suggested that higher prenatal Vitamin D intake may be associated with improved health outcomes in childhood. However there been mixed results this area some negative studies, especially for effects on atopic and respiratory outcomes. We examined the effect of healthcare utilisation first three years life. Methods In an ethnically stratified randomised controlled trial conducted at St Mary's Hospital London, 180 women 27 weeks gestation were...

<h3>Background</h3> Tumour Necrosis Factor (TNF) inhibitors are routinely used in managing rheumatoid arthritis (RA), psoriatic (PsA) and spondyloarthritis (SpA). In 2012 2015, the patents for Etanercept (ETN) Infliximab (IFX) originator molecules expired Europe respectively use of biosimilar ETN IFX was approved England. <h3>Objectives</h3> To determine proportion rheumatology patients who experienced a flare their disease following switch from to or those flared, whether control can be...

There is evidence of an association between early life vitamin D insufficiency and future risk developing asthma. Given the high prevalence in women during pregnancy when developmental programming occurring, this may be critical public health importance. are plausible biological mechanisms for association. Vitamin pro-hormone calcitriol, a secosteroid hormone with widespread pleiotropic actions. It powerful immune modulator has been shown animal vitro work to have role lung development....

<h3>Aims</h3> Vitamin D deficiency in childhood is a common and recognised public health issue. National guidance recommends that all women should take 10 mcg vitamin supplements daily during pregnancy until their child fully weaned, midwives offer this advice at the booking appointment. Two recent severe cases of infancy presented to our hospital, one with cardiac arrest secondary hypocalcaemia cardiomyopathy, illustrating importance such guidance. This study aimed evaluate knowledge,...

The UK is the sick man of Europe in terms management asthma children and young people (CYP). Only one 28 CYP deaths assessed National Review Asthma Deaths was adequately managed. Clearly, we are incapable following established, evidence-based guidelines (https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills). Unfortunately, response appears to be not follow what works, but switch poorly evidenced strategies. One example use very high, unlicenced dose ‘salbutamol weaning...

Background: Management of preschool wheeze is based predominantly on symptom pattern. Objective: To determine whether personalising therapy using blood eosinophils or airway bacterial infection results in fewer attacks compared to standard care. Methods: A proof-of-concept, randomised trial investigate prescription inhaled corticosteroids (ICS) guided by eosinophils, targeted antibiotics for infection, unscheduled healthcare visits (UHCV) Children aged 1-5 years with &gt;2 the previous year...

<h3>Background</h3> European working time directive has limited trainees’ exposure to learning opportunities¹. Consultant delivered care is thought benefit the training of junior doctors², however there little evidence support this³. <h3>Aim</h3> To evaluate effect consultant in paediatric emergency department on doctors self-assessment quality their training. <h3>Method</h3> A prospective study conducted before (baseline) and after introduction dedicated...

<h3>Background</h3> Deficient transfer letters are widely recognised as a significant cause of increased risk.¹ Following coroner’s enquiry which cited suboptimal letter factor in delayed medical intervention, the Hillingdon Hospital Paediatric department introduced standardised template and powerful quality improvement project began. <h3>Methods</h3> A was devised using APLS² CATS³ documents to identify gold standards. retrospective audit carried out,...

<h3>Objective</h3> Bronchiolitis is a leading causes of hospital admission in children under two. In May 2021 our children's hospital@home service, PATCH (Providing Assessment and Treatment for Children at Home), began after collaborating with neighbouring trusts. We have seen significant reduction admissions bronchiolitis (26% to 14%) since adopting this. However, we noticed regular referrals infants 3 months bronchiolitis, contrary guideline. NICE guidance recognises age as risk factor...

<h3>Objectives</h3> Hillingdon Hospital has operated a 'Providing Assessment and Treatment for Children at Home (PATCH)' service since May 2021. Clinically stable children who required observation or low-intensity treatments were discharged to our PATCH team of senior paediatric nurses reviewed them in their own homes. If required, referred back the hospital review by registrar consultant. A large cohort those attended A&amp;E admitted Paediatric Unit (PAU) Ward with acute asthma...

<h3>Introduction</h3> Preschool wheezing affects over 1/3 of children, and is associated with lung function deficits. There a need for clinical tool to evaluate in preschool which able detect pathology wheezing. Spirometry the most common measurement school aged children adults, however spirometry measurements are challenge when conducted outside specialised labs due complexity manoeuvres needed. Impulse oscillometry (IOS) measure resistance resonant frequency lungs from normal breathing,...

Methods All scans were performed with a Philips 3-Tesla MR scanner. Infants fed and allowed to fall into natural sleep without the use of sedation or anesthesia. laid in custom made cradle, ear protection routine monitoring. A Flex-M surface receiver coil was placed on chest wall. No respiratory compensation techniques used. Acquisition parameters for phase contrast (PC) balanced fast field echo (bFFE) imaging optimised. PC assessments flow immediately distal aortic pulmonary valves, as well...

<h3>Introduction</h3> Persistent episodes of wheezing are common in preschool children, however we have few effective therapies. We hypothesised that objective biomarker based management wheeze would be superior to current clinical guidelines. <h3>Methods</h3> A single-centre randomised, controlled trial children aged 1–5 years with moderate severe recurrent wheeze, requiring at least 2 admissions ± short courses oral steroids the last 12 months, one 6 months. Children were recruited from...

<h3>Aims</h3> Asthma prevalence has been on the rise for last forty years¹ and it is most common chronic respiratory disease of childhood.² The aim this pilot study was to provide a forum facilitate discussion between primary care asthma specialists, with overall improve healthcare professionals' confidence in treating paediatric patients. <h3>Methods</h3> From September December 2021, local Integrated Care System (ICS) ran childhood reviews GP practices. Using data...