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Children’s Health Ireland at Crumlin,
Dublin, Ireland
9th Annual Research & Audit
Conference
May 17th 2019
Conference Programme &
Book of Abstracts
Kindly supported by:
National Children’s Research Centre
Royal College of Surgeons in Ireland
Trinity College Dublin
University College Dublin
Foreword
Welcome to the 9th Annual Research & Audit Conference at
Children’s Health Ireland (CHI) at Crumlin.
Children's Health Ireland at Crumlin is an acute paediatric teaching
hospital and is Ireland’s largest paediatric hospital. The hospital is
responsible nationally for the provision of the majority of quaternary
and tertiary healthcare services for children, and is the national
centre in Ireland for a range of specialties including children’s
childhood cancers and blood disorders, cardiac diseases, major
burns, cystic fibrosis and rheumatology. The hospital also provides
secondary care for our local population. The mission of Children’s
Health Ireland is underpinned by a commitment to promote and
provide child-centred, research-led and learning informed
healthcare to the highest standards of safety and quality.
Research contributes to improved outcomes and experiences for patients and their families by
identifying the causes of illness, influencing the development of care and treatments, and improving
ways in which the service is delivered and experienced. The hospital supports research and audit in
all areas of children’s healthcare, and promotes and fosters partnerships among clinicians, nurses,
allied health professionals, scientists, support staff and academic partners to maximise the impact
of research on the health and wellbeing of our patients and their families.
This 9th Research & Audit Conference is an opportunity for CHI at Crumlin to share with their
colleagues the variety and quality of research activity ongoing in the hospital through posters,
presentations and attendance at this event.
I would like to take this opportunity to thank the organising committee of Professor Declan Cody,
Professor Eleanor Molloy, Carol Hilliard and Sinead Cassidy, whose hard work is essential to the
success of the day.
The 10th Annual Research & Audit Conference will be held in May 2020 and I would encourage you
all to consider submitting your research and audit projects and activities.
Prof Sean Walsh
Site Chief Executive
2CONTENTS
Page No
Programme 4-5
Guest Speaker Bio 6
Oral Presentation Abstracts 7-12
(as per running order)
Display Poster Listing 13-16
Display Poster Abstracts 17-60
3RESEARCH & AUDIT DAY
Friday 17th May 2019
Venue: Haematology/Oncology Conference Rooms
3rd Floor, Medical Tower, CHI at Crumlin
Programme:
09.15-10.00 Tea/Coffee and Registration – Board Room on First Floor Atrium, Medical Tower
10.00 -11.00 Poster Walkabout – First Floor Atrium, Medical Tower
11.05 - 11.15 Opening of meeting – Tracey Wall, Director of Nursing, CHI at Crumlin
11.15 - 12.15 Oral presentations – Moderator: Carol Hilliard (6 x 10 minute Presentations)
11.15-11.25 THE MAGNITUDE OF PHYSICIAN EMIGRATION AND THE ROLE FAMILY CAN PLAY
IN INFLUENCING PHYSICIANS’ MIGRATION DECISIONS
Katie A. O’Connor, RCSI and UCD, Dublin, Ireland
11.25-11.35 THE RELATIONSHIP BETWEEN LEFT VENTRICULAR SYSTOLIC LONGITUDINAL
DEFORMATION MEASUREMENTS AND PRELOAD IN PREMATURE INFANTS
Neidin Bussmann1; Aisling Smith1; Alessia Cappelleri1; Naomi McCallion1,2; Orla Franklin3;
Afif EL-Khuffash1,2. 1 Department of Neonatology, The Rotunda Hospital, Dublin, 2
Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland.
Dublin, 3 Department of Paediatric Cardiology, CHI at Crumlin, Dublin
11.35-11.45 IS DOWN SYNDROME-ASSOCIATED ARTHRITIS (DA) A DISTINCT DISEASE FROM JIA?
1
Charlene Foley, 2Achilleas Floudas, 2Sharon Ansboro, 2Mary Canavan, 2Monika Biniecka,
1
Emma Jane MacDermott, 3Ronan Mullan, 1Orla G Killeen, 2Ursula Fearon
1
National Centre for Paediatric Rheumatology, CHI at Crumlin, Dublin, 2Trinity Biomedical
Sciences Institute, Dublin, 3Rheumatology Department, CHI at Tallaght, Dublin
11.45-11.55 INCIDENCE AND 5 YEARS SURVIVAL RATES OF CHILDHOOD CANCER DIAGNOSED LESS
THAN 1 YEAR OLD IN IRELAND 2007-2017.
Jsun Loong Wong *, F.Clinton*, M. Carroll, A. Malone, A. O’Marcaigh, OP Smith, J. Pears,
M. Capra, C. Owens. National Children’s Cancer Service, CHI at Crumlin, Dublin. *These
authors contributed equally.
11.55-12.05 HOSPITAL SURVEY OF CURRENT PARENTAL KNOWLEDGE OF EARLY WEANING AND
ALLERGY PREVENTION
Marianne Dempsey1 Aoife Fox1 Aideen M Byrne 2
1
School of Medicine, Trinity College Dublin, Ireland
2
Dept. of Paediatric Allergy, Children’s Health Ireland (CHI) at Crumlin
12.05-12.15 THE EFFICACY OF AN ADVANCED PRACTICE PHYSIOTHERAPY TRIAGE SERVICE IN
PAEDIATRIC ORTHOPAEDICS: INNOVATION AND COLLABORATION TO IMPROVE
SERVICE DELIVERY.
Marie O Mir, 1,2, Catherine Blake2 ,Ciara Cooney1, Olive Lennon2, Pat O’ Toole3, David
Moore3, Slawa Rokicki4, Cliona O’ Sullivan, 2
1
Physiotherapy Dept, CHI at Crumlin, Dublin; 2 UCD School of Public Health,
Physiotherapy and Sport Science, University College Dublin (UCD); 3 Dept. of
Orthopaedic Surgery, CHI atCrumlin, Dublin; 4Geary Institute for Public Policy, University
College Dublin
12.15-13.00 Guest Lecture:
'Engaging and supporting parents of children with chronic illness'
Professor John Sharry,
Founder of the Parents Plus Charity, adjunct Professor at the School of
Psychology in University College Dublin, a founder of Silver Cloud Health and
weekly health columnist with the Irish Times
13.00 -13.55 Lunch - Board Room on First Floor Atrium, Medical Tower
4RESEARCH & AUDIT DAY
Friday 17th May 2019
Venue: Haematology/Oncology Conference Rooms
3rd Floor, Medical Tower, CHI at Crumlin
13.55-14.45 Oral presentations – Moderator: Prof. Eleanor Molloy (5 x 10 minute
Presentations)
13.55-14.05 LIVING WITH ADOLESCENT IDIOPATHIC SCOLIOSIS: INSIGHTS FROM A QUALITATIVE
INVESTIGATION
Gillian Motyer1, Barbara Dooley1, Patrick J. Kiely2, Vincent McDarby3, Amanda Fitzgerald1
1
School of Psychology, University College Dublin
2
Department of Orthopaedics, 3Department of Psychology, CHI at Crumlin, Dublin
14.05-14.15 A REVIEW OF THE DIAGNOSTIC EVALUATION OF COMPLICATED PARAPNEUMONIC
EFFUSION OR EMPYEMA IN AN IRISH PAEDIATRIC TERTIARY HOSPITAL
Oksana Kozdoba,1 Patrick Gavin,1 Richard Drew,2 Des Cox 1
1
CHI at Crumlin and 2 Irish Meningitis and Sepsis Reference Laboratory, CHI at Temple
Street, Dublin
14.15-14.25 KALYDEKO AND LUNG INFLAMMATION IN CHILDREN (KLIC)
Daryl Butler1, Lennon J2, Cox D1,2, Greally P3, Linnane B 2,4,5, McNally P1,2,6
1
Cystic Fibrosis Centre, CHI at Crumlin, Dublin 12
2
National Children’s Research Centre, Our CHI at Crumlin, Dublin 12, 3 Cystic Fibrosis
Centre, CHI at Tallaght, Dublin 24, 4 Graduate Entry Medical School and Centre for
Interventions in Infection, Inflammation & Immunity (4i), University of Limerick,
Limerick, 6 Department of Paediatrics, Royal College of Surgeons in Ireland, CHI at
Crumlin, Dublin 12
14.25-14.35 DIRECT OBSERVATIONAL STUDY OF INFUSION ERRORS ASSOCIATED WITH SMART-
PUMP TECHNOLOGY IN PAEDIATRIC INTENSIVE CARE
Moninne M. Howlett, 1, 2, 3 Brereton, Erika;2 Cleary, Brian.J;3, 4 Breatnach, Cormac.V2
1.
