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Background In March 2020, Covid-19 secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was declared a global pandemic. Methods This retrospective observational study included patients with Covid-19, managed in a single intensive care unit (ICU). We collected data on patient characteristics, laboratory and radiological findings and ICU management. Data are reported as median (interquartile range). Binary logistic regression modelling was used to identify variables at ICU admission associated with mortality. Results 85 patients (age 57.3 years [49.4–64.2], 75.3% male) were followed up for 34 days (26–40). The commonest comorbidities were hypertension (51.8%), obesity (48.7%), and type 2 diabetes (31.8%). Covid-19 presented with shortness of breath (89.4%), fever (82.4%), and cough (81.2%), first noted 8 days (6–10) prior to ICU admission. PaO2/FiO2-ratios at ICU admission were 8.28 kPa (7.04–11.7). Bilateral infiltrates on chest X-ray, lymphopenia, and raised C-reactive protein and ferritin were typical. 81.2% received invasive mechanical ventilation (IMV). Acute kidney injury occurred in 62.4% with renal replacement therapy required in 20.0%. By the end of the follow-up period, 44.7% had died, 30.6% had been discharged from hospital, 14.1% had been discharged from ICU but remained in hospital and 10.6% remained in ICU. ICU length of stay was 14 days (9–23). Age was the only variable at admission which was associated with mortality. PaO2/FiO2-ratio, driving pressure and peak ferritin and neutrophil count over the first 72-hours of IMV all correlated with mortality. Conclusions We report the clinical characteristics, ICU practices and outcomes of a South London cohort with Covid-19, and have identified factors which correlate with mortality. By sharing our insight, we hope to further understanding of this novel disease.

AimsAlthough rare, craniopharyngiomas are the commonest suprasellar tumour in childhood. Despite high overall survival, children and young people<19 years with craniopharyngiomas are at risk of multiple relapses and long-term tumour- and treatment-related neuroendocrine, cognitive and visual morbidity. We sought to provide, for the first time, a national standard for best practice based on currently available evidence for the assessment, treatment and follow-up of paediatric craniopharyngiomas under the auspices of the RCPCH, UK Children’s Cancer and Leukaemia Group (CCLG) and the British Society for Paediatric Endocrinology and Diabetes (BSPED).MethodsClinical questions were formulated based on a PICO (Population, Intervention, Comparison, Outcome) format by a multidisciplinary Guideline Development Group. Systematic searches were conducted via the Ovid MEDLINE (1946-February 2017) and Cochrane Library (2016, Issue 12) databases, identifying 2023 separate research articles. Publications underwent a three-tier filtering process and 300 were reviewed using the GRADE approach. Where recommendations could not be made, a two-stage international Delphi consensus process was conducted.Results44 clinical questions were identified, leading to 35 recommendations largely based on low to very low quality evidence. 30 further recommendations achieved >70% agreement via the Delphi consensus process. Important highlights include the recommendation that craniopharyngiomas are managed in tertiary paediatric centres with sufficient neuro-oncology, neurosurgery, endocrinology, radiology, pathology and neuropsychology multidisciplinary experience. At diagnosis, tumours should be graded using the ‘Paris’ grading system and subsequent surgical treatment tailored to avoid hypothalamic damage, with adjuvant upfront radiotherapy being offered where tumour resection is incomplete. Detailed recommendations on the neuroendocrine, ophthalmological and psychological pre-treatment assessment of patients and long-term follow-up of survivors are also made, with a review on the safety of growth hormone replacement therapy in this cohort.ConclusionsThese guidelines provide the first evidence- and consensus-based national recommendations for the management of paediatric craniopharyngioma, and highlight the need for further research in areas such as the efficacy of proton beam therapy, radiosurgery and intracystic therapies in children, and the management of late effects such as hypothalamic obesity. Through their implementation, we hope to achieve better consistency in the quality of care of such patients and improve long-term quality of survival.

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