Emma Children's Hospital Research Articles

A high rate of post thrombotic complication in pediatric portal vein thrombosis

IntroductionPortal vein thrombosis (PVT) is a rare disease in children and may be complicated by portal hypertension (PH), hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) but their incidence and risk factors are unknown. MethodsAn observational, retrospective cohort study of all consecutive children (≤18 years) with PVT treated at the Emma Children's Hospital Amsterdam University Medical Centers between January 1996 and January 2022 was conducted to identify the incidence and risk factors of these post thrombotic complications (PTC) in pediatric patients. ResultsIn total 43/ 703 thrombosis patients had PVT (boys 72.1 %; mean age 1.3 ± 0.5 years). Overall, 51 % of patients developed PH (n = 22), complicated by PPHTN in one of them. In 16 of 22 patients, PVT presented with portal hypertension. Clinically relevant bleeding due to portal hypertension occurred in 13 (59.1 %) patients with PH. The mean age at the first clinically relevant bleeding was 5.1 ± 5.9 years. Risk factors for the development of PH were lack of complete thrombus resolution (OR 24.3, 95 % CI 1.2–7.0; p = 0.008) and unprovoked VTE (OR, 35.4; 95 % CI 1.4–6.3; p = 0.012). Median time from PVT to PH was 137 days (range: 0 days to 5.04 years). ConclusionWe demonstrated that half of the patients develop PH after PVT, with a lack of thrombus resolution and unprovoked VTE as independent risk factors. This high incidence underlines the importance of long-term standardized follow-up of patients after PVT and standard screening in patients at risk of PTC.

Echocardiography for the 10-year prediction of cardiomyopathy in long-term survivors of childhood cancer

Abstract Background Childhood cancer survivors (CCS) treated with anthracyclines and/or chest-directed radiotherapy receive life-long echocardiographic surveillance to detect cardiomyopathy early. Current risk stratification and surveillance frequency recommendations are based on anthracycline- and chest-directed radiotherapy dose. We assessed the added prognostic value of an initial left ventricular ejection fraction (EF) measurement at >5 years after cancer diagnosis. Patients and methods Echocardiographic follow-up was performed in asymptomatic CCS from the Emma Children's Hospital (derivation; n=299; median time after diagnosis, 16.7 years [inter quartile range (IQR) 11.8–23.15]) and from the Radboud University Medical Center (validation; n=218, median time after diagnosis, 17.0 years [IQR 13.0–21.7]) in the Netherlands. CCS with cardiomyopathy at baseline were excluded (n=16). The endpoint was cardiomyopathy, defined as a clinically significant decreased EF (EF<40%). The predictive value of the initial EF at >5 years after cancer diagnosis was analyzed with multivariable Cox regression models in the derivation cohort and the model was validated in the validation cohort. Results The median follow-up after the initial EF was 10.9 years and 8.9 years in the derivation and validation cohort, respectively, with cardiomyopathy developing in 11/299 (3.7%) and 7/218 (3.2%), respectively. Addition of the initial EF on top of anthracycline and chest radiotherapy dose increased the C-index from 0.75 to 0.85 in the derivation cohort and from 0.71 to 0.92 in the validation cohort (p<0.01). The model was well calibrated at 10-year predicted probabilities up to 5%. An initial EF between 40–49% was associated with a hazard ratio of 6.8 (95% CI 1.8–25) for development of cardiomyopathy during follow-up. For those with a predicted 10-year cardiomyopathy probability <3% (76.9% of the derivation cohort and 74.3% of validation cohort) the negative predictive value was >99% in both cohorts. Conclusion The addition of the initial EF >5 years after cancer diagnosis to anthracycline- and chest-directed radiotherapy dose improves the 10-year cardiomyopathy prediction in CCS. Our validated prediction model identifies low-risk survivors in whom the surveillance frequency may be reduced to every 10 years. Calibration in both cohorts Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation

Venous Thrombosis in Children with Acute Lymphoblastic Leukemia Treated on DCOG ALL-9 and ALL-10 Protocols: The Effect of Fresh Frozen Plasma.

