A Drop in Number of Hospitalizations Among Children with Bacterial Infections During the COVID-19 Pandemic

Children hospitalised with gastroenteritis before and during the COVID-19 pandemic

AIMS

The COVID-19 pandemic altered the pattern of many paediatric infections. We aimed to assess the incidence and characteristics of children hospitalised with gastroenteritis during the early and the late pandemic, relative to previous years.

METHODS

In a retrospective study, we collected data from patient files of children aged 1 month to 5 years, admitted with gastroenteritis to a paediatric department in Denmark during January-June, of 2017 to 2021, comparing incidence rates and clinical features in the early pandemic (March to June 2020), and late pandemic period (January to June 2021), to similar pre-pandemic months.

RESULTS

In the early pandemic, admission rates per 1000 children/month declined to 0.5 (95% CI: 0.3-0.6) from pre-pandemic rates of 1.6 (95% CI: 1.4-1.7) (p < 0.0001) and increased in the late pandemic to 2.2 (95% CI: 1.9-2.6) (p = 0.006). Children admitted in the late pandemic period were older than those admitted previously.

CONCLUSION

A resurgence of gastroenteritis in children occurred in the spring of 2021, with higher hospital admission rates of children, who were older, but not more severely ill than previously.

Characteristics and spectrum changes of PICU cases during the COVID-19 pandemic: a retrospective analysis

Objective

This study aims to compare the changes in the disease spectrum of children admitted to the Pediatric Intensive Care Units (PICU) during the COVID-19 pandemic with the three years prior to the pandemic, exploring the impact of the COVID-19 pandemic on the disease spectrum of PICU patients.

Methods

A retrospective analysis was conducted on critically ill children admitted to the PICU of Hunan Children's Hospital from January 2020 to December 2022, and the results were compared with cases from the same period between January 2017 and December 2019. The cases were divided into pre-pandemic period (January 2017-December 2019) with 8,218 cases, and pandemic period (January 2020-December 2022) with 5,619 cases. General characteristics, age, and gender were compared between the two groups.

Results

Compared to the pre-pandemic period, there was a 31.62% decrease in the number of admitted children during the pandemic period, and a 52.78% reduction in the proportion of respiratory system diseases. The overall mortality rate decreased by 87.81%. There were differences in age and gender distribution between the two periods. The length of hospital stay during the pandemic showed no statistical significance, whereas hospitalization costs exhibited statistical significance.

Conclusion

The COVID-19 pandemic has exerted a certain influence on the disease spectrum of PICU admissions. Implementing relevant measures during the pandemic can help reduce the occurrence of respiratory system diseases in children. Considering the changes in the disease spectrum of critically ill PICU children, future clinical prevention and treatment in PICUs should continue to prioritize the respiratory, neurological, and hematological oncology systems.

Emergency department visits and hospitalizations for pediatric vaso-occlusive pain events during the COVID-19 pandemic

The coronavirus SARS-CoV-2 (COVID-19) pandemic altered all aspects of life, including healthcare. During the pandemic, social distancing led to decreased transmission of typical viral illnesses, leading to a decrease in these pediatric admissions. Studies have shown that pediatric emergency department (ED) visits and hospitalizations decreased during the pandemic, which may have led to some unmet healthcare needs and delays in treatment. Little is known about the effect of the COVID-19 pandemic on ED visits and hospitalizations specifically for pediatric sickle cell pain. A retrospective review across hospitals in the Northwell Health system was conducted to compare the ED visits and hospitalizations for pediatric patients with sickle cell pain during 2020 (the year of the pandemic), the following year (2021), and the 2 years prior to the pandemic (2018, 2019). The average length of stay for patients hospitalized with vaso-occlusive events was also compared between these years. Total 511 patient encounters for patients seen and discharged home from the ED and 985 hospitalization encounters were included over the 4-year timespan. ED visits per year decreased significantly in 2020 compared with the 2 years prior (p < .001): 91 visits in 2020, 162 visits in 2019, and 143 visits in 2018. The number of ED visits for pediatric vaso-occlusive events trended upward in 2021 to 115. Hospitalizations also decreased in 2020 compared to the 2 years prior (n = 202 vs 196; p < .001), compared with 298 in 2019 and 289 in 2018. The number of patients hospitalized remained stable in 2021 (n = 202 vs 196). There was a statistically significant increase in the median length of stay in 2020 compared to years prior (p = .002): median (interquartile range [IQR]): 4.0 days (2-6 days) in 2020 compared to 3.0 days (2-5 days) in 2018 and 2019. ED encounters and hospitalizations for pediatric patients with sickle cell disease pain decreased during the pandemic; however, admitted patients had a longer median length of stay.

