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Background and aims: The Coronavirus pandemic has imposed home-schooling on most countries. This became a new lifestyle for most children. Therefore, children’s physical activity, sedentary behaviours, nutrition, weight status and sleeping habits needed to be evaluated.

Methods: A seven-day recall questionnaire was distributed on local social media groups. Parents with children under 16 years of age were invited to anonymously fill the five-minute questionnaire on a voluntary-basis. Responses were collected over one week in June 2020.

Results: A total of 492 responses were received. Only 16.9% of children attained the recommended daily physical activity during the pandemic. 34.6% of all children were found to be overweight or obese (BMI z-score >1). Obese children were noted to be significantly less active (p=0.026). Home-schooling averaged 3 hours in primary school children and 3.6 hours in secondary school children. Additionally, most children spent a further 3 hours in sedentary activities during the pandemic. The average daily vegetable and fruit intake were 2 portions each. The preferred beverage was water (93.5%). Most children ate three main meals daily and over half ate an additional two snacks. The mean number of hours of sleep was 9.9 hours. 57.4% of children have an electronic gadget in their bedroom.

Conclusions: Physical inactivity, increased sedentary behaviours and low intake of fruit and vegetables were the main culprits of increased BMI in Maltese children during the Coronavirus pandemic. A better balance of home-schooling hours, physical activity and nutrition should be advocated especially if home-schooling will become the new norm.

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Social jetlag is linked with inconsistent sleeping patterns on work and free days and is said to result in poor sleep quality. Lifestyle factors including sleep quality may have an important role in gestational weight gain (GWG) during pregnancy. Hence, this study aimed to investigate the associations between gestational weight gain with social jetlag and sleep quality among pregnant women. Seven government maternal and child health clinics in Kuala Lumpur, Malaysia were randomly selected for recruitment. In total, 287 pregnant women in 2^nd and 3^rd trimester were recruited in this study. Maternal information such as pre-pregnancy body mass index (BMI), gestational age and gestational weight gain were extracted from maternal health records. Validated questionnaires were used to obtain data of sleep quality and social jetlag. Mean gestational week of pregnant women was 26.8 (7.5) weeks. Majority of pregnant women had an unhealthy rate of GWG whereby 69% had inadequate and 9% had excessive weight gain. Fifty five percent of pregnant women reported poor sleep quality and 56% had social jetlag. Positive significant correlation was found between social jetlag and sleep quality (r=0.146, p=<0.013). Pregnant women who experienced social jetlag had significantly lower rate of GWG (r=-0.12, p=0.042). In short, current study elucidates that pregnant women presented with social jetlag gained lesser weight and experienced poorer sleep quality. Future studies should look into recommending good sleep hygiene among pregnant women to ensure pregnancy progresses well.

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Optimal sleep during pregnancy is one of the key contributors to lower risk of pregnancy complications. This study aimed to determine the association between screen time with sleep quality among pregnant women. This cross-sectional study was conducted from September to November 2019 at 9 government maternal and child clinics in Kuala Lumpur, Malaysia. A total of 240 Malaysian pregnant women aged 19 to 39 were recruited. Screen time was self-reported using standard questionnaire and smart phone application. Sleep quality data was gathered using Pittsburgh Sleep Quality Index (PSQI) questionnaire. Overall, mean PSQI score was 5.72 ± 3.36 with poor sleep quality prevalent at 49%. Mean nocturnal sleep duration was 6.37 hours. Significant positive correlations were found between gestational age with subjective sleep quality (r =0 .14, p = 0.027), sleep disturbances (r = 0.19, p = 0.004) and global PSQI scores ( r = 0.15 , p = 0.018). Meanwhile, gestation age was negatively correlated with nocturnal sleep duration (r = -0.16, p = 0.011) and habitual sleep efficiency (r = -0.15, p = 0.024). Screen habits in an hour before bedtime were linked to poor sleep quality. About 80% reported usage of electronic gadget one hour before bedtime and this was associated with longer sleep latency (p = 0.006), higher sleep disturbances (p = 0.044), more daytime dysfunction (p = 0.02) and poorer sleep quality (p = 0.045). Further studies are warranted, particularly longitudinal-design study to better understand the underlying association between sleep quality and screen time during pregnancy.

