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Background and aim Femoral vein catheterization is very com-
monly performed while managing children with septic shock.
However, the agreement between superior venal caval (ScvO
2
)
and femoral venous oxygen saturation (SfvO
2
) has not been
reported in children till date. Our aim was to evaluate the agree-
ment between ScvO
2
and SfvO
2
values.
Methods Children with septic shock in whom femoral vein cath-
eter was inserted before shifting to the ICU were eligible. Paired
blood samples from subclavian/Internal jugular vein and femoral
catheters were drawn simultaneously after initial fluid resuscita-
tion in these children and analysed. Agreement was assessed by
Bland and Altman (BA) analysis. The study was approved by
IRB.
Results A total of 32 patients were enrolled. The mean ScvO
2
and SfvO
2
were 72.3% and 76% respectively (p <0.001). BA
analysis showed relatively poor agreement between ScvO
2
and
SfvO
2
with mean bias of 3.6 and 95% limits of agreement of -
1.95 to 9.25 (r=-0.28, p = 0.14) (Figure 1). In general, SfvO
2
values were higher than ScvO
2
values with 14 of the 32 children
having values ≥5%. The SfvO
2
had poor sensitivity (45.5%) but
100% specificity for detecting low saturations. The PPV was
100% and the NPV was 77.8%. As SfvO2 values were generally
higher than ScvO
2
values, we tried a higher cut-off for SfvO
2
to
detect low mixed venous saturations. With a SfvO
2
cut off of
72%, the sensitivity and specificity were both 100%.
Conclusions A higher cut off of 72% for SfvO
2
may be used in
place of ScvO
2
in situations where ScvO
2
estimation has failed
or is impractical. Our study findings however, need further
validation.
O-118 HIGH PREVALENCE OF CYTOMEGALOVIRUS PROTEINS
IN SURGICAL SPECIMENS OBTAINED FROM INFANTS
WITH NECROTIZING ENTEROCOLITIS, BOWEL
PERFORATION OR BOWEL STRICTURE
1
S Omarsdottir,
2
M Agnarsdottir,
3
A Orrego,
1
E Skantz,
4
M Vanpée,
1
ARahbar,
1
C Söderberg-Nauclér.
1
Department of Medicine Solna, Karolinska Institute, Stockholm,
Sweden;
2
Institute of Immunology Genetics and Pathology, Uppsala University, Uppsala,
Sweden;
3
Department of Clinical Pathology and Cytology, Karolinska University Hospital,
Stockholm, Sweden;
4
Department of Women’s and Children’s Health, Karolinska
Institute, Stockholm, Sweden
10.1136/archdischild-2014-307384.185
Background and aims Necrotizing enterocolitis (NEC) is a fre-
quent cause of neonatal surgical emergency. The pathogenesis of
the disease is incompletely understood. Postnatal cytomegalovi-
rus (CMV) infection can present clinically as NEC and be related
to bowel perforation or intestinal stricture in the neonate. The
aim of this study was to evaluate the presence of CMV infection
in intestinal samples obtained from infants with these conditions.
Methods Surgical specimens from infants diagnosed with NEC,
bowel perforation or intestinal stricture during year 1997–2009
were collected from the pathology departments at Karolinska
University Hospital and Uppsala University Hospital. The intesti-
nal samples were retrospectively analysed for CMV Immediate
Early Antigen (CMV-IEA) and CMV Late Antigen (CMV-LA) by
immunohistochemistry.
Results Sixty-six intestinal specimens from 47 preterm infants
and 10 full term infants were collected. The median gestational
age of the infants was 27.9 weeks and their median birth weight
was 1015 grams. The pathological diagnoses were NEC (n =
36), NEC and intestinal perforation (n = 12), intestinal perfora-
tion (n = 12), sequel after NEC (n = 3) and unspecific changes
(n = 3). CMV-IEA and CMV-LA was detected in 85% and 61%
of the intestinal tissue samples, respectively. Of these samples,
71% and 38% were classified as having a high-grade (≥25%)
CMV infection.
Conclusions CMV proteins were detected in the vast majority
of intestinal specimens obtained from infants diagnosed with
NEC, bowel perforation or intestinal stricture. These findings
support a possible role of CMV in the pathophysiology of NEC
and other surgical conditions in the neonate.
Teaching Using Simulation
O-119 CAPNOGRAPHY IMPROVES NEONATAL FACE MASK
VENTILATION
G Hawkes, M Kenosi, CA Ryan, EM Dempsey. Department of Paediatrics and Child Health,
University College Cork, Cork, Ireland
10.1136/archdischild-2014-307384.186
Background Assessment of effective positive pressure ventilation
(PPV) in neonatal mask ventilation can be difficult.
Objectives To determine which was the most effective method
of providing PPV: a T-piece resuscitator (TPR) with no device
attached (ND), a TPR containing an in line CO
2
detector (Neo-
StatCO
2
<Kg
®
) (COD) or a TPR with a capnography device
attached (CAP).
Methods This was a randomised crossover trial. Neonatal train-
ees were randomly assigned to each method (ND, COD or
CAP). They then alternated methods such that all participants
provided PPV with each method for a period of 2 min on a
CO
2
producing mannequin. Participants were video recorded to
determine the amount of effective ventilations delivered, and the
overall percentage efficacy of each method. Informed consent
was obtained.