Changes in paediatric Ambulatory Care Sensitive Conditions in Victoria, 2018-20: the COVID-19 effect?

Objectives This study sought to describe the patterns in emergency department (ED) presentations and hospital admissions in children with Ambulatory Care Sensitive Conditions (ACSCs) before and during the coronavirus disease 2019 (COVID-19) pandemic restrictions in Victoria, Australia, to assess if changes in out-of-hospital care resulted in an increase in delayed/severe presentations. Methods This study involved secondary analysis of Victorian Emergency Minimum Dataset and Victorian Admitted Episode Dataset data. Patients (<18 years) attending EDs with a diagnosis of an ACSC were included. We compared the number and severity of ASCS presentations pre-COVID-19 (1January 2018-27 March 2020) and during COVID-19 (28 March-31 October 2020). A linear regression prediction model was built to compare the observed versus predicted presentation number in the 2020 period. Results In total, there were 108 104 paediatric ACSC ED presentations in Victoria during the study period. Females accounted for 51 462/108 104 (47.6%) of all presentations, with a median age of 3 years. A significant decrease in ED presentations was seen in 2020 (41 319 in 2018; 44 978 in 2019; and 21 807 until October 2020), predominantly due to reductions in conditions that are typically mediated by viruses in childhood (i.e. asthma, convulsions/epilepsy and ear, nose and throat conditions). The proportion of high-urgency presentations and those requiring admission was stable in 2020. Conclusions An overall reduction in the number of ED presentations and admissions with paediatric ACSCs was seen in Victoria in 2020, indicating that rates of delayed or more severe presentations did not occur as a result of changes in out-of-hospital care.

COVID-19 Impact on Intern Exposure to Common Inpatient Diagnoses

OBJECTIVE

We sought to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical exposure of pediatric interns to common pediatric inpatient diagnoses.

METHODS

We analyzed electronic medical record data to compare intern clinical exposure during the COVID-19 pandemic from June 2020 through February 2021 with the same academic blocks from 2017 to 2020. We attributed patients to each pediatric intern on the basis of notes written during their pediatric hospital medicine rotation to compare intern exposures with common inpatient diagnoses before and during the pandemic. We compared the median number of notes written per intern per block overall, as well as for each common inpatient diagnosis.

RESULTS

Median counts of notes written per intern per block were significantly reduced in the COVID-19 group compared with the pre-COVID-19 group (96 [interquartile range (IQR): 81-119)] vs 129 [IQR: 110-160]; P < .001). Median intern notes per block was lower in the COVID-19 group for all months except February 2021. Although the median number of notes for many common inpatient diagnoses was significantly reduced, they were higher for mental health (4 [IQR: 2-9] vs 2 [IQR: 1-6]; P < .001) and suicidality (4.5 [IQR: 2-8] vs 0 [IQR: 0-2]; P < .001). Median shifts worked per intern per block was also reduced in the COVID-19 group (22 [IQR: 21-23] vs 23 [IQR: 22-24]; P < .001).