Pharmacy Department, CHI at Crumlin, Dublin 12,
2.
Paediatric Intensive Care Unit, CHI at Crumlin, Dublin
3.
School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2
4.
The Rotunda Hospital, Parnell Square, Dublin 1
14.35-14.45 GROWTH IN INFANTS WITH UNIVENTRICULAR CONGENITAL HEART DISEASE
Leah Foyle1, Anne Marie Shine1, Aoife O’ Neill 1, Colin J. McMahon2
Clinical Nutrition and Dietetic Department, CHI at Crumlin1, Dublin 12.Department of
Paediatric Cardiology2, CHI at Crumlin, Dublin 12
14.45-15.00 NCRC Guest Lecture - Moderator: Carol Hilliard
“Immune system dystegulation, driving future risk of disease in
childhood obesity?”
Dr Andy Hogan, Institute of Immunology,Maynooth University, and the
Childhood Obesity Group
15.00-15.30 Presentations & Awards
The following awards will also be presented:
“Professor Edward Tempany CHI at Crumlin Junior Doctor Research Award 2019”
UCD Colman Saunders Medal 2018 – Lukas O’Brien
RCSI Paediatric Medal Winner – Aya Al-Hasani
TCD Medal Winners: O'Donohoe Medal, the Professors Prize in Paediatrics: Joint
winners: Conor Brown and Ernest Zhi Wei Low
UCD Nursing Medal BSc (Nursing) Children’s and General 2019 – Niamh Buckle
15.30 Close of Study Day
5Professor John Sharry
‘Engaging and supporting parents of children with chronic
illness'
Prof John Sharry is a founder of the Parents Plus Charity,
adjunct Professor at the School of Psychology in University
College Dublin, a founder of Silver Cloud Health and weekly
health columnist with the Irish Times. He is the lead
developer of the award winning Parents Plus and Working Things Out programmes and the
best selling author of fourteen positive psychology and self-help books including Becoming a
Solution Detective and Positive Parenting that have been translated into nine languages
including Japanese, Chinese and Arabic. He is currently developing the Parents Plus Positive
Pathways Programme ( supporting families with an adolescent with a disability) and the
Healthy Families Programme ( promoting healthy lifestyles to prevent obesity), the latter
being co-developed with Dr Adele Keating in Crumlin Hospital. See parentsplus.ie and
solutiontalk.ie
6THE MAGNITUDE OF PHYSICIAN EMIGRATION AND THE RELATIONSHIP BETWEEN LEFT VENTRICULAR
THE ROLE FAMILY CAN PLAY IN INFLUENCING SYSTOLIC LONGITUDINAL DEFORMATION
PHYSICIANS’ MIGRATION DECISIONS MEASUREMENTS AND PRELOAD IN PREMATURE
Katie A. O’Connor, RCSI and UCD, Dublin, Ireland INFANTS
Neidin Bussmann1; Aisling Smith1; Alessia
Background: High doctor emigration rates from Cappelleri1; Naomi McCallion1,2; Orla Franklin3; Afif
Ireland are continuously reported. For a health care EL-Khuffash1,2.
system to function there needs to be an adequate 1 Department of Neonatology, The Rotunda
supply of physicians with the necessary training and Hospital, Dublin, Ireland.
experience. Physician emigration therefore 2 Department of Paediatrics, School of Medicine,
represents a challenge for the system. We need to Royal College of Surgeons in Ireland. Dublin, Ireland.
have a better understanding of the factors that 3 Department of Paediatric Cardiology, Our Lady’s
contribute to doctors’ decision to stay or leave Children’s Hospital Crumlin, Dublin, Ireland.
Ireland.
Background: Longitudinal deformation imaging
Method: This study aimed to provide a profile of including Strain and Strain rate (SR) is gaining
Irish trained physicians and their emigration choices. interest in the neonatal field. Reference ranges in
A pragmatic mixed method approach was utilised extremely low birthweight infants are emerging.
and it consisted of four phases: However, the relationship between deformation
1) Geographical tracking of physicians parameters and loading conditions are still being
(n=280) debated. Strain is thought to be influenced by
2) Stakeholder meetings (n=12) loading conditions and therefore is not reflective of
3) Online questionnaire (n=99) intrinsic contractility. Systolic SR may be less load
4) Semi-structured interviews (n=10) dependent offering a better reflection of intrinsic
contractility. We aimed to assess the influence of
Results preload on left ventricular (LV) global longitudinal
A dichotomous stayer/ leaver perspective was strain (GLS) and SR.
applied in the geographical tracking (n=280) phase
which found that 56% of physicians were working Methods: We recruited three groups of premature
overseas at the time of the study. The survey infants < 29 weeks gestation who are enrolled in the
findings made a further distinction between the PDA RCT (ISRCTN:13281214) over two time points
different migration statuses by categorising (Day 2 & Day 8) to reflect different preload
respondents into the following cohorts: conditions. Group 1 (RCT-OPEN, n=22) are preterm
➢ Stayers not intending to emigrate infants with a large patent ductus arteriosus (PDA)
➢ Stayers considering emigrating that remains open over the two time points; Group 2
➢ Returners (RCT-CLOSED, n=10) are infants with a large PDA on
➢ Leavers Day 2 that closed on Day 8; and Group 3 (OBSERVED,
Examining the demographics of each of these n=11) are infants with a small or no PDA on both
cohorts revealed that married physicians are less days. PDA diameter, left atrial to aortic root ratio
likely to emigrate, with the exception of doctors who (LA:Ao), LV GLS and SR (measured using speckle
are married to non-Irish nationals who may be more tracking echocardiography) were assessed on Days 2
likely to emigrate. Survey findings show that and 8. Changes in those measurements were
emigrants were more likely to be single (23%) than examined overtime.
the other migration cohorts. Stayers considering
leaving (16%) were also likely to be single as they Results: Forty three infants with a mean ± SD
were viewed as being more mobile than those who gestation and birthweight of 26.7 ± 1.4 weeks and
were married and/or have children. 919 ± 227 grams respectively were included. LA:Ao
remained high in the RCT-OPEN Group (2.0 ± 0.3 vs.
Conclusion 2.1 ± 0.4, p=0.24) but decreased in the RCT-CLOSED
Different people have differing degrees of ability to Group (2.0 ± 0.4 vs. 1.6 ± 0.4, p=0.05) and remained
act upon their desire to emigrate. Immediate family low in the OBSERVED Group (1.7 ± 0.5 vs. 1.6 ± 0.6,
plays a significant role in physicians’ decision to p=0.3) over the study period. LV GLS remained high
emigration. Factors that influenced respondent’s in the RCT-OPEN group, decreased in the RCT-
migration decisions were: whether they had children CLOSED group, and remained low in the OBSERVED
or dependent elderly parents, their marital status, group. There were no differences in SR between the
their spouses’ nationality and their occupation. groups or over time.
7Conclusion: Longitudinal strain is highly influenced CD19+CD20+ B-cells when compared to children
by preload and mirrors changes in LV preload with JIA and HC. However, they had a greater
overtime. Therefore, it is not reflective of intrinsic proportion of memory B-cells (CD27+) when
contractility. There was no relationship between compared to children with DS. T-cell IFN-γ and TNF-
changes in preload in this cohort and longitudinal α production was significantly greater in DA
strain rate suggesting a lack of influence of preload. compared to both JIA and HC.
Strain rate is more likely to reflect intrinsic
contractility in extremely premature infants. DA synovial tissue demonstrated greater synovial
lining layer hyperplasia, vascularity and
IS DOWN SYNDROME-ASSOCIATED ARTHRITIS (DA) inflammatory cell infiltration compared to JIA.
A DISTINCT DISEASE FROM JIA?
