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Lockdown during the COVID-19 pandemic: impact on infants with pyloric stenosis
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  1. Paediatric Surgery Trainee Research Network1,
  2. Felicity Arthur2,
  3. Rachel Harwood3,
  4. Benjamin Allin4,
  5. George Stephen Bethell5,
  6. Tristan Boam6,
  7. Sumita Chhabra7,
  8. Mary Patrice Eastwood8,
  9. Kathryn Ford9,
  10. Hannah Rhodes10,
  11. Sesi Hotonu11,
  12. Aileen Rooney12,
  13. Jennifer Billington13,
  14. Joseph Rutherford Davidson14,
  15. Greg Dewar10,
  16. Ciaran Durand8,
  17. Nick Engall15,
  18. Patrick Green3,
  19. Matthew Jobson16,
  20. Anthony Starr17,
  21. Lucinda GC Tullie18
  22. PSTRN Collaborative Group
    1. 1Collaborative Trainee Research Group, Paediatric Surgery Trainees, UK, UK
    2. 2Paediatric Surgery, Royal Hospital for Children, Glasgow, UK
    3. 3Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
    4. 4Oxford Radcliffe Hospitals NHS Trust, Oxford, Oxfordshire, UK
    5. 5University Surgery Unit, University of Southampton, Southampton, UK
    6. 6Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
    7. 7Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, Merseyside, UK
    8. 8Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
    9. 9Paediatric Surgery, John Radcliffe Hospital, Oxford, Oxfordshire, UK
    10. 10Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK
    11. 11Edinburgh Royal Infirmary, Edinburgh, UK
    12. 12Paediatric Surgery, Glasgow Children's Hospital Charity, Glasgow, UK
    13. 13St George's University Hospitals NHS Foundation Trust, London, UK
    14. 14Paediatric Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
    15. 15Paediatric Surgery, Manchester Children's Hospitals, Manchester, UK
    16. 16Paediatric Surgery, Chelsea and Westminster Healthcare NHS Trust, London, UK
    17. 17Paediatric Surgery, Morecambe Bay Health Authority, Manchester, UK
    18. 18Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK
    1. Correspondence to Miss Felicity Arthur, Royal Hospital for Children, Glasgow G51 4TF, UK; felicity.arthur2{at}ggc.scot.nhs.uk

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    The COVID-19 pandemic has posed challenges for the delivery of healthcare for infants with disruption to 6-week health checks and health visitor services.1 An area of particular concern is late presentation to the hospital.2 However, current data do not offer an objective picture of how significant a problem this may be, with other reports showing low rates of delays in presentation.3 Infantile hypertrophic pyloric stenosis (IHPS) is a common, non-infective infantile condition with a predictable clinical course and therefore a good indicator condition to assess for delays in presentation. We aimed to assess whether infants with IHPS presented later during ‘lockdown’ compared with the same period the preceding year.

    Ten centres within the UK (England, Scotland and Northern Ireland) contributed data from babies with IHPS via a website (covidinchildren.co.uk) between 23 March 2020 and 31 May 2020 (the COVID-19 lockdown period) and between 23 March and 31 May 2019 (controls). A total of 87 eligible infants were included, comprising 40 controls (46%) and 47 cases (54%). The demographic and baseline characteristics of the two groups were similar (table 1 and figure 1).

    Table 1

    Characteristics of control (2019 patients) and lockdown (2020) patients

    Figure 1

    Comparison between the age at presentation (A) and admission weight (B) of infants with IHPS in the control period (2019) and the lockdown period. No significant difference is seen between the two groups (age at admission p=0.64, admission weight p=0.84). IHPS, Infantile hypertrophic pyloric stenosis.

    Median age and weight at presentation in the control group were 31 days (24–41) and 3600 g (3190–4081), and those in the lockdown group were 34 days (26–41) and 3580 g (3120–4085). These differences were not statistically significant (p=0.64, p=0.84) (figure 1). The change in standardised weight loss was also comparable. (table 2). Patients requirement for preoperative intensive care and serum biochemistry was also similar except the lockdown group had a statistically but not clinically significant higher serum potassium (4.16 vs 4.5 mmol/L, p=0.04) (table 2).

    Table 2

    Comparison of the primary and secondary outcome measures for infants presenting during the lockdown and control periods

    As an indicator condition, we have some reassurance that infants with IHPS have not had a significantly delayed presentation due to the COVID-19 lockdown. A recent objective study looking at paediatric presentations to emergency departments found very low numbers of delayed presentations to the hospital, with minimal associated morbidity.3 4 Prompt, proactive changes to National Health Service 111 algorithms, guidance for parents by the Royal College of Paediatrics and Child Health5 and the rapid uptake of virtual general practice and health visitor consultations may have avoided morbidity. Further work, focusing on different types of conditions, or different subsections of society will help provide useful information relating to the impact of societal lockdown on healthcare-seeking behaviour in the UK and will enable more effective delivery of healthcare provision and public messaging in the event of further lockdowns.

    References

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    Footnotes

    • Twitter @RachelHarwood10, @PaedSurgJoe

    • Collaborators PSTRN Collaborative Group: writing group: BA, FA, GB and RH. PSTRN Committee: BA, FA, GB, TB, SC, MPE, KF, RH, HR, SH and AR.

    • Contributors Writing group: BA, FA, GSB and RH. PSTRN committee: BA, FA, GSB, TB, SC, MPE, KF, RH, HR, SH and AR. Data contributors: FA, GSB, JB, TB, JRD, CD, GD, MPE, NE, PG, SH, MJ, AS and LGCT.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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