CONCLUSIONS

Our findings reveal a significant reduction in resident exposure to many common inpatient pediatric diagnoses during the COVID-19 pandemic. Residency programs and pediatric hospitalist educators should consider curricular interventions to ensure adequate clinical exposure for residents affected by the pandemic.

[Consequences of COVID-19 pandemic over acute bronchiolitis hospitalizations in the center and east of Spain]

INTRODUCTION

Non-pharmaceutical interventions that have been implemented in southern hemisphere countries because of COVID-19 pandemic declaration in March 2020, have evidenced some unexpected changes in the way of spreading of many other viruses. This study as a part of ECEALHBA's Project, reports the consequences of COVID-19 pandemic over 2020-2021 bronchiolitis epidemic period in the Central and Eastern regions of Spain.

METHOD

Multicenter, observational, descriptive and ambispective study of admitted infants with the diagnosis of bronchiolitis in 16 Spanish hospitals involved in the investigation project. Five epidemic periods previous to COVID-19 pandemic, from 2015 to 2020, were compared with the current one, 2020-2021, in both a qualitative and quantitative manner.

RESULTS

Total of 4643 infants were admitted to the participating hospitals along the study period. Pandemic season hospital admissions for bronchiolitis were 94.1% lower than in pre-pandemic period. December and January were peak months for bronchiolitis admissions during pre-pandemic period, but September was the peak month during pandemic year. There was a progressive decrease of admissions from this moment until the end of the follow up, in April 2021. Rhinovirus has been the commonest etiology for bronchiolitis in 2020-2021 epidemic period of bronchiolitis.

CONCLUSIONS

Some of the non-pharmaceutical interventions initiated because of COVID-19 pandemic are probably related to the dramatic decrease of bronchiolitis cases in 2020-2021 season. It would be rewarding to purpose novel research to clarify how these simple interventions can be useful, close to vaccines and antiviral drugs, to achieve the goal of avoiding the spread of respiratory viruses in pediatric population.

Consequences of COVID-19 pandemic over acute bronchiolitis hospitalizations in the center and east of Spain

INTRODUCTION

Non-pharmaceutical interventions that have been implemented in southern hemisphere countries because of COVID-19 pandemic declaration in March 2020, have evidenced some unexpected changes in the way of spreading of many other viruses. This study as a part of ECEALHBA's Project, reports the consequences of COVID-19 pandemic over 2020-2021 bronchiolitis epidemic period in the Central and Eastern regions of Spain.

METHOD

Multicenter, observational, descriptive and ambispective study of admitted infants with the diagnosis of bronchiolitis in 16 Spanish hospitals involved in the investigation project. Five epidemic periods previous to COVID-19 pandemic, from 2015 to 2020, were compared with the current one, 2020-2021, in both a qualitative and quantitative manner.

RESULTS

Total of 4643 infants were admitted to the participating hospitals along the study period. Pandemic season hospital admissions for bronchiolitis were 94.1% lower than in pre-pandemic period. December and January were peak months for bronchiolitis admissions during pre-pandemic period, but September was the peak month during pandemic year. There was a progressive decrease of admissions from this moment until the end of the follow-up, in April 2021. Rhinovirus has been the commonest etiology for bronchiolitis in 2020-2021 epidemic period of bronchiolitis.

CONCLUSIONS

Some of the non-pharmaceutical interventions initiated because of COVID-19 pandemic are probably related to the dramatic decrease of bronchiolitis cases in 2020-2021 season. It would be rewarding to purpose novel research to clarify how these simple interventions can be useful, close to vaccines and antiviral drugs, to achieve the goal of avoiding the spread of respiratory viruses in pediatric population.

Rotavirus gastroenteritis in children hospitalized in northeastern Poland in 2006-2020: Severity, seasonal trends, and impact of immunization

OBJECTIVES

The introduction of the rotavirus vaccine in 2006 significantly reduced childhood incidence of acute gastroenteritis (AGE) worldwide. The rotavirus vaccine was included in Poland's national immunization program in 2021. Our study aimed to summarize the epidemiology of AGE in northeastern Poland prior to 2021 and to evaluate the effectiveness of voluntary, out-of-pocket rotavirus childhood vaccination on the incidence of rotavirus AGE.