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Background: The incidence of AKI in critically ill children is high and associated with increased mortality rate and risk of chronic kidney disease. AKI in pediatric DKA has not been systematically studied as a longitudinal follow-up of AKI.Primary Objectives: To study the renal functional status in children with acute kidney injury in diabetic ketoacidosis during one- year follow-up. Secondary Objectives: To study the factors associated with acute kidney injury in children with diabetic ketoacidosis, the time taken to achieve the operational definition of renal recovery, the fluid strategies used during the management of diabetic ketoacidosis and children with acute kidney injury and to study the time taken to diabetic ketoacidosis resolution in children with/without acute kidney injury. Methods: All children less than 13 years of age with DKA admitted in paediatric critical care unit were included. Enrolled patient who developed AKI during the management of DKA and were followed for upto one year with minimum of six months at interval of three month, to assess the renal functional status. Results: Among the total number of patients enrolled (n=48), patients developed AKI at admission are 33 (68.8%). In the 33 patients with AKI, six patients developed stage I AKI (18.2%), twenty patients developed stage II AKI (60.6%) and seven patients developed stage III AKI (21.2%). Only one AKI patient required renal replacement therapy.We found that the proportion of acute kidney injury in paediatric diabetic ketoacidosis is 68.8%, among them 15% (n=5) patients were progressed to chronic kidney disease at the end of one year follow up. Conclusion: we recommend that proper follow of patients who develop AKI in DKA is needed to prevent further progression to chronic kidney disease

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Background and Aims: Once obese as an infant, the relative risk of remaining obese appears to rise with increasing age. We aimed to evaluate the initial impact of a novel obesity prevention trial during infancy. We hypothesized intervention infants would have more optimal growth (weight-for-length Z (WLZ) scores closer to 50%) and enhanced self-regulation of energy intake than control infants 6-months post-baseline.

Methods: We used a two-group randomized repeated measures design. Infants (N = 71) were healthy and age 4-9 months at study onset. Intervention mother-infant dyads (n = 37) received 4 monthly lessons in responsive feeding and infant communication. Control dyads (n = 34) received usual care. Infants’ length and weight were measured in triplicate. Self-regulation of energy intake was measured as the difference between the mean of total Kcal from two 24-hour recalls and age-and-sex-specific estimated energy requirements; lower values represent greater self-regulation. Mixed models analyses were used.

Results: Intervention infants’ WLZ (n = 28) were not significantly different compared to control infants WLZ (n = 26) 6-months post baseline (0.43 ± 0.15 vs. 0.12 ± 0.15; p = 0.07 [one-sided]). Intervention infants (n = 32) demonstrated significantly enhanced self-regulation of energy intake compared to control infants (n = 26) 6-months post-baseline (120.90 ± 43.37 Kcal vs. 242.06 ± 48.73; p = 0.04 [one-sided]).

Conclusions: While we did not see hypothesized differences in WLZ, we did see positive effects on precision of infants’ reported energy intake, a key component of self-regulation of energy intake. Further study is warranted.

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Aims

Genital injuries in children are rare.¹We aimed to add to existing literature on accidental genital injuries and confirm that the Irish data are comparable internationally by performing a retrospective, descriptive audit comparing practices with The British Society for Paediatric and Adolescent Gynaecology (BritSPAG) guidelines on management of genital trauma in girls.². We aimed to create a proforma to aid doctors.

Methods

The Hospital Inpatient Enquiry (HIPE) system was searched to identify patients aged 0-14 admitted from 1995 – 2020 with genital injuries. Retrospective chart review was performed.