Background Venous thromboembolism (VTE) is an important complication for treatment of acute lymphoblastic leukemia (ALL) in children. Especially, ALL treatment, with therapeutics such as asparaginase and steroids, increases the thrombotic risk by reduction in procoagulant and anticoagulant proteins. Replacement of deficient natural anticoagulants by administration of fresh frozen plasma (FFP) may have a preventive effect on the occurrence of VTE. Methods We retrospectively analyzed all consecutive children (≤18 years) with ALL, treated on the Dutch Childhood Oncology Group (DCOG) ALL-9 and ALL-10 protocols at the Emma Children's Hospital Academic Medical Center between February 1997 and January 2012, to study the effect of FFP on VTE incidence, antithrombin and fibrinogen plasma levels, and VTE risk factors. Results In total, 18/205 patients developed VTE (8.8%; 95% confidence interval [CI]: 4.9–12.7%). In all patients, VTE occurred after asparaginase administration. In total, 82/205 patients (40%) received FFP. FFP supplementation did not prevent VTE or alter plasma levels of antithrombin or fibrinogen. In the multivariate analysis, VTE occurred significantly more frequently in children ≥12 years (odds ratio [OR]: 3.89; 95% CI: 1.29–11.73) and treated according to the ALL-10 protocol (OR: 3.71; 95% CI: 1.13–12.17). Conclusion FFP supplementation does not seem to be beneficial in the prevention of VTE in pediatric ALL patients. In addition, age ≥12 years and treatment according to the DCOG ALL-10 protocol with intensive and prolonged administration of asparaginase in combination with prednisone are risk factors. There is a need for effective preventive strategies in ALL patients at high risk for VTE.

Multilingualism was associated with lower cognitive outcomes in children who were born very and extremely preterm.

AimThis study determined whether cognitive outcomes differed between very preterm (VPT) and extremely preterm (EPT) children who were monolingual or multilingual when they reached the corrected ages of two and five years.MethodsThe data were collected at the Emma Children's Hospital, Amsterdam, The Netherlands, as part of our national neonatal follow‐up programme and comprised 325 VPT/EPT children born between January 1, 2007 and January 1, 2012. The study used the Third Editions of the Bayley Scales of Infant and Toddler Development and the Wechsler Preschool and Primary Scale of Intelligence.ResultsWe compared 234 monolingual children, 65 multilingual children who spoke Dutch and at least one foreign language at home and 26 multilingual children who didn't speak Dutch at home. The best performers on the cognitive scale at two years of age and the verbal subscales at five years of age were the monolingual children, followed by the children who spoke Dutch and at least one foreign language at home, then the children who only spoke foreign languages at home.ConclusionIn our study cohort from The Netherlands, multilingualism lowered the cognitive and verbal outcomes of VPT/EPT children at the corrected ages of two and five years.

A humidifier in the invasive mode during noninvasive respiratory support could increase condensation and thereby impair airway patency.

Humidifying noninvasively ventilated preterm infants is critical to prevent dehydration of respiratory mucosa, but over-humidification can result in impaired airway patency and lung mechanics. This neonatal bench study investigated the humidity delivered using invasive and noninvasive humidification modes during nasal continuous positive airway pressure. The study was conducted at the neonatal intensive care unit of Emma Children's Hospital, the Netherlands, in March 2014. A mannequin was connected to a CareFusion Infant Flow SiPAP system, combined with a Fisher & Paykel MR850 humidifier and a Carefusion Infant Flow LP Generator. We measured the temperature, relative humidity and absolute humidity at the humidification chamber's expiratory port and at the patient's mask. The absolute humidity at the mask was 35-40 mg H2 O/L at 38-39°C (relative humidity 74-80%) for the invasive mode of the humidifier and 23-27 mg H2 O/L at 34-35°C (relative humidity 63-70%) for the noninvasive mode. The absolute humidities exceeded the recommended values for the invasive mode of the humidifier, but not the noninvasive mode, and could be associated with increased condensation. The absolute humidity delivered by the humidifier in invasive mode could be associated with increased condensation, which has been associated with airway impairment.