1
Charlene Foley, 2Achilleas Floudas, 2Sharon DA-SFC showed greater migratory and invasive
Ansboro, 2Mary Canavan, 2Monika Biniecka, 1Emma capacity, and increased basal metabolic activity and
Jane MacDermott, 3Ronan Mullan, 1Orla G Killeen, metabolic gene expression when compared to JIA-
2
Ursula Fearon SFC.
1
National Centre for Paediatric Rheumatology, Our Conclusion: Significant differences were observed in
Lady’s Children’s Hospital Dublin the immune, histiological and SFC functionality
2
Trinity Biomedical Sciences Institute, Dublin profiles of DA and JIA. These differences may explain
3
Rheumatology Department, Tallaght Hospital, the erosive phenotype observed in DA and suggest it
Dublin may be a distinct disease from JIA.
Background
Arthritis is 20-times more common in children with INCIDENCE AND 5 YEARS SURVIVAL RATES OF
Down syndrome (DS). It is an erosive, polyarticular- CHILDHOOD CANCER DIAGNOSED LESS THAN 1
RF-negative arthritis with predominance in the small YEAR OLD IN IRELAND 2007-2017.
joints of the hands and wrists. Little is known about J.L. Wong*, F.Clinton*, M. Carroll, A. Malone, A.
the underlying mechanisms that drive DA O’Marcaigh, OP Smith, J. Pears, M. Capra, C. Owens.
pathogenesis, however we hypothesise that it is a National Children’s Cancer Service, Our Lady’s
distinct disease from JIA. Children’s Hospital, Dublin.
*These authors contributed equally.
Our aims were to compare the following in DA and
JIA; Introduction: According to the National Cancer
• B-cell subsets; Registry of Ireland, an average of 137 cancers were
• T-cell cytokine profiles; diagnosed per year in children under the age of 15
• Synovial membrane immunohistochemistry; between 1994 and 2014. The 5-year overall survival
• Synovial fibroblast cell (SFC) functionality. rate for this entire cohort was 81%. It is well
documented that survival rates in paediatric
Methods: Multicolour-flow cytometry and Flowjo oncology vary depending on specific cancer
software were used to analyse B-cell subsets and T- diagnosis, age of the patient at diagnosis and disease
cell cytokine expression in PBMCs from 40 children stage.
(n=10/group - Healthy Control (HC), JIA, DS, DA).
Synovial tissue was obtained through US-guided Aim: We describe the incidence of cancer in very
biopsy and analysed by immunohistochemistry for young children and the influence of age on outcome
CD3, CD20, CD68, FVIII (DAn=3; JIAn=4). Levels of in children diagnosed with cancer in Ireland under
vascularity and lining layer hyperplasia were also the age of 1 between 2007-2017.
scored.
DA-SFC and JIA-SFC migration was assessed by Method: Data were extracted from the database of
wound repair scratch assays; invasion by Biocoat the National Children’s Cancer Service (NCCS) based
Matrigel™ Invasion Chambers; and bioenergetic at Our Lady’s Children’s Hospital, Dublin. The data
activity using the XFe96-Flux-analyser where presented refer to the International Classification of
oxidative phosphorylation and glycolysis were Childhood Cancer (ICCC) version 3 with the inclusion
quantified. Real-time PCR assessed glycolytic gene of Langerhans Cell Histiocytosis (LCH).
expression.
Result
Results 185 patients were diagnosed with paediatric cancer
Flow cytometry analysis revealed that children with under the age of 1 at the time of their initial
DA had a significantly lower number of circulating diagnosis. 159 (85.5%) patients were diagnosed with
8solid tumours or LCH. 86 (46.5%) were male. The by 1 year of age. However, only 1 in 4 of these
average age at diagnosis was 5.24 (range 0-12) children actually consumed peanut by 1year. Half of
months. Nineteen (10.3%) patients were diagnosed all parents surveyed seek weaning advice from their
following an abnormal antenatal scan. The most public health nurse. 52% also heed family advice.
common cancers diagnosed were neuroblastoma More modern sources such as social media (14%),
(22.7%), central nervous system (CNS) tumours state funded websites (13%) and other websites
(19.5%) and leukaemia (13.5%). 158 (85.5%) patients (25%) were less credited. 72% had never heard of
received treatment. 124 (78.4%) and 20 (12.7%) peanut prevention strategies.
patients received chemotherapy and radiotherapy as
part of their treatment respectively. The mean age Conclusion
for radiotherapy was 1.35 years (range 0.17-4). The There is minimal awareness of peanut allergy
cumulative overall survival rate at 5 years is 80%. prevention and changing guidance in the population
CNS tumours have the worst prognosis followed by surveyed. We believe this population is
leukaemias. representative of the wider Irish public. Ongoing
education of healthcare professionals on the front
Conclusion line such as public health nurses is likely to be
Incidence rates of specific paediatric cancer types important to effect change in Ireland. The influence
vary according to the age at diagnosis. There is no of traditional family weaning practices may slow
difference in survival rates between children change.
diagnosed with cancer under 1 year of age and older
children. Outcomes at the NCCS compare favourably THE EFFICACY OF AN ADVANCED PRACTICE
with international standards. PHYSIOTHERAPY TRIAGE SERVICE IN PAEDIATRIC
ORTHOPAEDICS: INNOVATION AND
HOSPITAL SURVEY OF CURRENT PARENTAL COLLABORATION TO IMPROVE SERVICE DELIVERY.
KNOWLEDGE OF EARLY WEANING AND ALLERGY Marie O Mir, 1,2, Catherine Blake2 ,Ciara Cooney1,
PREVENTION Olive Lennon2, Pat O’ Toole3, David Moore3, Slawa
Marianne Dempsey1 Aoife Fox1 Aideen M Byrne 2 Rokicki4, Cliona O’ Sullivan, 2
1
1 School of Medicine, Trinity College Dublin, Ireland Physiotherapy Dept, Our Lady’s Children’s Hospital,
2, Dept. of Paediatric Allergy, Children’s Health Crumlin, Dublin; 2 UCD School of Public Health,
Ireland (CHI) at Crumlin. Physiotherapy and Sport Science, University College
Dublin (UCD); 3 Dept. of Orthopaedic Surgery, Our
Background Lady’s Children’s Hospital, Crumlin, Dublin; 4Geary
It is now internationally accepted that regular Institute for Public Policy, University College Dublin
consumption of peanut from 4-6 months prevents
peanut allergy. Throughout the western world, Background:
dissemination of new guidance is occurring and Advanced Practice Physiotherapy (APP) clinics in
changes to weaning practices are being reported. In Paediatric Orthopaedics are well established in the
Ireland, changes to weaning guidelines are in the UK, Australia, and Ireland, yet there is little to no
early stages. We investigated parents’ current literature exploring their effectiveness.
understanding and practice of peanut introduction
and where parents source their information on Method
weaning. This is a mixed methods study. A review of a
prospectively garnered database established the
Method demographic profile of patients, clinic outcomes, and
The study population were parents of children under the reduction in patient wait-times over a 3-year
5yr, attending outpatient clinics in OLCHC from 19th period. The diagnostic agreement rate was evaluated
to 29th March 2019. They were provided with an between APPs and medical consultants. Stakeholder
ethics approved, 10 question, anonymous, survey. perceptions of the service were examined by
surveys and semi–structured interviews. A cost
Results minimisation analysis compared the cost of the APP
Out of 321 children surveyed, 287 were established clinic with that of the usual care pathway. Finally
on solid food. 42% of these had no peanut at all in parental willingness-to-pay to attend an APP clinic
their diet. 1 in 4 children had eczema with 41% of was explored via contingent valuation.
these not eating peanut. 6.4% reported peanut
allergy. 62% of those eating peanut only consume Results:
occasionally or monthly. 1 in 7 parents still believe A mean wait-time reduction per patient of 87 weeks
that peanut should not be introduced until 5 years of was observed, with a majority of the 2650 patients
age. 28% reported that peanut should be introduced managed without consultant intervention.
9Diagnostic agreement rate evaluation demonstrated emotional well-being, as well as coping strategies,
good to excellent agreement in almost all categories and support needs. Parent data focused on their
based on kappa co-efficient ,with raw percent experience of their children’s scoliosis and medical
agreement of 87%. Parental satisfaction rated as care, including the impact it has had on their lives.
