The impact of passive smoking in infancy on respiratory morbidity during covid-19 pandemic: a birth-cohort study

Objective: To evaluate the role of passive smoking (PS) on the incidence of wheezing and overall respiratory morbidity in infants born during the first peak of the coronavirus (COVID-19) pandemic, compared to infants born during the preceding year. Method(s): We used data collected in our recently published retrospective birth cohort study of 588 infants, 294 in each group, born in February-March 2020 (COVID-19 group) compared to a control group born in February-March 2019 (pre-COVID-19 group), at one year of age, using parental, telephone questionnaires. The primary outcome of wheezing/bronchodilator were similarly decreased, in PS and in non-PS (NPS)1. We further, conducted a post-hoc subgroup analysis of the respiratory outcomes: recurrent wheezing, emergency-room (ER) visits, pneumonia and admissions due to lower-respiratory-tract-infections (LRTI), to account for PS exposure. Atopy, daycare attendance, breastmilk, cesarean-section, siblings and gestational age were included in logistic regression models. Result(s): Demographic, perinatal, and atopic characteristics were similar between the groups. In NPS, secondary outcomes, including wheezing (OR 0.43, 95%CI 0.24-0.76), LRTI admissions (OR 0.1, 95%CI 0.01-0.89), recurrent wheezing (OR 0.28, 95%CI 0.11-0.7), ER admissions (OR 0.32, 95%CI 0.13-0.8) and pneumonia (OR 0.16, 95%CI 0.04-0.57) showed significant decreases during the COVID-19 first year pandemic. However, in PS, we did not observe these decreases in the respiratory morbidities. Conclusion(s): This study uncovers the overwhelming hazard of PS in abolishing the effect of the first year of COVID19 pandemic lock-downs, on infant's major respiratory morbidities.

The impact of virtual diabetes care on clinical outcomes

Introduction: There has been a necessity for healthcare services to greatly adapt delivery of care since the onset of the COVID-19 pandemic. Virtual diabetes consultations within our paediatric department were quickly set up to ensure continued care for children and adolescents with diabetes. Objectives: The study aimed to identify if the COVID-19 lockdown in 2020 and thus, the introduction of virtual diabetic reviews, had impacted upon patient outcomes of HbA1c levels, annual diabetic blood tests and number of admissions due to diabetes. Methods: A cross-sectional study was conducted with children under the age of sixteen diagnosed with type 1 diabetes prior to 1st January 2020. All were under the care of the paediatric diabetes team at Blackpool Victoria Hospital, U.K. Data was collected on whether each patient had been reviewed virtually, whether they had undergone annual diabetic blood and urine tests, as well as the number of HbA1c tests each patient had in 2019 and 2020 and their respective levels. Pre-lockdown admissions in 2019 were compared to admissions in 2020. Results: 108 patients were included in this study;all were reviewed virtually at least once in 2020. 82.24% and 60.75% had annual review of diabetic investigations in 2019 and 2020 respectively. 92.52% had at least one HbA1c test in 2019, with the same percentage tested in 2020. There was no significant difference in the median HbA1c levels in 2019 and 2020 as shown by Wilcoxon signed-rank test for the paired samples (p = 0.9932). This was the same for patients on insulin pumps (p=0.2174). There was no significant difference in the average number of admissions for those on insulin pumps (p=0.8211), however there was a greater number of pre-lockdown admissions in 2019 for those on basal-bolus regimes than in 2020 (p=0.0056). Conclusions: Virtual diabetes care did not appear to have a detrimental effect on diabetic outcomes. This paves the way for it to continue to play an active role in delivery of paediatric diabetes care.

The spectrum of multisystem inflammatory syndrome (MIS-C) in children infected with severe acute respiratory syndrome coronavirus 2

Introduction: The impact of SARS-CoV-2 infections in children has generally been described as relatively benign. However, since April 2020, there have been reports of a new multisystem inflammatory illness affecting children and related to COVID-19 termed multisystem inflammatory syndrome in children (MIS-C). Aim: To describe 3 cases of children diagnosed with MIS-C and discuss the disease spectrum. Methods: We collected and reviewed data from 3 cases diagnosed with MIS-C admitted to our pediatric ward between October 2020 and January 2021. Discussion: MIS-C is a newly described disease that spans a spectrum of phenotypes and severity, and while it shares clinical similarities with Kawasaki disease, it has a unique set of epidemiological, laboratory, and prognostic characteristics. In this review, we hope to add to the understanding of this new entity. Statement of Novelty: This report discusses 3 cases of MIS-C and elaborates on the spectrum and immunology of this entity. Our cases are unique in their relatively wide spectrum and variability. We hope our own experience with MIS-C adds to the accumulating knowledge and understanding of this emerging disease.