Psychosocial care for children with haemophilia and their parents in the Netherlands.

Children growing up with haemophilia are at greater risk for psychosocial problems than their healthy peers. Providing psychosocial care to children with haemophilia and their families is indispensable, since psychosocial factors can have a significant impact on health and health-related quality of life (HRQOL). Our aim was to give a description of psychosocial care provided by the multidisciplinary team of the Hemophilia Comprehensive Care Centre (HCCC) at the Emma Children's Hospital in Amsterdam, the Netherlands. With this overview, other caregivers and hospitals can benefit in organizing their psychosocial care for children with haemophilia. The focus of the psychosocial care provided by the multidisciplinary team is on preventing psychosocial problems and medical-related stress, and supporting and equipping the child with haemophilia and its parents with as many skills as possible to lead an independent life with a high HRQOL. Core elements of the psychosocial care are therefore monitoring and screening of HRQOL (e.g. in daily clinical practice via www.hetklikt.nu), psychoeducation (haemophilia camp, haemophilia school, disease-specific activities, meetings for girls, parent meetings), practical help (Emma at Work, an employment agency for adolescents and young adults; Educational Facility and school visits), psychosocial interventions (the On Track group intervention and the Haemophilia Coping and Perception Test) and individual care (psychological counselling and referrals). By providing this overview of psychosocial support offered and by sharing this knowledge, psychosocial care can become more structured and consistent between HCCCs around the world. Potentially, processes and outcomes of care can be improved.

Assessments carried out by a child abuse and neglect team in an Amsterdam teaching hospital led to interventions in most of the reported cases.

This study described cases of child abuse and neglect (CAN) that were reported to the multiagency CAN team at the Emma Children's Hospital in Amsterdam and the resulting interventions. We carried out a retrospective review of all cases that were reported to the CAN team from 1 January 2010 to 31 December 2012. There were 27 prenatal cases, 92 referrals based on parental characteristics and 523 children. Overall, 1.2% of the children visiting the emergency department of our hospital, attending the outpatients department or being admitted were reported to the team. More than half of the referrals (55.1%) were confirmed as CAN. The most common diagnoses were as follows: witnessing intimate partner violence, physical neglect and emotional abuse. If CAN was confirmed an intervention was offered in 98.3% of cases. If a CAN diagnosis was undetermined or rejected, the figures were still 83.5% and 64.2%, respectively. Our results showed that CAN affected more than one in every 100 children visiting our hospital, and the expertise of our hospital-based CAN Team led to an intervention in the majority of the reported cases. The broad scope of problems that were encountered underlined the importance of a multidisciplinary CAN team.

Increasing Incidence and Recurrence Rate of Venous Thromboembolism in Paediatric Oncology Patients in One Single Centre Over 25 Years.

Venous thromboembolism (VTE) is a serious complication in paediatric oncology patients. To identify the incidence, risk factors and recurrence rate of VTE in paediatric oncology patients, an observational, retrospective cohort study of all consecutive children (≤18 years) with malignancies, treated at the Emma Children's Hospital Academic Medical Centre between January 1989 and December 2013, was done. A matched case-control study in children with lymphomas was performed, to identify thrombotic risk factors. Cumulative recurrence-free survival after first VTE was estimated by the Kaplan-Meier method. Of the 2,183 children included (male: female = 1.4:1.0; median age, 6.6 years) with cancer, 78 patients developed VTE (3.6%; 95% confidence interval [CI], 2.8-4.4). The incidence increased from 0.8% (4/478, 95% CI, 0.0-1.6) between 1989 and 1993 to 10.4% (44/423, 95% CI, 7.6-13.4) between 2009 and 2013. Independent risk factors for VTE were age ≥ 12 years, acute lymphoblastic leukaemia (ALL) and lymphoma. The case-control study in lymphoma patients showed a trend for increased VTE incidence in stage IV lymphoma. Twelve (15.4%) patients developed recurrent thrombosis, 7 patients while on therapeutic or prophylactic anticoagulation. The cumulative recurrence-free survival after first VTE was 88.5, 87.1 and 80.6% after 1, 5 and 10 years, respectively. In conclusion, we demonstrated an increasing incidence of VTE in children with malignancies, with age ≥ 12 years, ALL and lymphoma as independent risk factors. The elevated recurrence rate underlines the importance of full anticoagulant therapy and might warrant prophylactic anticoagulation after first VTE during cancer treatment.