“excellent” on linear scale with the same term being Key insights will be presented with supporting
the most frequently occurring coded comment . quotations.
Medical Consultants and referrers were extremely
satisfied with the service, describing the clinic as a Conclusion: Living with idiopathic scoliosis is a
positive adjunct to consultant-led services, and challenging experience for adolescents and their
improving access for paediatric patients. parents, considering the physical, psychological, and
Incremental cost savings of €24.51 per appointment social implications that can impact on everyday life.
in favour of the APP service over the usual However, the resilience of these adolescents and
consultant led pathway were established. Parents their families is evident.
demonstrated a postive willingness-to-pay to attend *This study is ongoing
an APP clinic that far exceeded appointment costs,
representing significnt cost savings both to the A REVIEW OF THE DIAGNOSTIC EVALUATION OF
health service and the health user. COMPLICATED PARAPNEUMONIC EFFUSION OR
EMPYEMA IN AN IRISH PAEDIATRIC TERTIARY
Conclusion HOSPITAL
This study demonstrates that routine elective Oksana Kozdoba,1 Patrick Gavin,1 Richard Drew,2 Des
paediatric orthopaedic referrals can be successfully Cox 1
1
managed by an APP in a cost effective manner. The Our Ladys Children’s Hospital Crumlin and 2 Irish
positive results from a broad, mixed methods Meningitis and Sepsis Reference Laboratory, Temple
evaluation firmly support Advanced Practice Street Children’s University Hospital, Dublin, Ireland
Physotherapists as first contact diagnosticians in
paediatric orthopaedics. Background: complicated parapneumonic effusion
or empyema is a relatively common complication of
LIVING WITH ADOLESCENT IDIOPATHIC SCOLIOSIS: pneumonia, often requiring thoracentesis. The
INSIGHTS FROM A QUALITATIVE INVESTIGATION diagnostic yield with traditional culture of blood or
Gillian Motyer1, Barbara Dooley1, Patrick J. Kiely2, pleural aspirate specimens is low, emphasizing the
Vincent McDarby3, Amanda Fitzgerald1 role for new molecular techniques to improve
1
School of Psychology, University College Dublin identification of the responsible pathogens.
2
Department of Orthopaedics, 3Department of
Psychology, Our Lady’s Children’s Hospital, Crumlin Methods: a retrospective review of paediatric cases
of complicated parapneumonic effusion or empyema
Background: Adolescent idiopathic scoliosis is a requiring thoracocentesis was undertaken in OLCHC
three dimensional curvature of the spine with onset over a five-year period, from January 2014 to
typically occurring around puberty. Acquiring a December 2018. Cases with clinical and radiographic
physical health condition such as scoliosis can have a findings consistent with a diagnosis of complicated
significant impact on the psychological wellbeing of parapneumonic effusion or empyema were only
adolescents, and can also be a difficult experience included if a sterile site specimen was taken for
for the parents of those affected. Using a qualitative diagnostic microbiologic evaluation. Baseline patient
approach, the current research investigated the demographic data, clinical findings, laboratory
psychological impact of scoliosis on adolescents and indices, microbiology results and imaging findings
their parents, in order to understand the lived were collected.
experience of this patient group and their families.
Results : sterile site specimens from 43 children with
Method: A sample of preoperative patients parapneumonic effusion/ empyema were identified
diagnosed with adolescent idiopathic scoliosis (females, 60%). 79% of the children were younger
(n=11), and their parents (n=16), participated in the then 5-years of age. 45% (14 of 31) of children who
study*. Semi-structured interviews were conducted had virologic testing performed had at least one
with the adolescents and their parents separately. respiratory virus detected. Six chldren had multiple
Audio recordings were transcribed verbatim and viruses detected. A causative bacteria was identified
thematically analysed. in 24 cases (56 %), 6 by conventional culture (pleural
fluid, 5; blood, 1) and 21 by PCR (pleural fluid, 20;
Results: A preliminary analysis of adolescent blood, 3). PCR had the highest detection rate of
interview data revealed a number of themes in causative organisms: pleural fluid PCR positive, 52%
relation to their day-to-day functioning, body image, (20 of 38 tested); blood PCR positive, 50% (3 of 6
10tested); pleural fluid culture positive, 11.6% (5 of 43 Results: Mean time of sampling post commencing
tested); and blood culture positive, 2.5% (1 of 39 Ivacafator was 4 months (1.5-6.5). Mean IL-8 before
tested). Streptococcus pneumonia was the causative Ivacafator was 3454 pg/ml, mean IL-8 post
organism detected in 95% of cases. treatment was 1515 pg/ml (P=0.23). Three of the 4
subjects had negative NE after commencing
Conclusion: this retrospective review confirms that Ivacafator (P=0.5). Mean ANC pre and post Ivacaftor
in paediatric cases of complicated parapneumonic was 348,197 and 49,398 (P=0.17). No significant
effusion or empyema traditional microbiological BALF inflammatory changes were demonstrated
culture of sterile site specimens infrequently both in IL-8, NE and ANC post commencing
identifies a causative organism. For such culture treatment.
negative cases, appropriate PCR testing significanlty
improves the detection rate of causative organisms. Conclusions:
This study demonstrates a trend towards a reduction
in lung inflammation in paediatric subjects with
G551D-CFTR mutations after commencing Ivacafator
treatment. Further surveillance will continue to
assess if this relationship can be better delineated.
DIRECT OBSERVATIONAL STUDY OF INFUSION
KALYDEKO AND LUNG INFLAMMATION IN ERRORS ASSOCIATED WITH SMART-PUMP
CHILDREN (KLIC) TECHNOLOGY IN PAEDIATRIC INTENSIVE CARE
Butler D1, Lennon J2, Cox D1,2, Greally P3, Linnane B Howlett, Moninne; 1, 2, 3 Brereton, Erika;2 Cleary,
2,4,5
, McNally P1,2,6 Brian.J;3, 4 Breatnach, Cormac.V2
1
Cystic Fibrosis Centre, Our Lady's Children’s 1. Pharmacy Department, Our Lady’s Children’s
Hospital Crumlin, Dublin 12 Hospital, Crumlin, Dublin 12, Ireland
2
National Children’s Research Centre, Our Lady's 2. Paediatric Intensive Care Unit, Our Lady’s
Children’s Hospital Crumlin, Dublin 12 Children’s Hospital, Crumlin, Dublin 12, Ireland
3
Cystic Fibrosis Centre, Tallaght Hospital, Dublin 24 3. School of Pharmacy, Royal College of Surgeons in
4
Graduate Entry Medical School and Centre for Ireland, Dublin 2, Ireland
Interventions in Infection, Inflammation & Immunity 4. The Rotunda Hospital, Parnell Square, Dublin 1,
(4i), University of Limerick, Limerick, Ireland Ireland
6
Department of Paediatrics, Royal College of
Surgeons in Ireland, Our Lady's Children’s Hospital Background and Aims:
Crumlin, Dublin 12 Smart-pump technology and standardised
concentration infusions (SCIs) are advocated to
Background: The effects of Ivacafator on cystic reduce infusion errors in the high-risk paediatric
fibrosis transmembrane conductance regulator intensive care unit (PICU) setting. In 2012, the PICU
(CFTR) activity in people with cystic fibrosis and of Our Lady’s Children’s Hospital, Crumlin
G551D-CFTR mutations have been well described implemented a smart-pump drug-library of SCIs;
regarding sweat chloride, weight gain, quality of life infusion data is auto-transferred to the PICU clinical
and exacerbation frequency. However, little is information management system. This study aims to
known about Ivacafator’s relationship with lung determine the frequency, severity and distribution of
inflammation in children. smart-pump infusion errors.
