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A previously healthy boy of preschool age was brought to the emergency department by ambulance with respiratory distress following the accidental inhalation of food contact dust (cake decorating powder). Prehospital oxygen saturations were 80% in room air. Initial treatment was with oxygen, nebulised salbutamol, oral dexamethasone and intravenous amoxicillin/clavulanic acid. Treatment was escalated to nasal high flow oxygen therapy and high dependency care within 8 hours. Lung fields on his initial chest X-ray were clear but the following day showed perihilar infiltrates extending into the lower zones in keeping with inflammation. He was treated with intravenous methylprednisolone, followed by a weaning dose of oral prednisolone over 14 days.He required oxygen therapy for 9 days and remained in hospital for 11 days. Outpatient follow-up, 24 days after the inhalation took place was reassuring with the child showing no signs of abnormal respiratory symptoms.

In our specialist clinic we emphasise the importance of healthy living but evidence around prevalence of obesity & fitness in this group is sparse Aim: To explore the prevalence of obesity & poor fitness levels in our asthma clinic & identify risk factors for poor fitness Method: Database analysis of routinely collected data for children who attended clinic since July 2018. BMI percentiles were calculated according to the National Child Measurement Programme, UK (93rd-97th percentile=overweight, 98th-99th percentile=very overweight). Fitness levels were assessed using the Chester step test, giving a valid approximation of VO2 max score. Poor fitness and overweight/very overweight were compared (chi-square or Person’s correlation) against demographic details, socioeconomic status (Postcode index of multiple deprivation index), and markers of asthma control, airway obstruction, and airway inflammation. Results: 99 children (median 12 years IQR 10-15;64% male),of whom 79 (80%) completed a fitness test. 44/99 (44%) were overweight/very overweight (15/99 (15%) and 29/99 (29%) respectively). 31/79 (39%) had sub-average or very low fitness levels. This was associated with female sex (p 0.047), older age (p 0.017) & baseline BMI category (p 0.03). Poor fitness was not associated with clinical or physiological markers of asthma severity, or socioeconomic status. Conclusion: Obesity & poor fitness are highly prevalent in children with asthma. Those at risk include girls, older teenagers & overweight children. Proactive screening to identify poor fitness should be conducted in clinics managing children with severe asthma.The impact of improved fitness on asthma control should also be explored.

Asthma is the most common chronic condition of childhood. In this review, we discuss an overview of strategies to empower children and young people with asthma. The key aspects of empowerment are to enable shared decision making and self-management, and help children minimise the impact of asthma on their life. The evidence behind these strategies is either sparse or heterogenous, and it is difficult to identify which interventions are most likely to improve clinical outcomes. Wider determinants of health, in high-resource and low-resource settings, can be disempowering for children with asthma. New approaches to technology could help empower young people with asthma and other chronic health conditions.

Introduction: There is interest in new therapies for severe asthma, and how network clinics can facilitate this. Aims and Objectives: We aimed to: 1) explore comorbidities and adherence issues in children referred to our regional multidisciplinary (MDT) asthma clinic 2) describe the interventions utilised by the specialist medical, psychology, nursing, pharmacy, and physiotherapy teams. Method: Retrospective casenote review of referrals into the clinic since July 2018. We extracted data on demographics, co-morbidities, and issues with inhaler technique and adherence. We summarised medical and non-medical interventions used in the clinic. Results: 52 patients were referred (Median age 13 years [IQR 10-15], 37/52 male; 17/52 (32%) demonstrated persistently low FEV1, and 29/52 (55%) had persistently high FeNO. 45/52 (86%) had suboptimal inhaler technique and/or adherence issues. 31/52 (60%) had concurrent medical issues such as allergy, obesity and adrenal insufficiency. 44/52 (85%) had dysfunctional breathing or low fitness on formal step testing. 40/52 (77%) had psychological comorbidities such as anxiety, depression, and low self-esteem. We changed inhalers in 14 patients and utilised methylprednisolone in 1 patient. Due to these interventions we have not needed to start any patient on biologic therapies, immunomodulators or maintenance oral steroids for asthma, and we successfully stopped these in 4 patients. Conclusion: Inhaler competency and adherence, breathing technique, fitness, and psychological problems are common in children with poor asthma control. Addressing these fundamental issues using an MDT specialist clinic can usually negate the need to step up medical treatment, even in children with severe asthma.

