Pediatr Crit Care Med 2014 • Volume 15 • Number 4 (Suppl.) 707 14C LABELLED PARACETAMOL MICROTRACER DOSING TO DETERMINE PHARMACOKINETICS FROM BIRTH TO 2 YEARS – INITIAL RESULTS OF THE PAMS STUDY A. Selby 1 , L. Byrne 1 , S. Siner 1 , E. Scott 1 , R.C. Garner 2 , C. Earnshaw 3 , N. French 3 , A. Schipani 3 , G. Grynkiewicz 4 , W. Maruszak 4 , E. van Duijn 5 , B.O. Fabriek 5 , W.H.J. Vaes 5 , H. Varendi 6 , J. Lass 6 , L. Korgvee 6 , K. Park 7 , M. Turner 8 ; 1 PICU, Alder Hey Children’s Hospital, Liverpool, United Kingdom 2 Garner Consulting, Hull York Medical School, York, United Kingdom 3 Centre for Drug Safety Sci- ence, University of Liverpool, Liverpool, United Kingdom 4 Warsaw, Pharmaceuti- cal Research Institute, Warsaw, Poland 5 Accelerator Mass Spectometry, TNO Zeist, Zeist, Netherlands 6 Department of Paediatrics, University of Tartu, Tartu, Estonia 7 Centre for drug Safety Science, University of Liverpool, Liverpool, United King- dom 8 Neonatal Unit, Liverpool Women’s NHS Trust, Liverpool, United Kingdom Background and aims: Pharmacokinetics of drugs in young children is unpredict- able, and pharmacokinetic studies in children aged less than 2 years are required to determine suitable dosage regimes. Administration of a microtracer dose of 14C-labelled drug and Ultraperformance Liquid Chromatography with Accelerator Mass Spectrometry analysis using micro samples can be used to study pharmacoki- netics and metabolic pathways. Aims: To validate the irst use of this technique in young children, using 14C labelled paracetamol (acetaminophen). Methods: he study protocol was developed by a team from the UK, Estonia, Poland and the Netherlands. Approvals were obtained from regulatory authorities and ethics com- mittees in the UK and Estonia. he study materials were not signiicantly more radioactive than background levels, so no special radiation precautions were needed. Subjects were recruited in a paediatric intensive care unit in the UK and a clinic in Estonia. A single microtracer dose of 14C labelled paracetamol with or without unla- belled oral or intravenous paracetamol was administered to children under 2 years of age. Samples of 100–250 microlitres blood (10-15microlitres plasma used for analysis) were collected at informative time points. Results: 59 children (36weeks – 23months corrected gestational age) were recruited and a total of 263 blood samples obtained. Good quality pharmacokinetic data were obtained from most subjects. Conclusions: We have demonstrated that 14C labelled drug microtracer dosing and sampling is acceptable to ethics committees, regulators, clinicians and parents. High quality pharmacokinetic data were obtained using this technique. his is a promising addition to methods available for drug development in very young children. 708 USE OF N-ACETYL CYSTEINE IN CHILDREN WITH FULMI- NANT HEPATIC FAILURE CAUSED BY ACUTE VIRAL HEPATI- TIS WITHOUT LIVER TRANSPLANTATION FACILITY N. Siddiqui 1 , A. Haque 1 , Q. Abbas 1 , A. Saleem 1 ; 1 pediatric and child health, Aga Khan University, Karachi, Pakistan Background and aims: hiol-containing agent, N-acetyl cysteine (NAC) scavenges free radicals of oxygen and nitrogen. Its use in Non-acetaminophen induced (NAI) ALF is still not being used as regular practice due to variable results of studies. Aims: To determine use and efectiveness of N-acetylycysteine (NAC) in children with acute viral hepatitis in tertiary care center of developing country. Methods: Medical records of chil- dren (1 mo-16 years) with FHF admitted with acute viral hepatitis of known etiology who received NAC during 2007–11 were reviewed retrospectively. Liver function tests (mean ± SD) at baseline, 24 hours after NAC and before or at the time of discharge/ death were recorded and compared via using repeated measures ANOVA (r-ANOVA). Mortality associated risk factors were identiied by using logistic regression analysis. P-value and 95% conidence interval were recorded. Results: Forty children (mean age was 80 ± 40 mo.) with acute viral hepatitis received NAC. Majority were males (n=25; 63%). Vomiting (75%) and jaundice (65%) were main presenting symptoms, one-third had hypoglycemic, while 40% had altered sensorium at time of admission. here is signiicant statistical diference in liver enzymes and prothrombin time on admission comparing at discharge in children received NAC (p=<0.01). Fifteen (38%) children died. Severe vomiting (Odds Ratio (OR) 0.22, 95% Conidence Interval (CI) 0.1–0.8), jaundice (OR 9.3, CI 1.1 – 82.6), inotropic support (OR 20.6, CI 3.5–118.3) and mechanical ventilation (OR 4.3, CI 1.1–16.6) at time of admission are associated with risk factors for mortality in children with FHF. Conclusions: NAC used in children with FHF is associated with markedly improved liver function tests and recovery. 