Results

Twenty-eight patients were included. The average age was 7.5 years. Fourteen (50%) had a labial laceration; 11(79%) labia majora and 3(21%) labia minora. 6(21%) had a posterior fourchette injury. Bruising was present in 16(57%). Clitoral injuries were noted in 4(14%). There were no hymenal injuries and most injuries were asymmetrical (48% right, 18% left). Regarding mechanism, 22(79%) reported straddle injuries [9(41%) related to bicycles] and 6(21%) reported penetrating injuries. Twelve(43%) required suturing/ EUA with 3(11%) requiring drainage of haematoma. Documentation of time of injury was noted in 11(39%) and the presence of a witness was documented in 8(29%). Paediatric review was performed in 5(18%) and child sexual abuse(CSA) was considered in 7(25%).

Conclusions

These results are in keeping with previous studies i.e. most accidental injuries lead to asymmetrical labial injury (lacerations/bruising) with less injuries seen on the fourchette or clitoris. Consideration of CSA is recommended particularly following penetrating injury and we aim to improve this aspect of documentation with our proforma.

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Background and case presentation

In current COVID-19 pandemic, severe infections with shock are being attributed to SARS-CoV-2. However, other pathogenic agents should not be overlooked. Our aim is to report a case of meningococcemia in a SARS-CoV-2 positive patient and highlight the importance of differential diagnosis, as well as the impact of an emergent disease.

A fourteen-year-old adolescent male, under psoriasis treatment with prednisolone, presented to the emergency department with 12-hour evolution of fever, dyspnea and vomiting. He lived in an area with high prevalence of SARS-CoV-2. Upon presentation he was poorly responsive, tachypneic, tachycardic and febrile. He had a petechial rash and prolonged capillary refill time. Intravenous antibiotic and fluid resuscitation were immediately started on the assumption of shock.

Laboratory tests revealed thrombocytopenia, high C-reactive protein, acute renal and cardiac failure and metabolic acidemia with hyperlactacidemia. Nasopharyngeal swab was positive for SARS-CoV-2.

Clinical deterioration with refractory shock and multiorgan dysfunction was observed, non-responsive to all treatment measures, resulting in subsequent death. Blood cultures were positive for Neisseria meningitidis B. The patient had not received vaccination for this strain of meningococcus.

Conclusion

Meningococcemia is a rare and sometimes fulminant disease. Therefore, prevention with appropriate vaccination and early diagnosis are of utmost importance. On the other hand, SARS-CoV-2, in the early pandemic era with limited clinical information, can cause life-threatening organ dysfunction. The authors debate wether corticosteroid treatment and SARS-CoV-2/ Neisseria meningitidis coinfection may have worsened the clinical course.

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INTRODUCTION:

Cow milk allergy (CMA) is an adverse immune reaction to milk proteins. Treatment consists of milk eliminating from diet. Controversy exists about effect of CMA &use of hypoallergenic formula and elimination diet (ED) on linear growth.

OBJECTIVES:

Evaluate growth status in infant and children diagnosed with CMA for 12 months of introducing ED.

MATERIAL AND METHODS:

We studied the longitudinal growth data of all infants and children diagnosed with CMA between 6-2016 and 12- 2017. The following anthropometric data (Wt, Ht were measured and weight Zscore (WTSD), height Zscore HTSDS, and BMI Zscore (BMISDS) and weight gain/day (WGD) calculated at diagnosis &after 12months of ED. IgE mediated CMA versus non-IgE mediated groups compared . A healthy age-matched group used as a control. ANOVA test used to compare variable among 3groups.

RESULTS:

Ninety-eight infants studied (49 CMA vs.49 controls). CMA infants divided into IgE-mediated, and non-IgE mediated. Multiple food allergies diagnosed in 22%of all infant with CMA(15% of non-IgE vs 25% of IgE). At presentation, WTSD, HTSDS, and BMISDS didn’t differ among the3groups. After a year of follow-up, Significant improvement occurred in WTSDS and BMISDS in the Non-IgE CMA group (P-value < 0.01).WtSDS of Non-IgE-CMA increased more significantly compared to IgE-CMA group (0.57+/-0.72 vs -0.33+/-0.75, P=0.00032). HtSDS didn’t differ between the 2groups at the end of follow up period.

Conclusion:

Significant weight gain achieved after the introduction of ED in infants with Non-IgE-CMA and IgE-M CMA. However, the WGD was more significant in the Non-IgE-CMA group.