Noncirrhotic Portal Hypertension in Perinatally HIV-infected Adolescents Treated With Didanosine-containing Antiretroviral Regimens in Childhood.

Noncirrhotic portal hypertension (NCPH) has been reported in HIV-infected adults. Antiretroviral drugs, as well as genetic and thrombophilic predisposition, have been suggested as possible etiologic factors. Clinical data were collected from 6 HIV-infected patients attending the Infectious Diseases Departments at respectively Emma Children's Hospital Academic Medical Centre in Amsterdam, The Thai Red Cross AIDS Research Centre, Bangkok, Imperial College Healthcare NHS Trust, London who were diagnosed with NCPH. All underwent extensive blood analysis, liver ultrasound, liver elastography, esophagogastroduodenoscopy and percutaneous needle liver biopsy for histological evaluation. We describe 6 perinatally HIV-infected adolescents, all female, who developed NCPH after prolonged exposure during childhood to a didanosine-containing antiretroviral regimen. Histology and electron microscopy showed periportal fibrosis and mitochondrial damage as key findings in their liver biopsies. One of these 6 patients required surgical intervention, the remainder have been managed conservatively to date. Thus, symptomatic NCPH may present in adolescence after perinatally acquired HIV-1 infection. In this case series, risk factors included female sex and prolonged exposure to antiretroviral regimens that included the nucleoside-analogue didanosine in childhood.

Consequences of Correcting Intelligence Quotient for Prematurity at Age 5 Years

To determine the effects of correcting for prematurity on full scale IQ (FSIQ), verbal IQ (VIQ), performance IQ (PIQ), and processing speed quotient (PSQ) scores, and to investigate whether differences between corrected and uncorrected FSIQ are associated with gestational age (GA), FSIQ, and age at assessment. Single-center consecutive cohort study. Data were analyzed from 275 very preterm children (GA <30weeks), born between January 2006 and December 2009 and assessed at 5years corrected age as part of the neonatal long-term follow-up program, at the Emma Children's Hospital in Amsterdam, The Netherlands. Outcome measures were FSIQ, VIQ, PIQ, and PSQ, calculated for uncorrected and corrected age. Paired sample t tests, repeated measures ANOVA, and ANCOVA were performed to explore differences between corrected and uncorrected IQ. Differences between corrected and uncorrected FSIQ, VIQ, PIQ, and PSQ ranged from 0-15 IQ points. All corrected IQ scores were significantly higher than uncorrected IQ scores (all P values <.001). Differences were larger at lower GAs, for higher IQ scores, and if time of assessment lay near the starting point of a 3-month age band of the Wechsler Preschool and Primary Scale of Intelligence-Third Edition-Dutch Version. Given the great variation observed in differences between corrected and uncorrected IQ scores, an international standard as to what age correction is appropriate should be pursued.

Parental child-rearing attitudes are associated with functional constipation in childhood

ObjectiveParenting factors are assumed to play a role in the development and maintenance of childhood constipation. However, knowledge about the association between parenting factors and childhood constipation is limited. This...

Individual prediction of heart failure among childhood cancer survivors.