709 RATES OF CORRECT CHANGES OF BROAD SPECTRUM ANTIBIOTIC IN PEDIATRIC INTENSIVE CARE UNIT A.R. Araujo da Silva 1 , C.T. Henriques 1 , L.S. Werneck 1 ; 1 Infection Control Com- mittee, Prontobaby, Rio de Janeiro, Brazil Background and aims: Rational use of broad spectrum antibiotic in Pediatric Intensive Care Unit (PICU) is a challenge by the fewer options and development of resistance. Aims: To describe the rates of correct changes of broad spectrum antibiotic in PICU. Methods: We performed a longitudinal descriptive study performed in two private PICUs of Rio de Janeiro, Brazil, with monthly mea- sure of correct change of broad spectrum antibiotic. Change was adequate if we detected any healthcare associated-infection diferent of the reason of admission or an etiologic agent resistant to empiric therapy.he study was approved by Eth- ics Committee of Hospital Clementino Fraga Filho. Results: Between March of 2013 and November 2013 we measured rates in two PICUs. In PICU one, we did 2,273 patients-days with 14 nosocomial infections (density of incidence of 6,2 per 1000 patient days). Initial rate of use of broad spectrum antibiotic was 23,2% (variation from 16,1% to 33,3%) and rates of correct change was 82,5% (variation from 66,7% to 100%). In PICU two, we did 2,277 patients-days with 33 nosocomial infections (density of incidence of 14,5 per 1000 patient-days. In this PICU we did an outbreak of nosocomial infection in March. he initial rate of use of broad spectrum antibiotic was 35,1% (22% to 44%) and rates of correct change was 78,4% (variation from 55,5% to 100%). here’s no statistical difer- ence about rates of correct changes in both PICUs. Conclusions: Rates of cor- rect change of broad spectrum antibiotic could be an important tool to improve rational use of antibiotic in PICUs. Ideal rates must be 100%. 710 SIMULATED TRAINING FOR PREVENTION AND CONTROL OF HEALTHCARE ASSOCIATED INFECTIONS IN PEDIATRIC INTENSIVE CARE UNIT A.R. Araujo da Silva 1 , C.M. Oka 1 , M.M. Almeida 1 , A.L.M. Campos 1 , J.M. Giral- des 1 , L. Pádua 1 ; 1 Materno-infantil, Universidade Federal Fluminense, Niterói, Brazil Background and aims: Healthcare-associated infections (HAI) represents morbity and mortality in children admitted in Pediatric Intensive Care Units (PICU). Aims: To measure student’s performance in simulated training about prevention and control of HAI in PICU. Methods: A cross sectional study was performed at a public federal university of Rio de Janeiro, Brazil. Learning of prevention and control of HAI in PICU was done by simulated training in small groups of students of diferent areas of healthcare. Evaluation of training was measured by a pre and post-test applied before and after the activities. We used McNemar and Wilcoxon tests to compare results.he study was approved by Ethics Committee of Federal Fluminense University. Results: We train 29 students (22 of medicine and 7 of nursing). he following themes were approached: hand washing, prevention of bloodstream infection related to venous central catheter, prevention of pneumonia related to mechanical ventilation, preven- tion of urinary tract infection related to vesical catheter and biosecurity. Performance in pretest evaluation (correct answers) of the previous items were, respectively: 49,8%, 44,1%, 51,7%, 73,3% and 54,3%. After the practical lessons the results were, respec- tively: 76,8% (p<0,001), 71% (p<0,001), 82,1% (p<0,001), 93,1% (p<0,001) and 78% (p<0,001). Global rates of correct answers in pretest was 50,8% against 79,1% in post-test (p<0,001). here’s no statistical diference about rates of correct answers according the students course or the theme of classes. Conclusions: Practices classes of LPEC IRAS utilizing simulators improve knowledge about major themes in pre- vention of HAI in PICU. his methodological approach can be reproduced by others countries to help health students in this matter. 711 CHALLENGES OF PHARMACOKINETIC/PHARMACODY- NAMICS (PK/PD) STUDIES WITHIN PICU: RESEARCH NURSE EXPERIENCE AND POTENTIAL SOLUTIONS S. Siner 1 , L. Byrne 1 , E. Scott 1 ; 1 PICU, Alder Hey Children’s Hospital, Liverpool, United Kingdom Background and aims: 2007 EU regulations encourage PK/PD studies within pae- diatrics to ensure safer, more efective drug dosing 1 Our 23 bedded PICU admits around 1200 children annually and has >180 nursing staf. Since 2011 our unit has conducted 3 PK studies. PK studies recruit small numbers of patients but require precisely timed blood samples. Aims: To explore the challenges of PK studies in prac- tice within PICU. Methods: A retrospective view of study participation. Results: Drug prescribing is driven by clinical need, therefore it is diicult to predict when patients will become eligible for studies and at times has been diicult to gain full sets of data. Lack of 24hr research nurse cover can hamper accurate administration and sampling. PICU nurses work in a busy and stressful environment and research activities are lower on the list of their clinical priorities. Small number of recruits means nurses have limited exposure to patients on PK studies, signiicant support is necessary for accurate data. Drug administration, particularly IV infusions can lead to inaccurate timings. We’ve found it important to standardise the way IV drugs are given, ensuring the lush is included in timings. his has been diicult to enforce when research nurses are not present. To overcome these issues we produced a guid- ance sheet for the bedside nurses, prompts for infusion delivery in prescription chart and provided ongoing bedside training. Conclusions: PK studies ofer many chal- lenges to the research nurse. Unpredictability of prescribing, large numbers of nurs- ing staf and busy PICU environment can lead to data inaccuracies in PK studies.