Results 23 paediatric trainees provided a total of 6035 ventila-
tions and 91.1% were deemed to be effective. There was no stat-
istically significant difference between the percentage efficacy of
breaths delivered between the three methods. Percentage of
effective ventilations with ND, COD and CAP were 90.8%,
90.9% and 91.8% respectively. 15 (65%) of the trainees indi-
cated a preference for the COD method and 8 (35%) for the
CAP method. No trainees indicated a preference for the ND
Abstract O-117 Figure 1 Agreement between ScvO
2
and SfvO
2
values at 1 h
Oral abstracts
A70 Arch Dis Child 2014;99(Suppl 2):A1–A620
group.bmj.com on July 17, 2015 - Published by http://adc.bmj.com/Downloaded from
method. The CAP method was most likely to provide the highest
efficacy per participant (47.8%).
Discussion Methods of CO
2
monitoring during manual ventila-
tion with a facemask results in greater efficacy of delivered
breaths. Whilst the NeoStat device was the preferred device by
the majority of participants, the highest efficacy was achieved
with the capnography device. Capnography may enhance face-
mask ventilation in the clinical setting and future trials are now
required.
O-120 CARDIAC COMPRESSION QUALITY DETERIORATES
WITH INCREASING COMPRESSION RATE DURING
PRETERM RESUSCITATION SIMULATIONS: A NEW
PRETERM SIMULATION TRAINER
S Tan, N Batey, D Sharkey. Academic Child Health School of Medicine University Hospital,
University of Nottingham, Nottingham, UK
10.1136/archdischild-2014-307384.187
Background Effective cardiac compressions (CC) with a full
relaxation phase ensure adequate coronary artery blood flow by
increasing coronary perfusion pressure (CPP). CC during neona-
tal resuscitations are rare thus requiring them to be practiced in
simulation training. No studies have explored the efficacy of CC
during preterm simulations.
Aims 1) Develop a preterm manikin simulation system for CC
training
2) Define key measures of effective CC in this preterm
simulation
Methods We used the Laerdel term and LifeForm preterm (~25
week gestation, 0.8kg) manikins with an in-house developed cali-
brated CC measurement system (accuracy ±3%). NLS trained
neonatal staff randomly performed 2 finger or 2 thumb (circling)
CC resuscitation simulations. Compression rate, depth (>1/3 AP
diameter of chest) and release (>75% release of compression dis-
tance) were measured.
Results 30 participants each performed 8 simulations (total
23,340 CC). Median CC rate was 93/min(IQR 84–111). For
both term and preterm simulations, the 2 thumb technique
achieved more adequate depth CC than the 2 finger technique
(P <0.0001). Incomplete release was significantly worse in the 2
thumb group especially in the preterm simulations. With increas-
ing CC rate, incomplete release increased significantly from 8%
in the 60–84 CC/min rising to 52% in the 112–140 CC/min (P
<0.0001, see Figure).
Conclusion We have developed a useful CC preterm training
simulator with important feedback measures. These simulations
demonstrate the quality of CC decreases with increasing rate
above NLS recommended guidelines. In clinical practice, this
would reduce CPP and delay the restoration of an adequate car-
diac output.
Two Different Views on Early Nutrition
O-121 LUNG FUNCTION IN 6 YEAR OLD CHILDREN BORN
VERY PRETERM AND FED DIFFERENT DIETS POST
DISCHARGE
L Toftlund, L Agertoft, S Halken, G Zachariassen. HC Andersen Childrens Hospital,
University Hospital Odense, Odense, Denmark
10.1136/archdischild-2014-307384.188
Background Research has shown that being born preterm may
affect lung capacity later in childhood. It is unknown if type of
early nutrition influences lung capacity and the risk of develop-
ing asthma in childhood.
Aim Was to investigate type of early nutrition and impact on
lung function and possible risk of developing asthma among 6
year old children born very preterm.
Method A prospective, randomised, interventional multicentre
study on nutrition of a preterm birth cohort has been
established and described previously. Inclusion criteria were
gestational age ≤32 weeks. From hospital discharge to 4 month
corrected age, the children received three types of nutrition:
A: Human milk (HM) B: HM enriched with fortifier (HMF)
C: Preterm formula (PF). At the age of 6, the children
performed an occlusion test (Rocc) and a lung resistance test
(SRtot).
Results 277 children are included in this project [SH1]. So far
96 children have performed the lung function tests (Group A:
31 B: 29 C: 36 respectively). The results (mean) from the Rocc-
test were very similar comparing the groups with no significant
differences: A: 1.05 B: 1.05 C: 1.04 (kPa*s/L). The SRtot test
showed that group B and C had a significant lower value com-
pared to group A: A 1.21 B: 0.98 C: 1.01 (kPa*s). P-value=
0,017 when comparing A and C, p-value= 0,003 when A com-
pares to B.
Conclusion This preliminary result indicates that children who
received exclusively breastfeeding have better lung function/lung
resistance compared to not exclusively breastfed infants at the
age of 6.
O-122 TARGET FORTIFICATION (TFO) OF BREAST MILK WITH
FAT, PROTEIN AND CARBOHYDRATES FOR PRETERM
INFANTS: INFLUENCE OF COMMERCIALLY AVAILABLE
FORTIFIERS ON MACRONUTRIENT INTAKE
N Rochow, G Fusch, A Ali, C Fusch. Pediatrics, McMaster University, Hamilton, Canada
10.1136/archdischild-2014-307384.189
Abstract O-120 Figure 1 Percentage of compressions with
inadequate release during the simulated cardiac compressions
Oral abstracts
Arch Dis Child 2014;99(Suppl 2):A1–A620 A71
group.bmj.com on July 17, 2015 - Published by http://adc.bmj.com/Downloaded from
Ventilation
Capnography Improves Neonatal Face Mask O-119
G Hawkes, M Kenosi, CA Ryan and EM Dempsey
doi: 10.1136/archdischild-2014-307384.186
2014 99: A70-A71 Arch Dis Child
http://adc.bmj.com/content/99/Suppl_2/A70.2
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