This study aims to better understand the relationship Methods:
between CFTR activity and lung inflammation in All infusions were directly observed at the bedside
patients with cystic fibrosis. and compared against both medication orders and
auto-populated infusion data. Identified deviations
Methods: We studied the bronchoalveolar lavage were categorised as either medication errors or
fluid (BALF) from 5 subjects with G551D-CFTR discrepancies. Five opportunities for error (OEs)
mutations before and after commencing Ivacafator. were identified: programming, administration,
Inflammation was assessed by quantitative documentation, assignment, and data transfer. Error
neutrophil elastase (NE), inter-leukin-8 (IL-8) ELISA rates were calculated as: number of infusions with
and absolute neutrophil counts (ANC). NE data was errors, and number of errors per OE. Pre-agreed
available for 4 of the 5 subjects. definitions, multi-disciplinary consensus and grading
processes were utilised.
11Results: Method: 90 infants with single ventricle physiology 1023 infusions for 175 patients were directly were included. All underwent a surgical procedure or observed on 27 days between February and hybrid intervention within the first 6 weeks of life in September 2017. 74% of patients were under 1 year, OLCHC between January 2014 - December 2018. 32% under 1 month. The drug-library accommodated Subject data collected included demographics, 96.5% of all infusions. SCIs were most common anthropometry, nutritional intake and nutrition (72%), followed by 13% maintenance fluids (13%) related complications. Weight for Age z scores (WAZ) and total parenteral nutrition (10%). Compliance and Length/Height for Age z scores (LAZ/HAZ) were with the drug-library was 98.9%. 55 infusions had ≥ 1 calculated using the World Health Organisation error (5.4%); a further 67 (6.3%) had ≥ 1 discrepancy. Standards. Data was analysed using SPSS. Ethical From a total of 4997 OEs, 72 errors (1.4%)and 107 approval was obtained. discrepancies (2.1%) were observed. Documentation errors were most common; programming errors Results were rare (0.32% OE). Errors were minor, with just A WAZ
DISPLAY POSTER BOARD LISTING
(LISTED ALPHABETEICALLY BY FIRSTNAMED AUTHOR – unless otherwise notified)
LASTNAME FIRSTNAME POSTER ABSTRACT TITLE PAGE IN
NUMBER ABSTRACT
BOOK
BARTLEY NAOMI 1 CARING FOR CHILDREN WITH COMPLEX 17
HEALTHCARE NEEDS IN THE COMMUNITY: WHAT
ARE THE EDUCATION NEEDS OF REGISTERED
NURSES?
BAYNE D 2 DEVELOPMENT OF A SELF-MANAGEMENT PLAN 17
FOR 8-14-YEAR OLDS WITH DIABETES MELLITUS
TYPE 1
BOURKE MAIRE 3 18
AN AUDIT OF MANAGEMENT OF ACUTE LIMP IN A
PAEDIATRIC EMERGENCY DEPARTMENT
BRADLEY RÓISÍN 4 A QUALITATIVE EXPLORATION OF ADOLESCENTS 18
WITH SEVERE HAEMOPHILIA AND THEIR
CARETAKERS REGARDING THEIR FUTURE
TRANSTION TO ADULT SERVICES.
BRADLEY RÓISÍN 5 THE ROLE OF THE RESEARCH NURSE IN CLINICAL 19
TRIALS
BRADY A 6 19
FAMILY EDUCATION IN RELATION TO
CONCUSSIONS
BRENNAN KIVA 7 IMPROVING VACCINE RESPONSES IN THE 20
PAEDIATRIC POPULATION BY PROMOTING TH1-
AND TH17- CELL RESPONSES
BUSSMAN NEIDIN 8 CIRCUMFERENTIAL AND RADIAL DEFORMATION 20
ASSESSMENT IN PREMATURE INFANTS: READY
FOR PRIMETIME?
BUTLER CELIA 9 WEANING FROM NJ TUBE FEEDS TO EXCLUSIVE 21
BREASTFEEDING FOLLOWING SURGICAL
REMOVAL OF NECK TERATOMAS IN A NEONATE –
THE ROLE OF SLT
CARBERRY EDEL 10 AUDIT OF THE IRISH NATIONAL CENTRE FOR 22
PAEDIATRIC RHEUMATOLOGY NEW PATIENT
WAITING LIST
CARBERRY EDEL 11 FEASIBILITY OF PHYSIOTHERAPY TRIAGE CLINIC 22
OF PAEDIATRIC RHEUMATOLOGY WAITING LIST’
CARMODY CATHERINE 12 RETROSPECTIVE SINGLE CENTRE REVIEW OF 23
AUDIOLOGICAL ASSESSMENTS OF CHILDREN
WITH SICKLE CELL DISEASE RECEIVING IRON
CHELATION THERAPY
CARNEY SARAH 13 THE IMPACT OF SODIUM DEFICIT ON GROWTH IN 23
SURGICAL INFANTS: A RETROSPECTIVE COHORT
STUDY
CONLON KAREN 14 INFLAMMATORY MARKERS OF ANTIPSYCHOTIC 24
WEIGHT GAIN AND CARDIOMETABOLIC
DYSFUNCTION IN YOUTH MENTAL HEALTH
DISORDERS
CONNELL ANNA 15 MUMPS RNA OR IGM DETECTION AS A 24
DIAGNOSTIC METHOD- IMPLICATIONS FOR
MUMPS OUTBREAKS IN A HIGHLY VACCINATED
POPULATION
COSTIGAN EMMA 16 CHILDREN’S FOLLOW UP ORKAMBI REAL WORLD 25
MULTIPLE BREATH WASHOUT STUDY (CFORMS)
CREALY MIRANDA 17 FOOD ALLERGY IN CHILDREN WITH 25
INFLAMMATORY BOWEL DISEASE IN IRELAND
DUFFY JAMES 18 AUDIT OF THE WEEKEND AND ON CALL 26
RESPIRATORY PHYSIOTHERAPY SERVICE AT OLCHC
IN 2018
DUNNE AMANDA 19 FAMILY PERSPECTIVES OF PSYCHOGENIC NON- 26
EPILEPTIC SEIZURES IN A PAEDIATRIC
POPULATION
13LASTNAME FIRSTNAME POSTER ABSTRACT TITLE PAGE IN
NUMBER ABSTRACT
BOOK
EISSNER GUENTHER 20 DIFFERENTIATED MESENCHYMAL STROMAL CELLS 27
FOR TRANSPLANT MONITORING OF ADVERSE
ENDOTHELIAL IMMUNE REACTIONS*
FARRELL DONAL 21 DIETETIC MANAGEMENT OF COELIACS IN 27
CRUMLIN AND TALLAGHT CENTRES
FITZGERALD FIONA 22 INCIDENCE OF HEARING LOSS IN PATIENTS WITH 28
A HISTORY OF CONGENITAL DIAPHRAGMATIC
HERNIA
FRAWLEY THOMAS 23 INVESTIGATING EGFR MEDIATED BIOLOGICAL 28
ACTIVITY OF TUMOUR DERIVED EXOSOMES ON
THE NEUROBLASTOMA MICROENVIRONMENT
GALLAGHER CIARA 24 RECONCONSTRUCTION OF NEUROBALSTOMA 29
MICROENVIRONMENT IN VITRO IN 3D
HYALURONIC ACID – COLLAGEN BASED
SCAFFOLDS
GEERTS NELE 25 LOCAL TUMOUR MICROENVIRONMENT DICTATES 29
INVASION STRATEGIES IN NEUROBLASTOMA
GENTLES EMMA 26 OPTIMISING STANDARD PARENTERAL NUTRITION 30
PROVISION IN OLCHC: A PILOT STUDY IN CARDIAC
INFANTS
GEOGHEGAN AISLING 27 THE POPULATION INCIDENCE OF CHILDHOOD 31
GONADOBLASTOMA OVER 20 YEARS IN THE
REPUBLIC OF IRELAND
