Conclusions: The predominant gas exchange impairment inBPD is a reduced VA/Q ratio. This can be described by the rightshift of the SpO2 vs. PIO2 relationship. This can be derivedfrom a single pair of PIO2 and SpO2 values and provides asimple method for defining BPD that grades disease severity.References[1] Jones JG, Jones SE. J Clin Monit Comput 2000;16:337–50.[2] Kjaergaard S, et al. Intensive Care Med 2003;29:727–34.[3] Olszowka A, Wagner P. Numerical analysis of gasexchange. Pulmonary gas exchange, vol. 1. New York:Academic Press; 1980. 263–306.

doi:10.1016/j.earlhumdev.2006.09.037——————————————————————————————————————————————————————————————

Neonatal transfers by advanced neonatal nursepractitioners: Is it time to end the debate?

Joanna Morrison, Irfan Ulhaq Cheema*

E-mail address: Irfan.cheema@addenbrookes.nhs.uk

Acute Neonatal Transport Service, Box 224, AddenbrookesHospital, Cambridge, CB2 2QQ, UK

Introduction: The outcome of neonatal transports conductedby Advanced Neonatal Nurse Practitioners (ANNPs) haspreviously been compared favourably with those conductedby Specialist Registrars (SpRs) [1]. With centralisation ofneonatal transport services, the traditional model of retriev-ing infants back to the base of the transport team is set tochange to that of a centralised team transferring infantsbetween several hospitals. This change in practice willinevitably bring new challenges for the staff. Junior doctorTsEuropean Working Time Directive (EWTD) is set to have aconsiderable impact on staffing of neonatal transport teams.Objective: This study was conducted to evaluate andcompare the role of ANNPs to that of SpRs in a centralisedtransport team.Methods: As a review of practice without patient identifyingdetails, approval by the ethics committee was not deemednecessary. Study was carried out by the centralised neonataltransport team for East of England. SpRs and ANNPs were onthe same roster and led the team accordingly, irrespective ofthe clinical status of the infant at time of referral.Emergency transfers carried out by the team over 1 yearwere included. Data on patient demographics, clinicalstatus, procedures undertaken and infantTs condition uponreaching the admitting hospital were collected from recordsof emergency transfers and analysed at the end of the studyperiod. Primary reasons for transfer included prematurity,respiratory, surgical and cardiac disorders as well asrepatriation and capacity management.Results: 313 emergency transfers were completed by 8 SpRsand 3 ANNPs. 170 transfers were led by SpRs and 143 byANNPs. 47.5% of ANNP transferred infants were ventilated,compared to 46.4% of infants transferred by SpRs (p=0.91).There were no significant differences between the twogroups in the pre- and immediate post-transfer physiologicalparameters (Table 1).

Parameter Teamlead by

Mean (S.D.) p value

Pre transfer pH ANNP 7.35 (0.10) 0.12SpR 7.33 (0.13)

Post transfer pH ANNP 7.33 (.17) 0.56SpR 7.31 (.20)

Pre transfer BP (mean) ANNP 46.5 (11.9) 0.79SpR 46.1 (12.4)

Post transfer BP (mean) ANNP 44.5 (12.1) 0.72SpR 40.3 (11.8)

Pre transfer temperature ANNP 36.8 (0.4) 0.26SpR 36.7 (0.6)

Post transfer temperature ANNP 36.9 (0.4) 0.57SpR 37.0 (.40)

Discussion: This is the largest study comparing the outcomeof transfers by SpRs and ANNPs in the UK. There were nosignificant differences between the groups in terms of theimmediate outcomes of the transfer. Our data suggest thatANNPs can lead a centralised emergency neonatal transportteam at least as effectively as a SpR.Conclusion: This study adds to evidence supporting moreadvanced roles for ANNPs as well as confirms the previouslypublished evidence on effectiveness of ANNPs in transport.Authors would suggest a skill-based rather than a title-based approach to clinical leadership on neonatal transportteam.Reference[1] Leslie A, Stephenson T. Arch Dis Child, Fetal Neonatal Ed. Nov

2003;88:509–12.

doi:10.1016/j.earlhumdev.2006.09.041——————————————————————————————————————————————————————————————

Are neonates born small for gestational age atincreased risk of developing early retinopathy ofprematurity?

E. Heckford, A. CurleyIntroduced by: A. Ogilvy-Stuart

E-mail address: emmaheckford@doctors.org.uk

Rosie NICU, Box 226, Addenbrooke's Hospital, Cambridge,CB2 2QQ, UK

Background: Retinopathy of prematurity (ROP) is a vasopro-liferative disorder of the eye that affects prematureneonates and can result in blindness. The Royal College ofOphthalmology guidelines recommend that all infants≤31 weeks gestation and/or ≤1500 g are screened for ROPfrom 6 to 7 weeks postnatal age [1]. In our unit a 29-weekgestation infant with birth weight (BW) <0.4th centile wasnoted to have stage 3 plus ROP bilaterally requiring lasertherapy at first ROP screen at 6 weeks.Objectives: To determine whether neonates born small forgestational age (SGA) are at increased risk of developing earlyROP and therefore should be screened at an earlier stage.

Table 1

134 Abstracts