ACUITY OF PEDIATRIC INFLAMMATORY BOWEL DISEASE ADMISSIONS PRE AND DURING THE COVID-19 PANDEMIC

ABSTRACT

BACKGROUND The COVID19 pandemic has introduced new challenges to the diagnosis and management of pediatric Inflammatory Bowel Disease (IBD). Many patients have had limited access to their providers through telemedicine and may choose to delay non-emergent treatment for fear of risking exposure in healthcare settings. Additionally, the “hygiene hypothesis” would suggest that decreased microbial exposure secondary to social isolation may result in greater incidence of new IBD diagnoses and worsened exacerbations of preexisting disease, particularly in urban populations. We hypothesize that these factors resulted in worsened disease status upon admission. METHODS We conducted a retrospective chart review of pediatric patients with IBD admitted to a tertiary care center before the onset of the COVID19 pandemic (01/01/18 – 03/01/20) and during the pandemic (03/01/20 – 08/01/21). All patients ≤18 yrs old who were admitted for a flare or new diagnosis of IBD were included. Variables collected included demographics, admission indication, length of stay, laboratory markers of disease severity, surgical or endoscopic procedures performed during admission, and new treatments started on discharge. Data were analyzed using paired t-tests. Study was IRB approved. RESULTS The pre-COVID (N=50) and during-COVID (N=52) populations were similar in regard to demographic and clinical characteristics. More patients during-COVID19 underwent major surgical interventions (11.5% vs. 0%, p=0.007), and were started on biologic therapies or steroids (38.5% vs. 26%, p=0.09 and 11.5% vs. 0%, p=0.007 respectively). Length of stay was also increased during-COVID (5.5 days vs. 4.9 days, p=0.3). UC patients admitted during-COVID exhibited more severe thrombocytosis (483 vs. 419, p=0.2) while CD patients admitted during-COVID exhibited more severe anemia (10.7 vs. 11.6, p=0.1) and hypoalbuminemia (2.7 vs. 3.1, p=0.04). Although not significant, more patients during-COVID were admitted from urban areas (63.5% vs. 56%, p=0.2). DISCUSSION Increased length of stay and incidence of major surgical interventions and biologic therapy initiation suggest that pediatric patients admitted for a flare or new diagnosis of IBD during the COVID19 pandemic experienced worsened disease severity. More severe thrombocytosis, anemia, and hypoalbuminemia upon admission supports this correlation. We hypothesize that many families chose to delay presentation given fear of exposure to COVID19. Furthermore, partial department closures may have led to delays in seeing patients in-person and ultimately admission. Lastly, we suspect that during-COVID fewer patients were admitted from rural areas given they experienced less emotional stress and physical isolation than their urban peers. Uninterrupted exposure to farm animals and peers at school may have had a protective effect on microbiome balance and stress level.