P03 CLINICIAN VARIATION IN TREATING CHILDHOOD WHEEZE IN EMERGENCY DEPARTMENTS OF THE UNITED KINGDOM AND IRELAND – AN INTERNATIONAL SURVEY 1,2 MD Lyttle, 3,4 RO’Sullivan, 5 I Doull, 5 I Morris, 5,6 CVE Powell; 1 Emergency Department, Bristol Royal Hospital for Children, Bristol, UK; 2 Academic Department of Emergency Care, University of the West of England, Bristol, UK; 3 Department of Emergency Medicine, Cork University Hospital, Cork, Ireland; 4 Paediatric Emergency Research Unit, National Children’s Research Centre, Dublin, Ireland; 5 Department of Child Health, Children’s Hospital for Wales, Cardiff, UK; 6 Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK 10.1136/archdischild-2014-306237.3 Aims National clinical guidelines for childhood wheeze have existed for several years. Despite being one of the commonest reasons for childhood Emergency Department (ED) attendance, significant variation in practice has been demonstrated in other settings. The aim of this evaluation was to examine variations in practice of clinicians working in EDs in the UK and Ireland. Methods In March 2013, PERUKI EDs (generic and paediatric) were invited to respond to a departmental survey. Consultant clinicians responsible for childhood wheeze management within those EDs were also invited to participate outlining their per- sonal practice. Information regarding pharmacological and other management strategies was sought, including approaches to inhaled and intravenous (IV) therapies. Results 30 (100%) EDs and 186 (80%) clinicians responded. 29 (97%) EDs had wheeze guidelines and 13 (43%) had care path- ways. Amongst clinicians variation existed in dose, timing and frequency of inhaled bronchodilators for all levels of severity. On escalation to IV bronchodilators in severe wheeze 100 (54%) preferred salbutamol as their first line agent, 54 (29%) Magne- sium Sulphate (MgSO 4 ) and 27 (15%) aminophylline. 88 (47%) routinely administered IV bronchodilators sequentially and 30 (16%) concurrently, with the remainder basing either approach on case severity. 146 (79%) continued inhaled therapy after commencing IV bronchodilators. Of 173 who used IV salbuta- mol, 149 (86%) gave rapid boluses, 21 (12%) a longer loading dose, and 167 (97%) an ongoing infusion, each with a range of doses and durations. Of 176 who used IV MgSO 4 , all used a bolus only. 44 (24%) used non-invasive ventilation. Conclusions Significant variation in ED management of child- hood wheeze as reported by consultant clinicians exists despite the presence of national guidance. This reflects the lack of evi- dence in key areas of childhood wheeze and emphasises the need for further robust multi-centre research studies. P04 THE PHENOTYPIC EFFECTS OF ANTENATAL MULTIPLE MICRONUTRIENT SUPPLEMENTATION IN NEPALESE CHILDREN 1 D Devakumar, 2 JCK Wells, 3 SS Chaube, 1 NM Saville, 3 DS Manandhar, 1 A Costello, 4 JG Ayres, 5 J Stocks, 1 D Osrin; 1 Institute for Global Health, University College London, London, UK; 2 Childhood Nutrition Research Centre, University College London, London, UK; 3 Mother and Infant Research Activities (MIRA), Nepal; 4 Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK; 5 Institute of Child Health and Great Ormond Street Hospital, University College London, London, UK 10.1136/archdischild-2014-306237.4 Background A growing body of evidence suggests that changes in early-life environment can have lasting effects. To investigate this, we followed up children from a double-blind randomised controlled trial of antenatal multiple micronutrient (UNIMAPP) supplementation. The trial showed the intervention group was 77 g heavier at birth and 204 g heavier at 2.5 years, with a 2.5 mmHg lower mean blood pressure. Aims To investigate whether antenatal multiple micronutrient supplementation led to sustained phenotypic differences in mid- childhood. Methods The study was conducted in the south of Nepal, from September 2011-December 2012. We measured anthropometry, body composition using bioelectrical impedance (with a popula- tion specific isotope calibration), blood pressure and kidney dimensions by ultrasound. Spirometry was performed according to the ‘ American Thoracic Society/European Respiratory Society’ standards, adjusted for children. We produced a personal esti- mate of air pollution exposure by sampling respirable particle mass in the microenvironments in which the children reside. We calculated the crude difference by trial group, then constructed a directed acyclic graph from which we chose potential confound- ers in multiple linear regression models. Results We saw 841 children (80% of total), mean age 8.5 years. Other than maternal education and residence, children lost to follow-up were no different. The unadjusted mean (95% CI) dif- ference (intervention minus control), showed weight-for-age 0.05 z-scores (–0.09, 0.19), height-for-age 0.02 z-scores (–0.10, 0.15) and BMI-for-age 0.04 z-scores (–0.09, 0.18). Similarly there was no difference in blood pressure or lung function. The adjusted differences were similar for all outcomes. There was a tendency for girls in the intervention group to be slightly heavier with lower lung function values, but these results did not reach statistical significance. Conclusions Differences in phenotype were not apparent at 8.5 years between children born to mothers who received ante- natal UNIMMAP supplements compared with iron and folate. While not ruling out physiological differences and longer-term effects, our findings do not suggest a sustained effect of antena- tal micronutrient supplementation on growth. P05 NO EFFECT OF HELMET THERAPY CAN BE SHOWN IN INFANTS WITH POSITIONAL SKULL DEFORMATION: A RANDOMISED CONTROLLED TRIAL 1 RM van Wijk, 1 MM Boere-Boonekamp, 1 CMG Groothuis-Oudshoorn, 2 CPB van der Ploeg, 3,4 LA van Vlimmeren, 1 MJ IJzerman; 1 Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; 2 TNO Child Health, Leiden, The Netherlands; 3 Department of Rehabilitation, Pediatric Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands; 4 Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands 10.1136/archdischild-2014-306237.5 Aims To determine the effectiveness of helmet therapy com- pared with the natural course in children aged five months with positional skull deformation, measured at 24 months. Methods Pragmatic randomised controlled trial in 84 healthy five-month old infants with moderate to severe skull deforma- tion in The Netherlands. Infants were randomly assigned to six- month helmet therapy (Helmet Therapy, n = 42) or no helmet therapy (Natural Course, n = 42). Baseline measurements were performed at 5 months, follow-up measurements at 8, 12 and 24 months. Primary outcome was change in skull shape from 5 to 24 months assessed using plagiocephalometry (anthropometric measurement instrument). Furthermore, parental satisfaction (5-point Likert scale), side effects and motor development (BSID- III composite score) were assessed. Groups were compared using the independent t-test or chi square test. Change scores for plagio- cephaly (Oblique Diameter Difference Index – ODDI) and Abstracts A2 Arch Dis Child 2014;99(Suppl 1):A1–A212 on 5 May 2018 by guest. Protected by copyright. http://adc.bmj.com/ Arch Dis Child: first published as 10.1136/archdischild-2014-306237.4 on 7 April 2014. Downloaded from