To create clinically useful models that incorporate readily available demographic and cancer treatment characteristics to predict individual risk of heart failure among 5-year survivors of childhood cancer. Survivors in the Childhood Cancer Survivor Study (CCSS) free of significant cardiovascular disease 5 years after cancer diagnosis (n = 13,060) were observed through age 40 years for the development of heart failure (ie, requiring medications or heart transplantation or leading to death). Siblings (n = 4,023) established the baseline population risk. An additional 3,421 survivors from Emma Children's Hospital (Amsterdam, the Netherlands), the National Wilms Tumor Study, and the St Jude Lifetime Cohort Study were used to validate the CCSS prediction models. Heart failure occurred in 285 CCSS participants. Risk scores based on selected exposures (sex, age at cancer diagnosis, and anthracycline and chest radiotherapy doses) achieved an area under the curve of 0.74 and concordance statistic of 0.76 at or through age 40 years. Validation cohort estimates ranged from 0.68 to 0.82. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups, corresponding to cumulative incidences of heart failure at age 40 years of 0.5% (95% CI, 0.2% to 0.8%), 2.4% (95% CI, 1.8% to 3.0%), and 11.7% (95% CI, 8.8% to 14.5%), respectively. In comparison, siblings had a cumulative incidence of 0.3% (95% CI, 0.1% to 0.5%). Using information available to clinicians soon after completion of childhood cancer therapy, individual risk for subsequent heart failure can be predicted with reasonable accuracy and discrimination. These validated models provide a framework on which to base future screening strategies and interventions.

What brings children home? A prognostic study to predict length of hospitalisation

Adequate discharge planning could improve patient health and reduce readmissions. Increased accessibility and adequate use of hospital capacity are asking for an adequate discharge planning by means of efficient prediction of length of stay (LOS). Predictive factors of LOS for paediatric patients are lacking in the current available evidence. We aimed to identify these predictive factors in order to predict an optimal LOS. We conducted a prognostic study of all patients admitted to five different paediatric wards of Emma Children's Hospital, a tertiary university hospital in the Netherlands. We investigated possible predictive factors based on the literature and an expert panel categorised in patient characteristics and medical and non-medical factors. This preliminary list was scored for all patients at the moment of discharge. All significant or relevant factors were used in a linear regression model to predict the LOS. We included 142 patients and explored the relationship between 28 variables, reflecting a mix of patient characteristics, medical and non-medical factors and LOS. In a univariable analysis, 17 variables were significantly related with LOS. Multivariable analysis found seven independent variables: sex, age category, specialism, risk of malnutrition, complications, home care and the involvement of other disciplines. These seven variables explained 48 % of the LOS (R(2) of 0.476). Predictors of LOS consist patient characteristics, medical factors as well as non-medical factors (i.e. the need for home care and other disciplines). The latter factors can be influenced by changes in hospital policies.

Predicting Anthracycline‐induced Cardiotoxicity in Children – Genome‐Wide Association Study

Identified genetic markers for anthracycline‐induced cardiotoxicity (ACT) explain only a small fraction of the variability of this phenotype, suggesting the presence of other, as‐of‐yet unidentified susceptibility loci. Therefore, our goal is to identify additional genetic markers with large effect size via genome‐wide association study (GWAS).Patients were recruited and clinically characterized (age at start of treatment, cumulative dose, gender, anthracycline and tumor type, radiation therapy involving the heart, follow‐up time and assessment of LV dysfunction) via the Canadian Pharmacogenomics Network for Drug Safety. We have recruited and clinically characterized over 400 patients from across Canada to serve as our discovery cohort and over 120 patients from the Emma Children's Hospital in Amsterdam, the Netherlands, to be used as our replication cohort. More patients are currently being recruited and the clinical characterization is ongoing. We are now genotyping samples with an Illumina GWAS panel and the statistical analyses will be underway soon using SVS/Helix Tree, SPSS, Epi Info, PLINK and R.Novel genetic predictors for ACT may become essential for screening patients before the start of treatment, comprehensive risk assessment and management, and evidence‐based treatment decisions, monitoring and prevention.This work was supported by CIHR, CFRI, and Genome BC.

