Parenting a newborn baby during the COVID-19 pandemic: a qualitative survey.

OBJECTIVE: The COVID-19 pandemic caused long periods of lockdown, social isolation and intense challenges for parents. This study examines parenting in an infant cohort born at the pandemic onset. METHODS: The CORAL study is a prospective longitudinal observational study looking at allergy, immune function and neurodevelopmental outcome in babies born between March and May 2020. Demographic information was collected, babies were reviewed at 6-monthly intervals, and serology for COVID-19 infection was recorded. When babies were 12 months old, parents were asked for 3-5 words to describe raising a baby during the pandemic. Frequency of word usage was compared between first time parents and parents with other children, and parents of babies with and without a diagnosis of COVID-19 infection. RESULTS: 354 babies were recruited to CORAL study. Social circles were small. At 6 months the median number of people (including parents) who had kissed the baby was 3, and by 12 months one-quarter of babies had never met another child of similar age. 304 parents completed the word choice. Commonly reported words were lonely (44.4%), isolating (31.9%) and strong bond (15.8%). 12 of those 304 babies had COVID-19 in their first year of life and there was no significant difference in reported negative or positive word number compared with parents of babies without a COVID-19 infection, or by first time parents or those who already had children. CONCLUSION: The lockdowns and social restrictions made raising an infant challenging for all parents in Ireland. It is important parents know this was a shared experience.

Glycaemic control improves after continuous subcutaneous insulin infusion therapy: results from an Irish regional centre for paediatric type 1 diabetes mellitus.

OBJECTIVES: The use of continuous subcutaneous insulin infusion (CSII) in the management of paediatric patients with type 1 diabetes mellitus (T1DM) has increased substantially in the last decade. The aim of this study was to evaluate and compare glycaemic control in a population of paediatric patients with T1DM before commencing CSII compared with 2 years after commencing CSII. METHODS: This is a retrospective study with data collection from diabetes clinic records. Complete data were obtained on 34/45 eligible patients. Glycosylated haemoglobin (HbA1c) and body mass index (BMI) were compared 6 months pre- and 2 years post CSII commencement. Data were stratified in 6-month blocks. RESULTS: Mean HbA1c improved over 2 years post CSII with the lowest value in the first 6 months post-commencement. When gender, age, time since diagnosis and time on pump were added as covariates, results became non-significant, with only age exhibiting a statistically significant influence on glycaemic control (p = 0.03). This improved glycaemic control is associated with some increment in BMI which showed no statistical significance in the first year post-CSII. CONCLUSION: CSII commencement is associated with significantly improved glycaemic control most notably in the first 6 months after CSII commencement. There is association between CSII commencement and increased BMI noted to be statistically significant in the second year.

Therapeutic drug monitoring of darunavir/ritonavir in pregnancy.

BACKGROUND: Physiological changes during pregnancy can have a significant impact on antiretroviral pharmacokinetics (PK), which may result in reduced drug efficacy. Here we describe the PK of darunavir/ritonavir (DRV/r) 800/100 once daily in a cohort of pregnant women undergoing routine therapeutic drug monitoring (TDM) as well as transplacental passage of DRV by measuring and comparing cord blood and maternal blood samples at delivery. METHODS: Pregnant HIV-positive women received DRV/r as part of routine pre-natal care. Demographic and clinical data were collected. DRV plasma concentrations [DRV] were determined in the first (T1), second (T2) and third (T3) trimester and at postpartum (PP). The target concentration was 550 ng/ml. Where possible, paired maternal and cord blood samples were taken at delivery. RESULTS: A total of 33 women were enrolled. Samples were taken 14-20 h post-dose and measured concentrations were extrapolated to 24 h post-dose. At the time nearest to delivery, all but four had undetectable plasma viral loads (pVL). [DRV] were determined in 1 (T1); 14 (T2); 32 (T3) and 29 (PP). 1 sample was <550 ng/ml at T2, 6 at T3 and 3 at PP. [DRV] were significantly lower at T2/T3 relative to PP. CONCLUSIONS: [DRV] in T2 and T3 were 36-55% when compared with PP. However, DRV PK in pregnancy were not associated with a lack of virological suppression at delivery as of the 33 patients enrolled in this study, 31 had no HIV transmission from mother to child. Data regarding two candidates were not available as they delivered in a separate health-care facility.