{
  "abstract": "Why did you do this work? Paediatric Oral Fluid challenges (POFC) are a widespread, inexpensive intervention for a common presentation to paediatric emergency departments. However, anecdotally there is significant variation with regards to how they are undertaken (eg. indication, fluid type/volume and antiemetic use) and little consensus about what POFC protocol is most successful. If a standardised, evidence-based POFC protocol could be implemented, we may be able to promote regional best practice, reducing the need for IV fluids and hospital admission.What did you do? We aimed to identify current POFC practices across London by disseminating a survey utilising the London REACH (Research, Evaluation and Audit for Child Health) network. 1 Data gathered included indication for POFC, fluid type used, fluid volumes and frequencies used, antiemetic use and pass/fail criteria. For trusts that provided guidelines we compared practitioner reported practice with trust guideline practice recommendations. We also compared the guidelines provided to published guidance from the National Institute for Clinical Excellence (NICE) guidance for rehydration in gastroenteritis (NICE CG842), which recommends that if dehydration is present 50 mls/kg of Oral Rehydration Solution (ORS) is given over 4 hours, without an antiemetic.What did you find? We received 22 survey responses ( table 1) and 9 trust POFC guidelines. Gastroenteritis, poor oral intake and fever are the three most common indications for a POFC. Weight and age are the most common basis for calculating the total POFC fluid volume, however in 36% of responses (n=22) no calculations are used. Where specified (73% of responses, n=xx), fluid is reported to be given in frequent increments; usually every 5-10 mins,. Oral rehydration solution is used in 86% (n=22) of responses; however, apple juice, squash, water and milk are also commonplace. 59% (n=22) of responses can use an anti-emetic as part of a POFC; the antiemetic of choice is Ondansetron. Pass criteria are generally a combination of drinking a certain volume, not vomiting and positive clinical assessment. 9 trusts provided guidelines; 2 of the survey responses indicated guidelines were being fully followed in practice (table 2). 2 guidelines were fully adherent to NICE CG84 recommendations; 7 deviated either in amount of fluid per kg or total duration of the POFC.What does this mean? Our survey clearly reflects that clinical practice does not tend to follow NICE or local guidance fully. Reflecting on why this is; it is likely because children are highly variable and require pragmatic approaches to rehydration. What would we recommend? A systematic review of best practice in terms of the protocol for POFCs, and what makes them most successful. This can feed into a best practice guideline that we would aim to implement across the region, to improve the success of POFCs, reducing the need for admission and Intravenous fluids.Abstract 7800 Table 1Practitioner reported paediatric oral fluid challenge practice points as detailed in a total of 22 survey responses, n=22 (received from 22 trusts across the London region)Abstract 7800 Table 2Practitioner survey responses compared to their own guidelines provided and whether these guidelines followed NICE CG84 guidance (50 mls/kg of oral rehydration solution (ORS) is given over 4 hours, without an antiemetic) (trusts that provided guidelines= 9)References REACH London Network; Research, Evaluation & Audit for Child Health. London. c2021. [Updated 2024 Jan; cited 2024 Oct]. Available from www.reachnetworkldn.comNational Institute for Clinical Excellence; Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management; Clinical guideline [CG84]Published: 22 April 2009. www.nice.org.uk/guidance/cg84",
  "authors": [
    {
      "affiliations": [
        "Evelina Childrens Hospital"
      ],
      "name": "Rosie Roots"
    },
    {
      "affiliations": [
        "REACH network"
      ],
      "name": "Eva Loucaides"
    },
    {
      "affiliations": [
        "North Middlesex"
      ],
      "name": "Clare Mulvenna"
    },
    {
      "affiliations": [
        "Evelina Children’s Hospital"
      ],
      "name": "Yasmin Mahfouz"
    },
    {
      "affiliations": [
        "REACH London Network"
      ],
      "name": "REACH London Network REACH London Network"
    }
  ],
  "title": "7800 Paediatric oral fluid challenges in London; is there a standard protocol?",
  "uid": "0db45fd1-6d05-5458-ae1f-dd2cf48d4155"
}