Sleep-disordered breathing (SDB) refers to a group of disorders characterized by abnormalities of respiration or ventilation during sleep. It encompasses obstructive sleep apnea (OSA), central sleep apnea (CSA) syndromes, sleep-related hypoventilation and sleep-related hypoxemia disorders. This review will concentrate on the disorder most prevalent in pediatrics, i.e., OSA, highlighting the most recent developments in our understanding of the etiology, pathophysiology and treatment options of this condition. OSA morbidities primarily involve the neurocognitive, cardiovascular and metabolic systems. However, there can be significant phenotypic variation in terms of end organ morbidity for the same OSA severity. This is likely due to the interplay between genetic and environmental factors; recent developments in the fields of genomics and proteomics have the potential to shed light on these complex pathological cascades. As we enter the era of personalized medicine, phenotyping patients to enable clinicians to tailor bespoke clinical management plans will be of crucial importance.

summary Background & aims: Neonatal parenteral nutrition (NPN) does not prevent early postnatal growth failure and negative nitrogen balance in very preterm infants. Individualised NPN (iNPN) prescribing remains standard practice. Macronutrient delivery is often suboptimal with iNPN. Aim: to establish whether a new standardised concentrated NPN (scNPN) regimen can improve protein intake while maintaining metabolic stability. Methods: Demographic and biochemical data was collected from the NICU electronic/paper data management system. In the infant subset ( 12 days) detailed fluid/drug infusion data was collected. Actual calorie and protein intake were calculated and compared to the previous RCT control group receiving a nutritionally identical iNPN. Cost analysis of scNPN was performed. Results: ScNPN usage was: scNPN1 (18%); scNPN (65%); scPN3 (17%) in 118 infants receiving scNPN in June–December 2006 (1483 scNPN days). In the patient subset (n ¼ 38; 526scNPN days) median (range) of 98 (80–102)% prescribed scNPN target volume was delivered. Mean (SD) protein intake (g/kg/14 days) was 34.5 (4.1) for scNPN and 28.1 (2.5) for iNPN (p < 0.001). Rates of electrolyte derangement, treated hyperglycaemia or metabolic acidosis were within an acceptable range. Annual cost savings were £39 510 (38% reduction). Conclusions: Using scNPN improves the efficiency of PN delivery and early protein intake while maintaining biochemical and metabolic stability and at less cost.

Impaired early protein intake in very preterm infants contributes to early growth failure and may affect long-term neurocognitive development. The authors have previously shown that a standardized concentrated neonatal parenteral nutrition (scNPN) formulation can improve the efficiency of early protein administration. They recognized that very early protein intake could be improved further by modifying the original scNPN regimen and starting PN within 4 hours.To demonstrate that the new scNPN regimen could improve very early protein intake in infants29 weeks' gestation without causing clinically important PN intolerance and complications.All eligible infants29 weeks' gestation, receiving the modified scNPN regimen and born between October 2009 and December 2010, were studied (group scNPN2). These were compared with previously studied infants,29 weeks' gestation and receiving the original scNPN regimen and born between June 2006 and December 2006 (group scNPN1). Infant details, actual nutrition intake, and metabolic/infection data were recorded.Thirty-eight infants29 weeks' gestation (group scNPN2) were compared with the 38 infants previously studied (group scNPN1). PN was started earlier in group scNPN2, leading to increased mean (95% confidence interval) total protein intake (first 7 days) of 15.3 (14.5-16.1) g/kg in group scNPN2 vs 11.8 (11.0-12.6) g/kg in group scNPN1. There were no differences in calorie, lipid, and carbohydrate intake. Infants receiving insulin for hyperglycemia fell from 20 (53%) in group scNPN1 to 10 (26%) in group scNPN2.Increasing early protein intake is associated with a reduction in insulin-treated hyperglycemia in infants29 weeks' gestation.