Fewer Respiratory Admissions in Covid‐19 Era

Abstract

The baby was born full term via spontaneous vaginal delivery to non-consanguineous parents (Table 1). He was breastfed every 3-4 h. At 57 h-of-life, he missed a feed stretching to a 6-h feeding interval. He was then noted to be hypothermic, pale and lethargic with a weak cry. He was also hypotonic and had hepatomegaly. He was transferred to the special care nursery. Investigations showed hypoglycaemia (1.5 mmol/L) and transaminitis (Table 1). He was treated with a 10% dextrose bolus (2 mL/kg) and maintained on Solution 120 (dextrose containing fluids) at 120 mL/kg/day. Within 24 h, the patient's lethargy, hypothermia and hypoglycaemia resolved but abnormal transaminases persisted. The metabolic service was consulted on day 4 of life and the differential diagnosis included fatty-acid oxidation and glycogen storage disorders. The patient was transferred to the tertiary hospital for management. Septic work-up was negative. The laboratory findings of rhabdomyolysis and transaminitis especially AST which is present in high concentrations in skeletal muscles were more in keeping with a fattyacid oxidation disorder. The abnormal acylcarnitine species (particularly C14:1 and its ratio to C10) in the dried blood spot, increased C4:1 species on qualitative analysis of the plasma carnitine and results of the genetic and enzymatic tests supported the diagnosis of VLCAD deficiency (Table 1). With low long-chain fat diet supplemented with medium-chain fats, the creatine kinase gradually decreased. Our patient had a severe and early clinical presentation with significant hypoglycaemia and rhabdomyolysis with no cardiac involvement. Management of the patient included a low long-chain fat diet supplemented with medium-chain fats and avoidance of prolonged fasting or dehydration to prevent complications such as hypoglycaemia and rhabdomyolysis. 2 When the patient is unwell, especially with poor oral intake, the parents have been advised to call the metabolic service and present early to an emergency department for prompt assessment and intravenous glucose therapy. This case highlights that: (i) a fatty acid oxidation disorder should be suspected in newborns/infants with unexplained hypoglycaemia and/or acute liver disease, rhabdomyolysis and cardiac arrhythmias/ cardiomyopathy; (ii) glucose-containing fluids should be started; (iii) newborns with a fatty-acid oxidation disorder can become symptomatic even before newborn bloodspot screening can be done; and (iv) Prompt referral to a metabolic service is recommended.

Review of Ireland’s First Year of the COVID-19 Pandemic Impact on People Affected by Eating Disorders: ‘Behind Every Screen There Was a Family Supporting a Person with an Eating Disorder’

“…Reporting and media coverage has highlighted increased contact with eating disorders services has also occurred internationally. In Australia, hospital admissions have increased for anorexia nervosa, with patients requiring medical stabilisation, with factors such as anxiety and stress thought to play a role [ 32 , 33 ]. The Butterfly Foundation reported 150% increase in calls during the first school term compared to the same period 2019 [ 34 ].…”

Trends in the Incidence of New-Onset Anorexia Nervosa and Atypical Anorexia Nervosa Among Youth During the COVID-19 Pandemic in Canada

“… 9 , 10 , 11 Two single-center studies from Australia also found an increase in hospitalizations during the first wave of the pandemic among adolescents with previously diagnosed anorexia nervosa. 12 , 13 Similarly, a recent single-center study in the US reported a doubling of hospitalizations for restrictive eating disorders during the COVID-19 pandemic. 14 To date, the association between the pandemic and its confinement measures and the genesis of new-onset anorexia nervosa or atypical anorexia nervosa has not been studied.…”

Very Long‐chain Acyl‐coa Dehydrogenase Deficiency: Case Report of Hypoglycaemia and Rhabdomyolysis in a 2‐day‐old Infant

“…The reduction in respiratory infection is consistent with the drop in influenza cases in Australia from 106 000 between 01 May to 31 July 2019 to just 642 in 2020. 2 Another contributor has been the collapse of tourism, with a 97% reduction in arrivals to Gold Coast Airport from May to July 2019 from 1 530 000 to 50 000 in 2020 meaning interstate children have not required admission to GCUH. 3 A troubling finding was a doubling of cases of children requiring acute in-patient care for eating disorders (EDs).…”

“…Management of the patient included a low long-chain fat diet supplemented with medium-chain fats and avoidance of prolonged fasting or dehydration to prevent complications such as hypoglycaemia and rhabdomyolysis. 2 When the patient is unwell, especially with poor oral intake, the parents have been advised to call the metabolic service and present early to an emergency department for prompt assessment and intravenous glucose therapy.…”

“…Mr Kai M Hong 2 Dr Joel Sadowsky 3 A/Prof Ronda F Greaves 2,4,5 Dr Joy Yaplito-Lee 1 Despite little acute illness in children due to COVID-19, we have witnessed extraordinary changes in the case mix of in-patient children managed at Gold Coast University Hospital (GCUH) during 2020. We conducted an audit of the registrar handover sheets used for the daily report and compared 01 May to 31 July 2020 to the corresponding period of 2019.…”