Background The long-term prevalence and risk factors for post-acute COVID-19 sequelae (PASC) are not well described and may have important implications for unvaccinated populations and policy makers. Objective To assess health status, persistent symptoms, and effort tolerance approximately 1 year after COVID-19 infection Design Retrospective observational cohort study using surveys and clinical data Participants Survey respondents who were survivors of acute COVID-19 infection requiring Emergency Department presentation or hospitalization between March 3 and May 15, 2020. Main Measure(s) Self-reported health status, persistent symptoms, and effort tolerance Key Results The 530 respondents (median time between hospital presentation and survey 332 days [IQR 325–344]) had mean age 59.2±16.3 years, 44.5% were female and 70.8% were non-White. Of these, 41.5% reported worse health compared to a year prior, 44.2% reported persistent symptoms, 36.2% reported limitations in lifting/carrying groceries, 35.5% reported limitations climbing one flight of stairs, 38.1% reported limitations bending/kneeling/stooping, and 22.1% reported limitations walking one block. Even those without high-risk comorbid conditions and those seen only in the Emergency Department (but not hospitalized) experienced significant deterioration in health, persistent symptoms, and limitations in effort tolerance. Women (adjusted relative risk ratio [aRRR] 1.26, 95% CI 1.01–1.56), those requiring mechanical ventilation (aRRR 1.48, 1.02–2.14), and people with HIV (aRRR 1.75, 1.14–2.69) were significantly more likely to report persistent symptoms. Age and other risk factors for more severe COVID-19 illness were not associated with increased risk of PASC. Conclusions PASC may be extraordinarily common 1 year after COVID-19, and these symptoms are sufficiently severe to impact the daily exercise tolerance of patients. PASC symptoms are broadly distributed, are not limited to one specific patient group, and appear to be unrelated to age. These data have implications for vaccine hesitant individuals, policy makers, and physicians managing the emerging longer-term yet unknown impact of the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07379-z.

Posters 316 stress (serious quarrel with classmates, physical activities) have been observed. The patients had no coronary risk factors. Their average blood pressure was 150/90 mmHg and heart rate was 120 beats/ min. ST-segment elevations and T-wave inversions were registered on electrocardiograms of teenagers. Dysfunction and dyskinesia of the left ventricle apex and interventricular septum was detected on echocardiography. The levels of creatine kinase-MB and troponin I did not increase. Occlusions and anomalies of vessels were not demonstrated by aortocoronarography. Tako-Tsubo cardiomyopathy was diagnosed in all cases. Symptomatic medical treatment had been administered and the function of heart was normalized within 3-4 weeks. Conclusions:Tako-Tsubo cardiomyopathy may occur not only in adults, but in teenagers too. Therefore increased awareness of Tako-Tsubo cardiomyopathy will lead to its more frequent diagnosing, which will result in adequate medical management. (3) and Branch Pulmonary Stenosis( 2). 6 of these (31%) with significant lesions were referred to tertiary cardiac centre for further assessment/intervention. 617 Conclusion:Childhood murmurs are sometimes transient and vast majority of persistent murmurs are innocent. Asymptomatic murmurs after infancy could be reviewed by paediatricians and persistent or symptomatic ones referred to paediatric cardiac clinic. Facility to perform an echocardiography at district general hospital will help in confirming innocent murmurs and more importantly reassuring anxious parents. It also has a role in detecting few, yet significant, congenital heart conditions that could then be referred on to tertiary centre. SIGNIFICANCE OF MURMURS IN INFANCY

Aims Overweight-obesity is an emerging major health issue in children in the UK. Success of any initiative to address this and mitigate its potential health burden during adulthood relies on proactive engagement of children, parents and professionals. Paediatricians will naturally be at the forefront of such interventions. This study explores if opportunities available in children's outpatient clinics are utilised effectively. Methods This retrospective study looked at 1000 data-sets (routine height and weight) of 2-16 year-old children who attended clinics in the paediatric outpatient department of an inner-city District General Hospital between April 2008 and March 2009. We calculated body mass index (BMI) to identify overweight or obesity as described in the NICE guideline (UK 1990 BMI growth reference chart). Clinic letters from our electronic database were checked to answer three specifi c questions -Was overweight-obesity recognised? Was it discussed with the parent? Was any action initiated to address this issue? Results In this cohort of 1000 children, 231 (23%) were underfi ve; 483 (48%) were 5-11 year-old and 286 (29%) were over-11 to 16 year-old. 583 (58%) were boys. BMI plots revealed that 152 (15%) were obese and 121 (12%) were overweight. 106 (25%) girls and 167 (29%) boys were overweight-obese. Prevalence of overweight-obesity -27.3%-and its distribution among boys (29%) in this cohort correlate with a recent UK-wide survey (2008). Information extracted from clinic letters suggested that only 4 out of 10 overweight-obese children (38%; n=104) were recognised -better if obese (56%; n=84) than overweight (17%; n=20). Documentation of discussion was even less frequent. Specifi c action was initiated only in 43% of obese (n=65) and 10% of overweight (n=12) children.

Trisomy18 (Edwards's syndrome) is the second commonest trisomy. While most affected foetuses either die in-utero or terminated following antenatal diagnosis, postnatally diagnosed cases create a major ethical dilemma. We reviewed five postnatally diagnosed Trisomy 18 cases over last 4 years. Two were antenatally suspected to have dysmorphic features but parents declined diagnostic testing. All were born by emergency section for foetal distress needing resuscitation (3 at 33–36 weeks & 1 term). Echocardiogram confirmed heart defects in all (three Ventricular Septal Defects (VSD) and one Hypoplastic left heart syndrome (HLHS)). Although senior doctors counselled parents about this possibility with clinical suspicion, it was difficult to come to agreement until chromosomal confirmation. In two babies needing ventilation, intensive care was subsequently withdrawn after parents agreement, Baby1 (Large VSD) died in hospital and Baby2 (HLHS in whom prostaglandin stopped) died after going home. It was difficult to decide whether to stop oxygen/CPAP or to consider diuretics for Baby3 (Large VSD). Baby4 who underwent repair of oesophageal atresia after parents wanted full treatment is still alive aged 2 years (small VSD closed spontaneously). Palliative care after confirmation of Trisomy18 is not straightforward. This depends primarily on parental views. Severity of cardiac defects and ventilatory dependency at confirmation also play crucial roles. More severe cardiac defects are easier to counsel as we believe that invasive cardiac surgery is totally unethical. Court is also likely to support this even if it is against parents' wishes. While nasogastric feeds are thought to be a part of palliation, no-one is clear about others that prolong poor quality of life such as diuretics or oxygen. It may be argued that each case should be individualised and parent's decision should be final for non-invasive treatment. However when looking at baby's best interest, this poses a real challenge to neonatologists.