GUNNE EMER 28 TOWARDS ESTIMATING THE INCIDENCE OF RARE 31
DISEASES IN A PAEDIATRIC POPULATION, BORN
IN IRELAND IN THE YEAR 2000
HAWKE ANA-LOUISE 29 ERYTHROPOETIN AS A TREATMENT MODALITY IN 332
HYPERHAEMOLYSIS COMPLICATING SICKLE CELL
ANAEMIA
HAWKE ANA-LOUISE 30 TAKAYASU ARTERITIS PRESENTING IN AN 11 YEAR 32
OLD BOY
HAWKE ANA-LOUISE 31 PFAPA – THE IRISH EXPEREICNE IN A TERTIARY 33
AUTOINFLAMMATORY CLINIC
HAYES EADAOIN 32 ETHINYLOESTRADIOL MEDICATION ERRORS 33
IMPACTING PUBERTAL INDUCTION IN
ADOLESCENT FEMALES ATTENDING THE
ENDOCRINE CLINIC
HOWLETT MONINNE 33 PROVOCATION OF PAEDIATRIC HEARTS - A SAFE 34
& SMART SOLUTION
HOWLETT MONINNE 34 DIRECT OBSERVATIONAL STUDY OF INFUSION 34
ERRORS ASSOCIATED WITH SMART-PUMP
TECHNOLOGY IN PAEDIATRIC INTENSIVE CARE
IATAN MARIA 35 A COMPARISON OF CPAP COMPLIANCE IN 35
TREATMENT OF OBSTRUCTIVE SLEEP APNOEA IN
A TRISOMY 21 AND NON TRISOMY 21 PATIENT
POPULATION
JOSEPH SUNNIMOL 36 REDUCING TIME TO EXTRA CORPOREAL 35
MEMBRANE OXYGENATION (ECMO) DURING
EXTRA CORPOREAL CARDIOPULMONARY
RESUSCITATION (ECPR) IN CHI CRUMLIN
KAMAL MOHSIN 37 HOME OXYGEN THERAPY- A DRUG LIKE ANY 336
OTHER
KELLY LYNNE 38 NEONATAL ENCEPHALOPATHY: HYPOXIA- 36
INDUCIBLE FACTOR AND HYPOXIC RESPONSIVE
CYTOKINES FROM NEONATE TO EARLY
CHILDHOOD
14LASTNAME FIRSTNAME POSTER ABSTRACT TITLE PAGE IN
NUMBER ABSTRACT
BOOK
KENNEDY MARTINA 39 A QUALITY INITIATIVE TO IMPROVE THE SAFE 37
NURSING TRANSPORTATION OF NON-CRITICAL
INFANTS AND CHILDREN WHO REQUIRE
TRANSPORTATION ABROAD FOR TREATMENT
OR INVESTIGATIONS ABROAD
KENNEDY/HOWLIN MARTINA 40 PREPARATION OF CHILDREN FOR ELECTIVE 38
SURGERY AND HOSPITALISATION: THE
PARENTAL PERSPECTIVE
KENNY MEABH 41 BREAKING NEWS TO CHILDREN 38
KENNY MEABH 42 THE ISOLATION OF BEING IN ISOLATION 39
KIELY PATRICK 43 THE INTRODUCTION OF THE NEW DATABASE: 39
IPOP (IRISH PAEDIATRIC ORTHOPAEDIC
PATHWAY)
LEFEIVRE THOMAS 44 INVESTIGATION OF THE FUNCTIONAL INTERPLAY 40
BETWEEN SIGNALLING PATHWAYS AND
EPIGENETIC FACTORS IN ACUTE LEUKAEMIA
MAGUIRE JENNIFER 45 CASE REPORT: IMMUNE THROMBOCYTOPENIA 40
PURPURA (ITP) – AN INTRA-ORAL AND EXTRA-
ORAL PRESENTATION
MAHONY REBECCA 46 THE ROLE OF IL-1Β AND IL-18 IN REGULATING 41
SKIN BARRIER FUNCTION
McCAN L 47 41
THE BURNING QUESTION: HOW TO CARE FOR
CHILDREN WITH THERMAL INJURIES AT HOME
McCormack/McGarry Geraldine/Tina 47a EVALUATING THE FOLLOW-UP REQUIREMENTS 42
OF PATIENTS WITH MINOR TRAUMA INJURIES
TREATED IN A NURSE LED DRESSING CLINIC
MCGOVERN MATTHEW 48 SEX DIFFERENCES IN INNATE IMMUNE 42
FUNCTION IN PRETERM NEONATES
MCKAY CIARA 49 AUGMENTATIVE AND ALTERNATIVE 43
COMMUNICATION (AAC) – IMPROVING
COMMUNICATION WITH PATIENTS WHO HAVE
COMMUNICATION SUPPORT NEEDS
MacMAHON JAYNE 50 YOU GIVE ME FEVER! – THE 43
AUTOINFLAMMATORY CLINIC IN AN IRISH
TERTIARY PAEDIATRIC HOSPITAL
MEENAGHAN SAMANTHA 51 PHYSIOTHERAPY FOLLOW-UP OF CHILDREN 44
SUPPORTED BY CARDIAC EXTRA-CORPOREAL
LIFE SUPPORT (ECLS)
MURPHY CATHERINE 52 DECODING INDUCTION OF APOPTOSIS IN 44
NEUROBLASTOMA
NIEDZWIECKA TERESA 53 WHAT ARE THE EFFECTS OF CARE BUNDLES ON 45
THE INCIDENCE OF VENTILATOR-ASSOCIATED
PNEUMONIA IN PAEDIATRIC AND NEONATAL
INTENSIVE CARE UNITS? A SYSTEMATIC REVIEW
NOLAN JOHN 54 MYCN EXPRESSION DRIVES THE EXPORT OF MIR- 45
17~92 CLUSTER ONCOMIRS THROUGH
EXTRACELLULAR VESICLES IN NEUROBLASTOMA
MODELS IN VITRO AND IN VIVO
O'CONNOR KATIE 55 MEDICAL EDUCATION IN THE DIGITAL AGE 46
O'DONNELL R 56 EPILEPSY IN THE SCHOOL ENVIRONMENT - A 46
RESOURCE PACK FOR STAFF
O'DWYER JAMES 57 CO-EXISTING AUTOIMMUNE THYROID 47
DISORDERS AND COELIAC DISEASE IN AN IRISH
PAEDIATRIC POPULATION
O'GRADY/O'REILLY BLAITHIN/PAUL 58 PROMOTING HEALTH ADJUSTMENT FOLLOWING 47
MAJOR SURGERY: EVALUATION OF ICANCOPE
POSTOP SCOLOISIS SMARTPHONE APPLICATION
15LASTNAME FIRSTNAME POSTER ABSTRACT TITLE PAGE IN
NUMBER ABSTRACT
BOOK
O'KEEFFE CLAIRE 59 RAPID REHABILITATION AND ACCELERATED 48
DISCHARGE PROTOCOL IN ADOLESCENT
IDIOPATHIC SCOLIOSIS (AIS)
O'LEARY H 60 SEPSIS IN THE EMERGENCY DEPARTMENT 48
PHILBIN DEIRDRE 61 TRAUMA MANAGEMENT CHARTS: AN AUDIT OF 49
PRACTICE
RYAN EMER 62 IL1- Β LEVELS AT PRESENTATION CORRELATE 50
WITH SYMPTOM BURDEN AT 2 WEEKS IN
PAEDIATRIC MILD TRAUMATIC BRAIN INJURY
RYAN EMER 63 ALTERED SYSTEMIC INFLAMMATORY RESPONSE 50
IN PAEDIATRIC TRAUMATIC BRAIN INJURY
RYAN EMER 64 IL1- Β LEVELS AT PRESENTATION WITH 51
PAEDIATRIC MILD TRAUMATIC BRAIN INJURY
ARE HIGHER IN CHILDREN WITH PREVIOUS MILD
TRAUMATIC HEAD INJURIES
RYAN EMER 65 PAEDIATRIC MILD TRAUMATIC BRAIN INJURY IS 51
ASSOCIATED WITH SYSTEMIC INFLAMMASOME
ACTIVATION AND PUBERTAL SCORING
RYAN SINEAD 66 RISKY HUDDLE: A NURSING CONTRIBUTION TO 52
THE PATIENT SAFETY AGENDA
SASAKI ERINA 67 SHORT STATURE: WHAT’S FIRST? 52
SEMPLE DIARMAID 68 A BASELINE REVIEW OF THE ACTIVITY OF THE 53
PICU PHARMACISTS USING ELECTRONICALLY
CAPTURED DATA
SHINE ANNEMARIE 69 BREAST MILK PROVISION IN INFANTS WITH 53
UNIVENTRICULAR CONGENITAL HEART DISEASE
SHINE ANNEMARIE 70 NUTRITION INTAKES OF NEONATES WITH 54
UNIVENTRICAL CONGENITAL HEART DISEASE
SMITH HAZEL 71 SUPPORTS AND CHALLENGES TO NURSE-LED 54
RESEARCH IN CHILDREN'S HOSPITALS: A CROSS-
SECTIONAL SURVEY (CONSULT STUDY)
SOMANADHAN SUJA 72 EXPLORING CHILDREN AND GENERAL NURSING 55
STUDENTS’ REFLECTION ON THE USE OF POSTER
AS AN EXPERIENTIAL LEARNING ACTIVITY AND
ASSESSMENT WITHIN THE UNDERGRADUATE
CURRICULUM
SOMANADHAN SUJA 73 CHILDREN NURSING STUDENT’S REFLECTION ON 55
PATIENT SAFETY CULTURE (CONSIST STUDY)
STAFFORD AISLING 74 WARD NIV – WOULD YOU/SHOULD YOU ADJUST 56
IT?