Then and now: Past Opitz winners discuss the influence of the award on their careers

Then and now: Past Opitz winners discuss the influence of the award on their careers

Heart Function Disorders In Sickle Cell Disease

AbstractAbstract 4815Abstract Background:Sickle cell disease (SCD) is a hereditary anemia characterized by chronic hemolytic anemia and vaso-occlusive episodes, associated with a high susceptibility for infections and damage to all vital organs. Cardiologic effects of SCD are dilatation and hypertrophy of the left ventricle and pulmonary hypertension. The prevalence of these cardiac complications in children with SCD living in the Netherlands is unknown. The role of hemolysis in this process is still unclear. Therefore, the objectives of this study are: 1) to evaluate the prevalence of cardiac abnormalities in children with SCD living in the Netherlands, 2) to analyse the association between cardiac abnormalities and the severity of anemia and hemolysis. Methods:Cross-sectional study, including 92 children with SCD (genotype HBSS, HBSC or HBS-beta 0) treated at the Emma Children's Hospital AMC. None of the children had cardiac abnormalities unrelated to SCD. Echocardiograms and electrocardiograms were performed in a stable state. All cardiac values were corrected for BSA. Echocardiographic values 20% above or under the average of an age matched control group were considered abnormal. Laboratory hematological parameters were obtained within one year of the cardiac imaging. All statistical analyses were performed with SPSS 18 software, using Pearson correlations and T-tests. Forced-entry multivariate regression analysis was conducted with hematological parameters, age and SCD genotype as independent variables and cardiologic parameters as dependent variables. Results:The study group had a mean age of 13 years (SD 5,5) and contained 49 boys (53,3%). All children had a normal shortening fraction. Almost half of the children (39%) had a dilated left ventricular internal diameter in diastole and systole. Dilatation was inversely correlated with the Hb level. When analysed with multivariate analysis, both Hb and bilirubin were independently associated with left ventricular dilatation, suggesting that hemolysis deteriorates cardiac structure by a mechanism separate from the effect of anemia. There was no association between the left ventricular dilatation and age. Conclusion:Pediatric sickle cell patients have significant dilatation of the left ventricle, an abnormality that is significantly and independently associated with the severity of anemia and bilirubin levels, but in spite retain a normal shortening fraction. Disclosures:No relevant conflicts of interest to declare.

469 Patient Safety: A Cultural Must!

Background and aims: Although patient safety has been a major topic in healthcare for more than a decade, the challenge remains to find effective and sustainable safety improvement programmes. A culture of safety is a key factor in the success of such programmes. We investigated the differences in patient safety culture on wards before the start of a safety program with wards where a safety program was implemented for several years. Methods: A survey was undertaken amongst paediatricians and specialized nurses by means of the Hospital Survey on Patient Safety Culture (HSOPSC) on wards without a safety program (group A) and on wards with a safety program (group B). The study took place at the Emma Children's Hospital, Amsterdam. Results: In group A 252 surveys were provided with a response rate of 67% (64% nurses). In group B 153 surveys were provided with a response rate of 53% (80% nurses). The HSOPSC consists of 40 questions, covering 11 dimensions. Results are presented in positive, neutral or negative ratings. We found the following significant differences between groups (A vs. B) in positive ratings: Ratings in the other dimensions were unchanged. Conclusion: Implementation of a patient safety programme improves some aspects in the culture on a ward, while other aspects demand more focused intervening.

Prevalence and Associated Clinical Characteristics of Behavior Problems in Constipated Children

