Clinical Spectrum of Children with Acute Hepatitis of Unknown Cause.

BACKGROUND: Since January 2022, there has been an increase in reports of cases of acute hepatitis of unknown cause in children. Although cases have been reported across multiple continents, most have been reported in the United Kingdom. Investigations are ongoing to identify the causative agent or agents. METHODS: We conducted a retrospective study involving children referred to a single pediatric liver-transplantation center in the United Kingdom between January 1 and April 11, 2022. These children were 10 years of age or younger and had hepatitis that met the case definition of the U.K. Health Security Agency for confirmed acute hepatitis that was not hepatitis A through E and did not have a metabolic, inherited or genetic, congenital, or mechanical cause, in the context of a serum aminotransferase level greater than 500 IU per liter. We reviewed medical records and documented demographic characteristics, clinical features, and results of liver biochemical, serologic, and molecular tests for hepatotropic and other viruses, as well as radiologic and clinical outcomes. The outcomes were classified as an improving condition, liver transplantation, or death. RESULTS: A total of 44 children had hepatitis that met the confirmed case definition, and most were previously healthy. The median age was 4 years (range, 1 to 7). Common presenting features were jaundice (in 93% of the children), vomiting (in 54%), and diarrhea (in 32%). Among the 30 patients who underwent molecular testing for human adenovirus, 27 (90%) were positive. Fulminant liver failure developed in 6 patients (14%), all of whom received a liver transplant. None of the patients died. All the children, including the 6 who received liver transplants, were discharged home. CONCLUSIONS: In this series involving 44 young children with acute hepatitis of uncertain cause, human adenovirus was isolated in most of the children, but its role in the pathogenesis of this illness has not been established.

O6 Delivery of a national paediatric gastroenterology, hepatology and nutrition virtual teaching programme during the Covid-19 pandemic

IntroductionAt the onset of the Covid-19 pandemic, hospital educational activities were halted in order to focus on healthcare delivery and maintain social distancing. As a response to this disruption, BSPGHAN trainees set up the BSPGHAN Education Series, a twice- weekly virtual learning programme. The core objective of this programme was to deliver high quality paediatric gastroenterology, hepatology and nutrition (PGHAN) teaching during the pandemic.In this study, we analysed the attendances and feedback received from the education series, in order to guide future directions.MethodsWe reviewed the Zoom meeting attendance logs and Survey Monkey feedback forms for the BSPGHAN Education Series from April 2020 to December 2020. ResultsIn nine months, a total of 55 talks were delivered by 43 speakers. 23 (41.8%) sessions were gastroenterology-themed, 25 (45.4%) were hepatology-themed and 7 (12.7%) were nutrition-themed. Thirteen paediatrics gastroenterology units (12 in the UK and 1 in the United States) and all 3 UK tertiary paediatric liver centres contributed to the talks. The highest contributing centres were Birmingham Children’s Hospital (20 sessions), followed by King’s College Hospital (9 sessions) and Leeds Children’s Hospital (7 sessions).Attendance logs and feedback forms were available for 53 sessions. A total of 2369 attendances were logged, with a median of 41 attendees per session (IQR 31–54). Attendees from 22 countries have participated in these sessions.A total of 810 survey feedback forms were received, with a median of 14 forms received per session (IQR 10–18). 32% were filled in by PGHAN Grid trainees, 23% by consultants, 15% by clinical fellows. Allied Health Professionals (AHPs) comprised 6% of feedback returns. 54% of survey feedback respondents accessed the teaching sessions from home.An average of 98% (95% CI 96.3–99.2) survey respondents strongly agreed/agreed that the sessions were relevant to their learning. 97% (95% CI 96–98.7) of survey respondents strongly agreed/agreed that the sessions delivered were of high quality.DiscussionThe BSPGHAN series has been a positive initiative arising from the pandemic, providing access to high quality PGHAN education when local availability was paused, and giving a platform for the society internationally. Our report shows that the BSPGHAN Education Series has been well-received by attendees. The virtual sessions are more accessible compared to in-person teaching sessions, as evidenced by the high percentage of feedback respondents accessing the sessions from home.Looking ahead, the BSPGHAN Education Group, set up in October 2020, will play a vital role in the further development of the Education Series. Sessions are recorded and made available to BSPGHAN members on the BSPGHAN website- further work may include creating online learning modules centred around these recordings. AHP involvement is an area for development- for 2021, we hope to include more topics that will be relevant to their interests. AcknowledgmentsWe thank all speakers for contributing to the teaching programme, and to all trainees who have devoted their time and efforts towards organising and running the teaching programme.