PAEDIATRIC RESEARCH SOCIETY ABSTRACTS

PAEDIATRICS AND CHILD HEALTH 17:10 41

clinician is effective in identifying infants with PJ in whom more detailed laboratory investigations are indicated. This pilot study suggests that changes in our PJ policy should be considered, including rationalising laboratory tests to a total and direct bili-rubin, haematocrit and/or postponing all investigations to day 21 in well term breast-fed infants. Such changes would need to be monitored prospectively. Little is known of isolated neutropenia in well term breast-fed infants, and further work is needed to characterise this phenomenon’s clinical significance.

Perianal lesions: a common sign of childhood Crohn’s disease at presentation

P Rao, A Kader, P Dryden, SK BunnDepartment of Paediatric Gastroenterology, Royal Victoria Infirmary, Newcastle upon Tyne

Introduction: Crohn’s disease (CD) is increasingly common in the paediatric age range. Symptoms may be non-specific and diagnosis is often delayed, even after presentation to secondary care. Some perianal changes are highly suggestive of CD, and identification may expedite diagnosis. Our aims were to assess the perianal symptoms and signs in children presenting with subsequent biopsy-proven CD, determining the pick-up rate of perianal lesions by GPs and secondary-care paediatricians.Methods: All children presenting with subsequent biopsy-proven CD between March 2001 and March 2007 to the Paediatric Gastroenterology Department were identified through the depart-mental database. A standard proforma was completed for each child by retrospective case note review.Results: Sixty-six children with subsequent biopsy-proven CD presented over this 6-year period, of which 65 notes were avail-able for review. The median age at diagnosis was 12.5 years (range 3.0–15.5 years). Findings on perianal inspection (note that several children had more than one type of lesion) are shown in the table.

Number of children with each

perianal lesion

Number

of

children

with

perianal

lesions

Number

of

children

with no

perianal

lesions

Infla­

mmatory

fissure(s)

Skin

tag(s)

Abs­

cess

Fistula(e)

With

perianal

symptoms

8 7 8 2 17 Nil

No perianal

symptoms

9 13 Nil Nil 21 27

Total 17 20 8 2 38 (58%) 27 (42%)

Eleven of the 38 children with perianal lesions were referred by GPs and 27 by general paediatricians/paediatric surgeons. There was no difference in the pick-up rate of perianal lesions by GPs and general paediatricians: 5/11 (45%) and 13/27 (48%), respectively. Only 4/21 (19%) of the asymptomatic lesions were identified at primary or secondary care.Conclusions: The majority of children presenting with CD have perianal findings, but only a minority complain of perianal

symptoms. GPs and general paediatricians infrequently inspect the perianal area in children who do not complain of symptoms, even when CD is suspected. All children in whom CD is a dif-ferential diagnosis should have a perianal inspection performed as identifying suggestive perianal findings may shorten the delay in diagnosing this condition.

Are we doing too many or too few paediatric endoscopies?

J Stojanovic, A Kader, P Dryden, JE Thomas, SK BunnDepartment of Paediatric Gastroenterology, RVI, Newcastle upon Tyne

Introduction: Diagnostic endoscopy is the standard method of detecting and diagnosing many gastrointestinal disorders. The threshold for examination varies with personal practice and access to endoscopy time and available expertise. An observed 10-fold increase in paediatric endoscopies performed raised the question of whether the threshold for endoscopy had fallen or demand had increased. Our aims were to evaluate the threshold for endoscopy within the paediatric gastroenterology department by assessing positive histological yield, comparing consultants and relating to a previous audit performed in 1991 (in which 65% cases had positive histology).Methods: All children undergoing diagnostic endoscopic proce-dures from January to May 2006 were identified from the depart-mental procedure database. A standard proforma was completed on each child, with information collected from the case notes and hospital computer laboratory system.Results: Between January and May 2006, 109 children (62 male) underwent 127 diagnostic endoscopies (some children had oeso-phogastroduodenoscopy (OGD) and colonoscopy). Indications were recurrent abdominal pain in 27 (34%), altered bowel habit in 16 (20%), persistent vomiting in 12 (15%), lower gastroin-testinal bleeding in 10 (12%), upper gastrointestinal bleeding in 7 (9%), dyspepsia I 3 (4%) and failure to thrive in 2 (2%). Histological findings were 77/127 (61%) procedures and 71/109 (65%) children with diagnostic histological findings. The three consultants had very similar diagnostic yields of 62%, 62% and 67% of children undergoing endoscopy.

Procedures

OGD = 83 Colonos­

copy = 37

Sigmoido­

scopy = 7

Total = 127

Normal histology 34 (41%) 11 (30%) 5 (71%) 50 (39%)

Abnormal histology 49 (59%) 26 (70%) 2 (29%) 77 (61%)

Oesophagitis 27

Gastritis/Helico­

bacter pylori

11

Coeliac disease 11

Crohn’s disease 11 1

Colitis 7 1

Other 8

Conclusions: The diagnostic yield has not significantly changed from 1991, suggesting that the increased number of paediatric endoscopies performed is due to increased demand rather than

6 © 2007 Published by Elsevier Ltd.

PAEDIATRIC RESEARCH SOCIETY ABSTRACTS

50–60% of all children receive a prescribed drug each year, but no longitudinal data are reported on overall paediatric prescrib-ing trends. We set out to measure the primary-care prescription rate for individual drugs for children and adolescents in the Tay-

a lower threshold for examination. ‘Negative’ endoscopies are important to ensure the pick-up of all significant pathology and often influence management. The diagnostic yield described is in line with other units.