Behavior problems are common in children with functional constipation. This study assessed the prevalence of overall, internalizing, and externalizing behavior problems in children with functional constipation and explored which clinical characteristics of constipation are associated with these behavior problems. Children who had functional constipation, were aged 4 to 18 years, and were referred to the gastrointestinal outpatient clinic at the Emma Children's Hospital were eligible for enrollment. This study made use of baseline data of 133 children who participated in a randomized, controlled trial that evaluated the clinical effectiveness of behavioral therapy compared with conventional treatment. Prevalence of behavior problems was assessed by the Child Behavior Checklist. Univariate and multivariate logistic regression models were used to test the association between clinical characteristics and behavior problems. The prevalence rate of overall, internalizing, and externalizing behavior problems was considerable: respectively 36.8%, 36.1%, and 27.1% compared with 9% in the Dutch norm population. A long duration of treatment was found to have the strongest association with overall and externalizing behavior problems in children with constipation. Children with constipation and nighttime urinary incontinence have an increased risk for having overall behavior problems. Fecal incontinence and the production of large stools seemed to be exclusively related to externalizing behavior problems. Behavior problems are common in children who have constipation and are referred to gastrointestinal outpatient clinics, suggesting that a behavioral screening should be incorporated into the diagnostic workup of children with constipation.

Analysis of the question–answer service of the Emma Children’s Hospital information centre

The information centre of the Emma Children’s Hospital AMC (EKZ AMC) is a specialised information centre where paediatric patients and persons involved with the patient can ask questions about all aspects of disease and its social implications. The aim of the study was to evaluate the question–answer service of this information centre in order to determine the role of a specialised information centre in an academic children’s hospital, identify the appropriate resources for the service and potential positive effects. For this purpose, a case management system was developed in MS ACCESS. The characteristics of the requester and the question, the time it took to answer questions, the information sources used and the extent to which we were able to answer the questions were registered. The costs of the service were determined. We analysed all questions that were asked in the year 2007. Fourteen hundred thirty-four questions were asked. Most questions were asked by parents (23.3%), healthcare workers (other than nurses; 16.5%) and nurses (15.3%). The scope of the most frequently asked questions include disease (20.2%) and treatment (13.0%). Information on paper was the main information source used. Most questions could be solved within 15 min. Twelve percent to 28% of total working hours are used for the question–answer service. Total costs including staff salary are rather large. In conclusions, taking over the task of providing additional medical information and by providing readily available, good quality information that healthcare professionals can use to inform their patients will lead to less time investment of these more expensive staff members. A specialised information service can anticipate on the information need of parents and persons involved with the paediatric patient. It improves information by providing with relatively simple resources that has the potential to improve patient and parent satisfaction, coping and medical results. A specialised information centre is therefore a valuable and affordable asset to an academic children’s hospital.

P01-220 - The psy-med unit (PMU); a unique integrated approach for children with invalidating therapy resistant functional complaints!

ObjectivePMU, Emma Children's Hospital, AMC Amsterdam, tertiary referral centre for children with invalidating functional complaints (at least two present):-impact on their social/family life's-given up their hobbies-school absenteeismComplaints; long-lasting (&gt; 3 months) and therapy resistantPMU-approach:•integrated approach starting at intake by paediatrician and psychiatrist/psychotherapist; → Explanation; body and mind belong together•Validation of complaints by full history and thorough physical examination → Complaints are real, no doubt.•Explanation of complaints by models (stress model, brain-gut axis, sensitisation model)•Individual treatment (rehabilitation, graded exercise, cognitive behavioural therapy etc.)Methods:•Retrospective observational study (charts) in children with abdominal pain (ap) and headache as primary complaint•Measuring persistence of complaints/ invalidation levelResults•66 pt evaluated (42 pt with ap, 24 pt with headache), 43 girls (65.2%) Age at first visit; mean 13.5 yr (range 6-17): -34 pt finished treatment-19 pt in treatment-6 pt one consult planned-5 pt no follow-up after intake-2 pt no complaints at moment of intake•Duration complaints: &gt;2 yrs in 31 pt (47.0%), school absenteeism ≥ 20% in 46 pt (69.7%), 33,3% visited &gt; 5 care providers for complaints.•16 pt (47.1%) treatment &lt; 6 months•25 pt (73,5%) lost/minimized complaints, 22 pt (64.7%) no school absenteeism.ConclusionPMU-approach; good results for this serious invalidated patient group with therapy resistant functional complaints. Note; relative small group, not yet long term follow-up.