Steam inhalation and paediatric burns during the COVID-19 pandemic

Brewster, Colin T; Choong, Jia; Thomas, Clare; Wilson, David; Moiemen, Naiem

doi:10.1016/s0140-6736(20)31144-2

Cited by 39 publications

(35 citation statements)

References 3 publications

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“…Out of all of them, 4 recovered the baseline situation before day 7, although 2 subsequently developed a late AKI. Of the other 8 patients: 3 continued in AKIN stage I at 7 th day, 1 increase to AKIN II and 4 to AKIN III [3]. Like in the study by Chen et al, we found that Early AKI patients had more TBSA% and worse severity burn scores.…”

Section: Early Acute Kidney Injury In Severe Burnssupporting

confidence: 81%

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Paediatric burns epidemiology during COVID-19 pandemic and ‘stay home’ era

D’Asta¹,

Choong²,

Thomas³

et al. 2020

Burns

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significant changes to society. It has changed the way people behave and how healthcare is provided. In our study, we seek to evaluate the impact of the pandemic on the epidemiology of burns in the paediatric population. Government-implemented lockdown measures and school closures have led to reduced outdoor activities and lifestyle changes. Our regional Paediatric Burns Centre introduced a new standard operating protocol involving a new phone consultation pathway, a secure email platform for effective communication with parents and tertiary referring hospitals. The aim is to reduce physical attendance to hospital where possible, streamline our referral service, avoid unnecessary admissions and empower parents where appropriate. We performed a retrospective comparison over five weeks in which the government imposed lockdown instructions from 23/3/2020 to 30/04/2020 (lockdown period) and compared it to a similar period from a year ago 23/03/2019 to 30/04/2019 (control period). During this period, the total attendance to our Emergency Department (ED) has decreased by 60% in the lockdown period (7127 versus 2936), as expected due to the national advice to avoid unnecessary visits to hospital. The incidence of burn injuries reported was instead greater in proportion-2.8% of all ED attendances, compared to 1.5% in the previous year, despite the overall decrease in total number of burn injuries (n = 83) by 24%. This could be due to a combination of the closure of some local and minor injury facilities, reduced faceto-face consultations with general practitioners and the advice given to the general public that even minor burn injuries still require medical attention for adequate treatment. This instruction is crucial for the well-known potentially lifethreatening complications of burns in children [1]. Concerns were raised by the Royal College of Paediatrics and Child Health that children may be coming to harm from delayed presentation to emergency departments for fears of contracting COVID-19 in hospital. In our cohort of burns patients, only 2 were deemed to have come to harm by delaying presentation. We also noted that the number of referrals to children social care increased from 4% (5/123) in the control period to 12% (12/ 95) in the lockdown period. The reduced opportunity to liaise with allied health professionals and education settings to share information and concerns and to finally agree on a plan for follow up might have been due to a more vigilant approach for the fear of missing child protection concerns. The mean age of patients presenting with burns increased from 2.9 to 4.8 years. School-age children are now spending more time at home due to school closures, and UK statistics have suggested that most burns happen at home [2]. Gender distribution is similar in both periods. The number of inpatients in our centre decreased by 37%. All patients required COVID-19 testing prior to admission to

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Section: Early Acute Kidney Injury In Severe Burnssupporting

confidence: 81%

“…Scald injuries remain the commonest cause of paediatric burn injuries (85% in the lockdown period, 68% in the control period). Recently, our centre observed a surge in scalds directly resulting from the practice of steam inhalation during the COVID-19 pandemic, as an unprescribed method to prevent and treat infection [3].…”

mentioning

confidence: 99%

Paediatric burns epidemiology during COVID-19 pandemic and ‘stay home’ era

D’Asta¹,

Choong²,

Thomas³

et al. 2020

Burns

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“…Also, complete or partial lockdowns in several African countries will hinder children's access to clinics and community-based immunization services (45)(46), and caregivers may avoid facility immunization visits due to fear of COVID-19 exposure. Abbas et al's benefit-risk analysis study reported that for every one excess death attributable to SARS-CoV-2 infection from exposure, 85,000 deaths could be averted among CU5 in SSA who successfully receive routine vaccinations (41).…”

Section: Vaccine-preventable Diseases (Including Diarrhea and Pneumonia)mentioning

confidence: 99%

“…In the US and in European countries, COVID-19-related movement restrictions including school closures have significantly reduced the incidence of road traffic accidents (81-82) and volume of pediatric emergency room visits (83-84). However, reports from these settings also indicate that domestic injuries (burns, accidental ingestion) have significantly increased in the same period (79,(84)(85). So far, there is little reported data on the indirect impact of COVID-19 on unintentional child injuries in SSA.…”

Section: Unintentional Injuriesmentioning

confidence: 99%

Things must not fall apart: the ripple effects of the COVID-19 pandemic on children in sub-Saharan Africa

et al. 2020

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Children aged 0–19 years in sub-Saharan Africa bear a disproportionate proportion of the global burden of communicable and non-communicable diseases. Significant public health gains have been made in the fight against these diseases. However, factors such as underequipped health systems, disease outbreaks, and conflict and political instability continue to challenge prevention and control. The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) introduces new challenges to public health programs in sub-Saharan Africa. Of particular concern are programs targeting major conditions among children, such as undernutrition, vaccine-preventable pneumonia and diarrhea, malaria, tuberculosis, HIV, and sickle cell disease. This article focuses on the impact of the COVID-19 pandemic on child health in sub-Saharan Africa. We review the epidemiology of major pediatric diseases and, referencing modeling projections, discuss the short- and long-term impact of the pandemic on major disease control. We deliberate on potential complications of SARS-CoV-2 co-infections/co-morbidities and identify critical social and ethical issues. Furthermore, we highlight the paucity of COVID-19 data and clinical trials in this region and the lack of child participants in ongoing studies. Lastly, approaches and interventions to mitigate the pandemic’s impact on child health outcomes are discussed. Impact Children in sub-Saharan Africa bear a disproportionate burden of communicable and non-communicable diseases globally; this remains true even as the COVID-19 pandemic persists.Amidst the fast-expanding COVID-19 literature, there is little comprehensive coverage of the pandemic’s indirect impact on child health in sub-Saharan Africa.This article comprehensively outlines the threat that the pandemic poses to major disease prevention and control for children in sub-Saharan Africa. It discusses the potential impact of SARS-CoV-2 co-infections/co-morbidities, highlights research gaps, and advocates for data and action to mitigate the ripple effects of the pandemic on this population.

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“…Worryingly, the warnings do not seem to be having the desired effect. A recent letter published in The Lancet [21] expressed concern over the increased use of steam inhalation for symptomatic treatment during the COVID-19 pandemic, with a subsequent increase in paediatric scald injuries. The authors reported 30-fold increase at their centre in the number of paediatric scalds directly resulting from steam inhalation since the start of UK lockdown.…”

Section: Discussionmentioning

confidence: 99%