PAEDIATRICS AND CHILD HEALTH 17:10 417 © 2007 Published by Elsevier Ltd.

Compliance with hepatitis B immunisation commenced in hospital

K Edge, H Mactier, Princess Royal Maternity Hospital

Introduction: The UK implements a selective immunisation programme for hepatitis B virus (HBV), screening all pregnant women antenatally and targeting high-risk groups. At the time of this audit, babies considered to be at environmental risk of HBV were scheduled to be immunised at birth, 2 and 4 months. This included all babies of women booked to deliver within the Wom-en’s Reproductive Health Service at the Princess Royal Maternity (PRM). The objective was to audit, through retrospective cohort analysis, compliance with the hepatitis B immunisation schedule in this group of babies.Methods: The study cohort included all babies who had received their first dose of hepatitis B vaccine at the PRM during the period 01/02/2005–01/03/2006. Infants considered to be at high risk of perinatal transmission were excluded. Sources of informa-tion were a database of infants notified directly to public health from the PRM, the Scottish Immunisation Recall System (SIRS), a database of infants born to drug misusing women at PRM and pharmacy records at PRM. Databases were compared to identify infants given one or more doses of hepatitis B vaccine.Results: A total of 203 infants were given a first dose of hepati-tis B vaccine in the PRM and notified directly to public health. A further 36 infants were notified to SIRS by their GP. During the same study period, 274 doses of vaccine were dispensed by the pharmacy at PRM. One hundred and fifty-four (67%) infants were born to mothers who were known to be drug misusers. Only 52.8% of infants given their first dose of hepatitis B vac-cination at the PRM completed the course (defined as more than three doses) and are therefore fully protected against HBV. In the drug-misusing population, the results were no better, with only 54.5% of infants completing the course.Conclusions: There are both clinical and practical reasons for poor compliance with hepatitis B vaccination, which include communi-cation problems (including notification to public health), the mobil-ity of the population, poor parental understanding, the increasing complexity of the childhood immunisation programme and prob-lems with implementing selective rather than universal immunisa-tion. An improved notification system, standardised consent form and parental information leaflet have been introduced. The cycle of audit will be completed after the changes have been implemented.

Trends in primary care drug prescribing in children and adolescents

J Shetty, M Kirkpatrick, M McGilchrist, S GreeneTayside Children’s Hospital, Dundee

Introduction: Limited data exists on primary care paediatric pre-scribing practice for the UK. European studies demonstrate that

side Region of Scotland (less than 16 years of age; population approximately 70 000) over a 10-year period, and to compare trends in prescribing rates for the most commonly prescribed drugs categorised by BNF classification and stratified by age.Methods: Data on all prescriptions ‘encashed’ at any community pharmacy in Tayside Region have been recorded onto a database since 1993 by the Health Informatics Centre in Dundee. This unique database documents drug name, date of encashment and specific patient identifier. Paediatric prescriptions were divided into four age bands (0–1, 2–4, 5–10, 11–16 years). Tayside population num-bers were extracted from the General Register Office for Scotland.Results: A total of 1 090 985 prescriptions were collated over 54 months in three epochs (1996/97, 2000/01 and 2005). The pro-portion of children receiving a drug prescription has risen from 69% in 1996 to 88% in 2005, a 19% rise over 10 years. Over a third of prescribed drugs in 2005 were for children over 10 years of age. Annualised prescription rates over the 10-year period demonstrate a marked upward trend in the older child, with no change in the under 5s. The five most commonly prescribed drugs were amoxicillin, inhaled beta- agonists, topical steroid creams, inhaled steroids and analgesics. Amoxicillin prescription fell by 37% across all age bands over 10 years, whereas that of skin emollient and topical steroids increased by 26%. Antihistamine prescription in children aged 11–16 years has increased by 50%.Conclusions: Almost 90% of children receive drug prescriptions from primary care over a single year. Over the last 10 years, the increase has been exclusively in the older child. However, for individual drugs, trends vary both up and down, across all ages. These data reflect either changing patterns of disease or changes in prescribing practice by primary-care physicians.

The relationship between angiotensin-converting enzyme (ACE) genotype, serum ACE concentration and markers of asymmetrical growth restriction in premature infants

S Redpath1, L Mills1, D McLean1, V Godfrey2, M Wallace3, L Jackson1

1Neonatal Unit, Princess Royal Maternity Hospital, Glasgow2Department of Medicine, University of Dundee, Dundee3Department of Biochemistry, Glasgow Royal Infirmary, Glasgow

Introduction: The renin–angiotensin–aldosterone system (RAAS) is known to influence organ-specific blood flow and future cardio-vascular health. Angiotensin-converting enzyme (ACE) genotype and renin-angiotensin axis activity may have pivotal roles during fetal and infant development and growth, and laboratory evi-dence indicates that angiotensin II has growth factor-like effects on specific target tissues. ACE gene polymorphisms are common and could modify later growth. Our objective was to explore the relationship between ACE genotype, serum ACE concentration and growth in the first year of life.Methods: Serial measurements of asymmetrical growth restric-tion, the ratio of mid-arm circumference to occipital frontal cir-cumference (MAC/OFC) and body mass were obtained from a cohort of premature infants at the time of discharge from the