ABSTRACT
BACKGROUND: In response to the COVID-19 pandemic, jurisdictions around the world implemented policies to reduce COVID-19 transmission through public masking, travel restrictions, and closure of non-essential businesses. Collectively known as non-pharmaceutical interventions (NPI), these strategies reliably reduce the spread of COVID-19. International data suggests NPI also reduce hospitalizations for pediatric respiratory infections and their consequences, particularly asthma exacerbation. However, few Canadian studies have examined the impact of NPI on hospitalizations for common causes of pediatric respiratory distress. OBJECTIVE(S): This study describes the impact of NPI on admissions for bronchiolitis, pneumonia, and asthma at a Canadian pediatric tertiary care centre. DESIGN/METHODS: A retrospective chart review was conducted including all pediatric patients <18 years admitted to the general pediatric and pediatric intensive care units with bronchiolitis, pneumonia, or asthma. Data regarding diagnosis, length of hospitalization, and mortality were collected before (September 2016-March 2020) and in the 6 months after provincial NPI implementation (March 2020-September 2020). NPI were present throughout this period, however, specific measures varied due to evolving public health orders. Chi-squared testing was conducted to describe the impact of NPI on number of admissions, length of hospitalization, and mortality. RESULT(S): Participants (n=1631) included 111 (6.8%) patients <1 month, 878 (53.8%) patients 1-23 months, 331 (20.3%) patients 24 months-4 years, and 311 (19.1%) patients >=5 years. A mean of 205 patients were admitted every 6 months with respiratory distress (bronchiolitis, pneumonia, and/or asthma) prior to NPI implementation. During this timeframe, the 6-month mean admissions due to asthma, pneumonia, and bronchiolitis were 48, 56, and 101, respectively. In the 6 months following NPI implementation, there were 56 admissions for respiratory distress, including 15 for asthma, 19 for pneumonia, and 22 for bronchiolitis. Mean length of stay increased following the implementation of NPI from 8.49 to 11.68 days, whereas 6-month mean mortality decreased from two to zero deaths. Results did not attain statistical significance (p>0.05). CONCLUSION(S): Results suggest NPI reduce hospitalizations and mortality from bronchiolitis, pneumonia, and asthma. Given the similar seasonality of these conditions, periodic use of NPI beyond the COVID-19 pandemic may reduce pediatric morbidity and mortality from common causes of respiratory distress. However, additional research is needed to describe the relationship between NPI and length of hospitalization. Future studies should also examine the impact of NPI on other pediatric infectious diseases to better characterize their utility.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has had marked effects on mental health, including in pediatric populations. Pediatric patients have faced mental health concerns at increased rates including anxiety and depression. Furthermore, patients with eating disorders represent a vulnerable group who have been negatively impacted as well, as a result of lack of support, loss of in-person follow-up and increased relapse. In our centre, and nationally, clinicians have noted a trend towards increased eating disorder referrals and increased hospitalizations during the pandemic. OBJECTIVE(S): The objective of this study was to determine the incidence, severity and triggers for eating disorders in the adolescent population during the COVID-19 pandemic and how it compares to the year prior. As well, the subset of patients who were hospitalized for medical stabilization were further analyzed to determine severity of illness. DESIGN/METHODS: A retrospective chart review compared the first year of the COVID-19 pandemic (March 2020-March 2021), to the previous 12 months. Inclusion criteria included referrals to an eating disorder clinic and inpatient admissions to pediatrics or mental health services during the specified time frame. Data collected included age of onset, triggers, comorbid mental health conditions, and weight measures. Among hospitalized patients, orthostatic vital changes, need for NG feeds, length of medical stabilization and length of mental health hospitalization were included. RESULT(S): Overall, 76 patients were included in the study. 44 (57.9%) were referred after COVID, which was significantly increased from the prior year (p=0.05). On average, patients presented at a younger age (14.2 +/- 2.3 vs. 14.9 +/- 1.9;p=0.08). Pre-COVID, approximately 44% of referrals were from family physicians and 19% from pediatrics. During COVID, approximately 39% were from family doctors and 25% from pediatricians. There was an increase in the number of patients requiring hospitalization for treatment (16 vs. 3), with 50% of the post-COVID admissions being direct from the ED Clinic on initial assessment. The reason for hospitalization was unstable vitals/ bradycardia in 68.7% of admissions;self-harm comprised the majority of the other admissions. CONCLUSION(S): Our results support national and international reports that eating disorder incidence has increased during COVID-19. Patients described loss of routine, anxiety, and isolation as triggers related to the pandemic. Disruptions to daily life including school, sports, recreation, and relationships had profound effects on the mental health of children. The effect of social media on body image has also contributed. It is important for clinicians to screen for mental health conditions, including eating disorders at all available opportunities. Furthermore, this study demonstrates the need for increased services at our centre. Limitations for this study include that it is a single-centre study with a relatively small patient population. As well, it does not capture patients who may have been referred only to psychiatry.