TUOHY MICHELLE 75 DIETARY MANAGEMENT OF CHYLOTHORAX IN 56
CONGENITAL HEART DISEASE
VERNON LUCY 76 COMPLEX OESOPHAGEAL PERFORATIONS 57
SECONDARY TO INGESTED FOREIGN BODIES: A
SERIES OF THREE RECENT CASES
VERNON LUCY 77 FEMORAL TUNNELLED CENTRAL CATHETER 58
INSERTION AS AN ALTERNATIVE ROUTE IN
CHILDREN WITH DIFFICULT VASCULAR ACCESS
VERNON LUCY 78 A RARE CASE OF ACUTE APPENDICITIS 58
PRESENTING AS AN ACUTE SCROTUM
VERNON LUCY 79 SURGERY FOR PANCREATIC MASSES IN 58
CHILDHOOD: A 13-YEAR NATIONAL EXPERIENCE
WALSH AIDEEN 80 PROFESSIONALS CONSULTATION SERVICE IN 59
THE CHILD SEXUAL ABUSE (CSA) UNIT
WORRALL MARY 81 ASSESSING MEDICINES FOR SAFE USE IN 59
PAEDIATRIC PATIENTS IN CHILDREN’S HOSPITAL
IRELAND AT CRUMLIN
16CARING FOR CHILDREN WITH COMPLEX DEVELOPMENT OF A SELF-MANAGEMENT PLAN
HEALTHCARE NEEDS IN THE COMMUNITY: WHAT FOR 8-14-YEAR OLDS WITH DIABETES MELLITUS
ARE THE EDUCATION NEEDS OF REGISTERED TYPE 1
NURSES? Bayne, D1., Fitzpatrick, A1., Kinch, M1., Moriarty, J1.,
Naomi M. Bartley, A/Director, Centre for Children’s O’Sullivan, D1., Somanadhan, S2.
Nurse Education, Children’s Health Ireland. 1. Stage 3 Integrated Children's and General
Nursing Student
Background: Caring for children close to home is a 2. Module Co-Ordinator, Programme
key priority for Irish healthcare. Increasing numbers Director Children's and General Registration
of children with complex healthcare needs require Education Programme. UCD School of
care delivery within their home. Children’s complex Nursing, Midwifery and Health Systems,
healthcare needs include multidimensional health University College Dublin, 2018.
and social care needs (Brenner et al. 2018). A
learning needs analysis was conducted to identify
the education needs of registered nurses who are Introduction
caring for children with complex healthcare needs in Type One Diabetes Mellitus (T1DM) is as an
the community. autoimmune condition characterised by loss of B-
cells. It is a chronic condition where insufficient/no
Methodology: An electronic, self administered insulin is produced by the pancreas27. An exact
survey was developed and ethical approval was cause is unknown. Research shows that genetic
granted from a hospital committee. The sample was predisposition and environmental factors
accessed via the Health Service Executive and contribute14. If a child presents with suspected
administered to registered nurses who care for T1DM, immediate referral to a paediatric diabetes
children with complex healthcare needs in the team is required for diagnosis and treatment19. In
community. 159 completed surveys were received 2017, approximately 586,000 children (Recommendations: 48(57.8%) cases of transient synovitis were
Numerous studies have identified a lack of diagnosed making it the most common cause for
knowledge in schools about T1DM. Whilst children limp. 57 (68.6%) patients were discharged. 6(7.2%)
are at home, they have parental support when patients re-attended during the study period.
managing their diabetes. However, this support is 17(27.4%) of patients were not given any advice on
not available in school. Thus, during school hours, discharge.
the child blood glucose levels are most likely to
fluctuate.20 Perhaps the development of a CONCLUSION
management plan for teachers in schools may be This audit found incomplete documentation,
beneficial in providing support to teachers looking inconsistent and sometimes inappropriate of use of
after kids with T1DM. More education in schools for investigations. These are important areas for
students and teachers alike may also be beneficial. improvement as they negatively impact both patient
experience and outcomes. In particular overuse of
AN AUDIT OF MANAGEMENT OF ACUTE LIMP IN A blood tests can cause significant distress. Further
PAEDIATRIC EMERGENCY DEPARTMENT education on existing guidelines followed by repeat
Dr. Máire Bourke, Dr. Ralph Hurley O’Dwyer, Dr. audit cycle is recommended.
Michael Barrett, Dr. Carol Blackburn, Dr. Laura
Melody. A QUALITATIVE EXPLORATION OF ADOLESCENTS
Emergency Department, Our Lady’s Children’s WITH SEVERE HAEMOPHILIA AND THEIR
Hospital Crumlin CARETAKERS REGARDING THEIR FUTURE
TRANSTION TO ADULT SERVICES.
INTRODUCTION Róisín Bradley, Children’s Health Ireland at Crumlin,
The limping child is a common presentation to the & The National Children’s Research Centre Dublin,
paediatric emergency department (ED) with a wide Beatrice Nolan, Children’s Health Ireland at Crumlin,
differential diagnosis from the benign to life- Dublin, Zena Moore, Royal College of Surgeons
threatening. Ireland, Declan Patton, Royal College of Surgeons
Our aim was to review the clinical presentations, Ireland.
diagnostic and management data relating to
children with limp presenting to the ED of Our Background: There is an active transition
Lady’s Children’s Hospital Crumlin(OLCHC) and programme for adolescents with haemophilia
compare our practice with that recommended by moving from the child to adult hospital in Ireland.
existing hospital guidelines. Transition of care from child to adult services has
been widely recognised as a challenge for those
METHODS with chronic conditions. There will be approximately
Symphony audit software was used to generate a 15 adolescents with severe haemophilia
list of patients presenting from 01/07/2018 to transitioning to the adult hospital over the next five
30/09/2018 diagnosed with “limp”, “transient years. This study explored the views of a cohort of
synovitis”, “septic arthritis”, “irritable hip”, “slipped adolescents with severe haemophilia, parents of
upper femoral epiphysis” and “Perthes”. A adolescents with severe haemophilia and MDT in
retrospective analysis of the ED notes pertaining to this service prior to the adolescent’s move to the
these patients was then performed. adult hospital.
RESULTS Methods: Qualitative design using semi-structured
83 patients were eligible for inclusion, mean age 5.2 interviews based upon the Critical Incident
years (standard deviation(SD) 3.2). Median duration Technique (CIT).
of symptoms 3 days (interquartile range(IQR) 1-7
days). Hip pain was the most frequent complaint Results: Thematic analysis using the CIT approach
accounting for 33 (39.7%) presentations. Fever was identified five themes all of which pertained to
present in 10 (12.0%)cases, while 12(14.4%) cases either the positive or negative aspects of the
did not document presence or absence of fever. 8 transition programme for adolescents with severe
(9.6%) presentations had no documented weight haemophilia, parents of adolescents with severe
bearing status. haemophilia and MDT. The main issues that
35(42.1%) patients had blood tests taken, with 27 emerged in the themes were the change in
(77.1%) of these having no indication according to independence, meeting peers, being prepared for
current OLCHC guidelines. Radiography was inevitable change, apprehension and
performed on 62(74.6%) patients, with 14 (22.5%) communication levels.
having no indication.