METHODS

A review of patients aged 0-17 years with gastroenteritis hospitalized between 2006 and 2020 in northeastern Poland in the context of rotavirus vaccine coverage in the region.

RESULTS

Rotavirus was the most common agent of gastroenteritis in hospitalized patients. The seasonality of rotavirus gastroenteritis peaked between February and May in each year of study, except for 2020, when the COVID-19 pandemic skewed any viable comparison of seasonality. Rotavirus vaccine coverage in northeastern Poland did not exceed 25% during the study period and had no impact on hospitalization numbers.

CONCLUSIONS

Rotavirus was the primary causative agent of AGE in children hospitalized in northeastern Poland during the study period. Voluntary vaccinations did not affect the number of hospitalizations due to rotavirus AGE. Our data suggest that universal immunization is key to achieving a significant reduction of rotavirus-associated diarrhea.

Changes in childhood vaccination during the coronavirus disease 2019 pandemic in Japan

Background

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected daily life. COVID-19 often causes asymptomatic or mild disease in children; however, delayed routine childhood immunization is a concern, as it could increase the risk of vaccine-preventable disease. No study has evaluated the status of childhood vaccinations in Japan during the COVID-19 pandemic.

Methods

This retrospective observational study evaluated the number of vaccine doses administered to children in 4 Japanese cities (2 cities in the Tokyo metropolitan area and 2 cities far from Tokyo) during the period from 2016 to 2020. Vaccine doses administered between January and September 2020 during the COVID-19 pandemic were compared, by month, with those given during 2016–2019. Age-stratified demographic data were collected to determine whether factors other than change in the child population over time affected vaccination trends.

Results

In all cities the decrease in vaccine doses administered was most apparent in March and April 2020, i.e., just before or coincident with the declaration of a nationwide COVID-19 emergency on April 7, 2020. The decrease started as early as February in the Tokyo metropolitan area. As child age increased, the decrease became more apparent. Before the lift of national emergency on May 25, catch-up of the vaccination was observed in all age groups in all cities. Vaccine doses persistently increased in older age groups but not in infants. The overall vaccination trends did not differ significantly among the 4 cities.

Conclusions

The COVID-19 pandemic significantly affected routine childhood immunization in Japan. Thus, a nationwide electronic surveillance system and announcements for guardians to encourage timely routine immunization are warranted.

Changes in pediatric healthcare utilization in Hunan Province, China, during the COVID-19 pandemic: a multi-center cross-sectional study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic brought remarkable disruption to the ways in which healthcare was delivered. This study aimed to examine changes in pediatric healthcare utilization in Hunan Province, China, during the COVID-19 pandemic.

METHODS

An electronic survey was conducted among 142 hospitals in Hunan Province, China. Using data from January 1 to April 30, 2019 as a reference, the changes in the number of visits for different types of pediatric healthcare between January 1 and April 30, 2020 were calculated. Changes in the number of admissions for infections and injuries were also evaluated.

RESULTS

The total number of pediatric healthcare presentations decreased by 53.3% in the first four months of 2020. The most remarkable reductions were observed in the utilization of emergency room (ranging from -45.7% to -94.9% among three hospital levels) and observation room (-55.8% to -77.7%); neonatal inpatient care experienced the smallest decreases (-21.2% to -25.5%). Approximately 85% of the total reduction in the number of pediatric inpatient admissions was attributable to the reduction in admissions for infections. A 13.3% increase in the number of admissions for injuries was observed among third-level hospitals.

CONCLUSIONS

The utilization of all types of pediatric healthcare services in Hunan Province declined markedly after the outbreak of COVID-19. The reasons, consequences, and responses to these changes should be addressed in future studies and actions.