key: cord-0064518-r3gwzhi1
authors: nan
title: THE PSYCHOSOCIAL IMPACT OF TYPE 1 DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS DURING THE COVID‐19 PANDEMIC
date: 2021-04-28
journal: J Paediatr Child Health
DOI: 10.1111/jpc.3_15467
sha: 784d38677f9652a6a96cdb7b1d1e86632cf0e6ab
doc_id: 64518
cord_uid: r3gwzhi1

nan

Background: Bilious vomiting (BV) in the neonatal period may herald malrotation with life-threatening volvulus. In NSW contrast fluoroscopy is not available in most non-tertiary paediatric centres; therefore transfer is required. An infant with BV referred to NETS NSW is prioritised for urgent transfer to a surgical centre for contrast fluoroscopy and paediatric surgical review via NETS medical or nursing led team, local nurse escort or paramedic transfer. This study aimed to determine how many neonates with BV need to be retrieved urgently to a surgical centre to prevent bowel loss or to save one life. Methods: All neonatal referrals (<29 days) to the NETS NSW service between 31st July 2014 -31st July 2020 with bilious vomits or aspirates were examined. Data on time of onset of BV, time of call for retrieval, lactate level at referral, time of arrival at the surgical centre and outcome were analysed. Results: Of 391 neonates referred with BV, 31(7.9%) had a life-threatening, time-critical malrotation and/or volvulus. All neonates were noted to be well at referral with normal vital signs including three neonates who subsequently died. Lactate levels at referral (1-7.5 mmol/L) were not predictive of outcome. The odds of a time-critical diagnosis increased with every day of age (OR = 1.097) and HR > 140 (p 0.04) and decreased for each kilogram of birth weight (OR 0.475; CI 0.294-0.768).

Conclusions: Neonates with BV require urgent referral to paediatric surgery and contrast fluoroscopy. Thirteen urgent transfers are required to preserve the bowel integrity and life in one baby. new national guidelines recommend a tiered approach to investigating aetiology in all children with hearing loss 1 .

Aim: To examine aetiology, comorbidities and health service use in a clinical cohort of children with permanent hearing loss.

Methods: We performed a retrospective audit of electronic medical records of 524 children attending the Caring for Hearing Impaired Children clinic from 2016-2019. Children born in 2016/2017 with bilateral moderate to profound hearing loss were offered whole exome sequencing (WES) as part of a research study 2 . We used descriptive statistics to summarise the data. We used chi-squared tests and logistic regression to investigate the relationship between aetiology and degree/laterality of hearing loss, and linear regression to investigate the relationship between degree of hearing loss, comorbidities and health services used.

Results: The majority (398/524, 76%) of children attending the clinic were diagnosed with hearing loss within the first 3 months of life, with 58/524 (11%) diagnosed after 4 years old. The median age at first clinic encounter was 1.7 years, 286/524 (55%) were male, and the majority of families resided in metropolitan areas (448/524, 85%). Overall 482/524 (92%) children had testing, which included 106/482 (22%) children born in 2016-17 who had WES testing. In children with bilateral moderate to profound hearing loss, 80 children received a definitive aetiological diagnosis without WES, with an additional 34 children receiving a definitive aetiological diagnosis with WES. The aetiology was confirmed in 234/482 (49%), suspected in 115/482 (24%) and unknown in 133/482 (27%). Amongst the 349 children with confirmed or suspected aetiologies, 17/349 (5%) had congenital CMV and 17/349 (5%) had enlarged vestibular aqueducts. Amongst children with bilateral hearing loss, who had testing, 67/215 (31%) had connexin mutation, 10/234 (4%) had STRC mutation, 4/234 (2%) had MYO15A mutation, 8/127 (6%) had Pendred syndrome and 2/67 (3%) had Usher syndrome. Amongst those with unilateral loss, 25/74 (34%) had hypoplastic/absent cochlear nerve on imaging. Overall, children with profound hearing loss were 2.7 times more likely to have an aetiology determined compared with those with mild hearing loss (OR 2.67, 95%CI 1.59 to 4.55, p < 0.001). The majority of children had medical comorbidities (313/411 (76%) bilateral, 73/113 (65%) unilateral loss). Most children attended otolaryngology (456/524, 87%), early intervention (362/524, 69%) and genetic (288/524, 55%) services. A positive correlation between total comorbidities and health service use was observed for all degrees of hearing loss (correlation coefficient 0.51, 95% CI 0.44 to 0.58], p < 0.001).

Conclusion: Children with hearing loss have diverse aetiologic profiles, comorbidities and health care needs. Most families elected to proceed with diagnostic testing. Current guidelines and expanded access to WES identified a confirmed/ suspected aetiological diagnosis in 73% of children tested. Identification of an underlying diagnosis was more likely if children had profound compared with mild hearing loss. Hearing loss was associated with multiple medical comorbidities which correlated with service use, regardless of hearing loss severity.

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