18Conclusions: There is a distinct paucity of research FAMILY EDUCATION IN RELATION TO
completed with this study group in Ireland. This CONCUSSIONS
study provided a comprehensive view of the Brady, A1., Doyle, L1., King, A1., McCarthy, S1., Nic
transition service from the view point of the Gabhann, S1. Somanadhan, S2.
adolescent, parent and MDT. Research findings 1. Stage 3 Integrated Children's and General
relating to positive and negative aspects of the Nursing Student
service were explored. Implications for practice for 2. Module Co-Ordinator, Programme
the three study groups were identified. Director Children's and General Registration
Education Programme. UCD School of
Nursing, Midwifery and Health Systems,
THE ROLE OF THE RESEARCH NURSE IN CLINICAL University College Dublin, 2018
TRIALS.
Róisín Bradley, Children’s Health Ireland at Crumlin Introduction
& The National Children’s Research Centre Dublin, Head injury is the most severe trauma caused by
Aileen Molloy Children’s Health Ireland at Crumlin & motorcycling, cycling, and other wheeled
Temperature Controlled Pharmaceuticals. recreational devices activities in children and these
are the leading cause of serious head and facial
THE ROLE OF THE RESEARCH NURSE IN CLINICAL injuries and mortality among children. Concussion
TRIALS. has been defined as a condition which changes
Róisín Bradley, Children’s Health Ireland at Crumlin one’s mental status, with or without loss of
& The National Children’s Research Centre Dublin, consciousness (LOC)1 often being referred to as a
Aileen Molloy Children’s Health Ireland at Crumlin & traumatic brain injury (TBI). Commonly it’s caused
Temperature Controlled Pharmaceuticals. by a direct blow/ whiplash, (2), slightly shifting the
brain interrupting with the electrical activities that
Background: The demand for research nurses has make up the reticular activating system (RAS). The
increased due to the expanding clinical research most cases occurring in children aged between 5 to
environment in hospitals. There are currently three 14 are due to cycling and sport (3). Yearly, it’s
research nurses working in the Haemostasis & estimated that 2000 people require hospitalisation
Thrombosis service here .They are involved due to a concussion episode (3). However, the exact
primarily with clinical trials, but also work on number of concussions in unknown yet its
academic studies and on patient databases. The role estimated that 1.6 to 3.8 million sports related TBI
of the research nurse in clinical trials in this arise annually (2). Parents’ knowledge of and
department varies depending on the trial specifics. understanding of concussions and its presenting
It was decided to review the published material on symptoms are often vital factors that affect care for
this topic to assess what is currently understood injured child.
about nurses working in research and on clinical
trials. Aim & Objectives:
This poster was developed as part of a module
Methods: A literature review was conducted to assessment, to critically discuss and educate
explore published articles on the role of the parents regarding concussions, and what to do if
research nurse in clinical trials. The search strategy symptoms linger as well as provide tips on how to
included articles published in English within the last prevent concussions.
10 years, and included terms such as “research
nurse” and “clinical trials”. Recognising symptoms:
Some symptoms of concussions may show up
Results: There were 123 relevant articles located in immediately and some may take a few hours or
the literature search of which 12 were deemed most days to appear. Parents most commonly correctly
relevant and were explored further. These articles identified vestibular-somatic and cognitive-sensory
included data from the U.K, U.S.A, Ireland, Canada, symptoms including headache, blacking out,
Australia & New Zealand. dizziness, trouble understanding, and trouble
remembering1. Continue to monitor for signs or a
Conclusions: Postgraduate qualification in Clinical concussion. Concussion is primarily diagnosed by
Research is not a requirement of the role, but may the presence of commonly assessed subjectively
be beneficial. Nurses with extensive clinical trial through patient reporting. Therefore, it is advocated
experience, whether with or without specific that the parent be included as an integral part of the
postgraduate training, are few, and are employed in concussion management and evaluation.
a wide variety of specialties and settings.
19Concussion action plan Pattern recognition receptors (PRRs) of the innate
Remove the injured individual from the situation. immune system represent the critical front-line
Keep the individual with a possible concussion out defence against pathogens, and many new vaccine
of any sports on the same day of the injury and until formulations target these PRR pathways to boost
cleared by a health-care professional. Under no vaccine responses. Evidence suggests that elements
circumstances should parents, coaches or non- of the innate immune system do not fully develop
health care professionals judge the severity of a until puberty, contributing to impaired response to
concussion. Record and share information about the infection and impaired vaccine responses in
injury such as how it happened and the signs and neonates, infants, and children. We have recently
symptoms to help health care professional assess reported that the activity of one family of PRRs, the
the individual. Inform parents and guardians about cytosolic nucleic acid (CNA) sensors, is intact in cord
the possible concussion and refer them to blood and peripheral blood of young children.
concussion information websites. Ask for written
instructions from the individuals’ health care This study investigates the function of CNA sensors
provider about the steps that should be taken to in specific cell types of the innate immune system,
help the individual return to sports or everyday namely monocytes, monocyte-derived dendritic
activities. cells (moDCs) and monocyte-derived macrophages
(MDMs), from cord blood. These cells are the critical
Conclusion: innate immune cells employed to activate and
The parents of youth sport participants would shape the adaptive immune response. Our work
benefit from increased concussion education thus far shows that these cell types, isolated from
focusing on the types of symptoms as well as the cord blood, can be activated to express important T
consequences of suffering a concussion. cell activatory markers and also to produce
important Th1 promoting cytokines. We have
1
Kay, M. C., Register-Mihalik, J. K., Ford, C. B., compared CNA activation to current adjuvants alone
Williams, R. M., & Valovich McLeod, T. C. (2017). or in combination and found that CNA activation is a
Parents' and Child's Concussion History as Predictors promising new adjuvant strategy.
of Parental Attitudes and Knowledge of Concussion
Recognition and Response. Orthopaedic journal of
sports medicine, 5(12). CIRCUMFERENTIAL AND RADIAL DEFORMATION
ASSESSMENT IN PREMATURE INFANTS: READY FOR
IMPROVING VACCINE RESPONSES IN THE PRIMETIME?
PAEDIATRIC POPULATION BY PROMOTING TH1- and Neidin Bussmann1; Aisling Smith1; Alessia
TH17- CELL RESPONSES Cappelleri1; Naomi McCallion1,2; Orla Franklin3; Afif
Kiva Brennan1,2, Simon Craven3, Eleanor J EL-Khuffash1,2.
Molloy1,2,4, Patrick T Walsh1,2, Fionnuala M 1 Department of Neonatology, The Rotunda
McAuliffe3, Sarah L Doyle1,2 Hospital, Dublin, Ireland.
1
National Children’s Research Centre, Crumlin, 2 Department of Paediatrics, School of Medicine,
Dublin 12, Ireland; 2School of Medicine, Trinity Royal College of Surgeons in Ireland. Dublin, Ireland.
College Dublin, Dublin 2, Ireland; 3UCD Perinatal 3 Department of Paediatric Cardiology, Our Lady’s
Research Centre, Obstetrics & Gynaecology, School Children’s Hospital Crumlin, Dublin, Ireland.
of Medicine, University College Dublin, National
Maternity Hospital, Dublin, Ireland; 4Coombe Background: The utility of longitudinal deformation
Women and Infants University Hospital, Dublin 8, measurements (longitudinal strain and strain rate)
Ireland. in in premature infants is becoming well
established. However, more studies are needed to
demonstrate feasibility and reproducibility of left
Two million infants die each year from infectious ventricular (LV) circumferential (circ) and radial
diseases before they reach 12 months; many of strain and strain rate (SR) in this population. We
these diseases are vaccine preventable in older aimed to assess feasibility and reproducibility of circ
populations. Vaccination is a highly effective and radial deformation measurements in preterm
method of preventing disease; however, although infants < 29 weeks gestation, and study the impact
the majority of the global vaccine market is of a haemodynamically significant patent ductus
paediatric, the current vaccine formulations are arteriosus (hsPDA) on those measurements.
modelled in adult blood and it is likely that the most
effective adjuvants for the neonatal and paediatric Methods: We recruited premature infants < 29
populations are being overlooked. weeks gestation who are enrolled in the PDA RCT
(ISRCTN:13281214) over two time points (Day 2 &
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