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To the Editor,The CORAL Birth cohort is a unique birth cohort project examining allergic and autoimmune dysregulation in infants born between March and May 2020, during the first SARS-CoV-2 lockdown in Ireland. We hypothesised that the dramatic social and environmental changes imposed by the pandemic-mandated lockdown would have implications on the incidence of allergic conditions, possibly mediated by changes in microbiome diversity. We report here interim data of health outcomes, including allergic conditions, at 12 months in this cohort.We have previously published health outcome data at 6 months. 1 A total of 365 infants were enrolled, and 344 were retained to 12 months.Allergic outcomes in the CORAL cohort were compared with a national pre-pandemic birth cohort from the BASELINE study. 2 The 12-month appointment involved skin prick testing (SPT), assessment of any atopic dermatitis (AD), lateral flow SARS-CoV-2 antibody testing and stool and blood sample for analysis. Patient demographic characteristics for the cohort at 12 months are outlined in Table 1.We hypothesised that social restrictions imposed by the SARS-CoV-2 lockdown would result in altered infant microbiome and atopic outcomes through reduced encounters with 'old friend' microbes brought to the infant through family members, creche and sibling school attendance. However, changes in other related health factors, including reduced antibiotic use and increased breastfeeding, which may positively affect gut microbiome diversity were also noted in this cohort.

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IntroductionThe SARS-CoV-2 (COVID-19) pandemic was managed with sustained mass lockdowns to prevent spread of COVID-19 infection. Babies born during the early stages of the pandemic missed the opportunity of meeting a normal social circle of people outside the family home.MethodsWe compared 10 parentally reported developmental milestones at 12-month assessment in a cohort of 309 babies born at the onset of the pandemic (CORAL cohort) and 1629 babies from a historical birth cohort (BASELINE cohort recruited between 2008 and 2011).ResultsCompared with a historical cohort, babies born into lockdown appeared to have some deficits in social communication. Fewer infants in the pandemic cohort had one definite and meaningful word (76.6% vs 89.3%), could point (83.8% vs 92.8%) or wave bye-bye (87.7% vs 94.4%) at 12-month assessment. Adjusted log-binomial regression analyses demonstrated significant differences in social communication in the CORAL cohort compared with the BASELINE cohort: one definite and meaningful word (relative risk (RR): 0.86 (95% CI: 0.80 to 0.92)), pointing (RR: 0.91 (95% CI: 0.86 to 0.96)) and waving bye-bye (RR: 0.94 (95% CI: 0.90 to 0.99)).DiscussionParentally reported developmental outcomes in a birth cohort of babies born into lockdown during the COVID-19 pandemic may indicate some potential deficits in early life social communication. It must be noted that milestones are parentally reported and comparison is with a historical cohort with associated limitations. Further studies with standardised testing is required to validate these findings.ConclusionPandemic-associated social isolation may have impacted on the social communication skills in babies born during the pandemic compared with a historical cohort. Babies are resilient and inquisitive by nature, and it is hoped that with societal re-emergence and increase in social circles, their social communication skills will improve.

ObjectiveThe 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.MethodsThe 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.Results354 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.ConclusionThe lockdowns and social restrictions made raising an infant challenging for all parents in Ireland. It is important parents know this was a shared experience.