BACKGROUND-Brain-derived neurotrophic factor (BDNF) has been found to be important in energy homeostasis in animal models, but little is known about its role in energy balance in humans. Heterozygous, variably sized, contiguous gene deletions causing haploinsufficiency of the WT1 and PAX6 genes on chromosome 11p13, approximately 4 Mb centromeric to BDNF (11p14.1), result in the Wilms' tumor, aniridia, genitourinary anomalies, and mental retardation (WAGR) syndrome. Hyperphagia and obesity were observed in a subgroup of patients with the WAGR syndrome. We hypothesized that the subphenotype of obesity in the WAGR syndrome is attributable to deletions that induce haploinsufficiency of BDNF.

Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. However, during the societal disruptions secondary to the coronavirus (COVID-19) stay-at-home regulations, there have been reported changes to the pattern and severity of pediatric trauma. We review our twoinstitution experience. Methods: Pediatric trauma emergency department (ED) encounters from the National Trauma Registry for a large, tertiary, metropolitan level 1 pediatric trauma center and pediatric burn admission at the regional burn center were extracted for children less than 19 years from March 15th thru May 15th during the years 2015-2020. The primary outcome was the difference in encounters during the COVID-19 (2020) epoch versus the pre-COVID-19 epoch (2015)(2016)(2017)(2018)(2019). Results: There were 392 pediatric trauma encounters during the COVID-19 epoch as compared to 451, 475, 520, 460, 432 (mean 467.6) during the pre-COVID-19 epoch. Overall trauma admissions and ED trauma encounters were significantly lower ( p < 0.001) during COVID-19. Burn injury admissions ( p < 0.001) and penetrating trauma encounters ( p = 0.002) increased during the COVID-19 epoch while blunt trauma encounters decreased ( p < 0.001). Trauma occurred among more white ( p = 0.01) and privately insured ( p < 0.001) children, but no difference in suspected abuse, injury severity, mortality, age, or gender were detected. Sub-analysis showed significant decreases in motor vehicle crashes ( p < 0.001), pedestrians struck by automobile ( p < 0.001), all-terrain vehicle (ATV)/motorcross/bicycle/skateboard involved injuries ( p = 0.02), falls ( p < 0.001), and sports related injuries ( p < 0.001). Fewer injuries occurring in the playground or home play equipment such as trampolines neared significance ( p = 0.05). Interpersonal violence (assault, NAT, self-harm) was lower during the COVID-19 era ( p = 0.04). For burn admissions, there was a significant increase in flame burns ( p < 0.001). Conclusions: Stay-at-home regulations alter societal patterns, leading to decreased overall and blunt traumas. However, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.

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