Neonatal and Pediatric Emergency Room Visits in a Tertiary Center during the COVID-19 Pandemic in Italy

Area of Science:

• Pediatric Emergency Medicine
• Infectious Disease Epidemiology
• Public Health Policy

Background:

• The COVID-19 pandemic and associated public health interventions, such as strict lockdowns, have profoundly impacted global healthcare systems.
• Understanding the specific effects on pediatric emergency department (PED) utilization is crucial for resource allocation and patient care.
• Previous research has indicated shifts in healthcare-seeking behaviors during pandemics, but detailed analyses of PED attendances during strict lockdowns are limited.

Purpose of the Study:

• To investigate the impact of a strict COVID-19 lockdown policy on the characteristics and trends of neonatal and pediatric attendances at a pediatric emergency department.
• To compare clinical features and visit patterns during the lockdown period (March-April 2020) with a non-lockdown period (March-April 2019).

Main Methods:

• A retrospective analysis of clinical data from a pediatric emergency department.
• Comparison of patient demographics, chief complaints, diagnoses, and disposition (admission, PICU admission) between two distinct periods: March-April 2020 (COVID-19 lockdown) and March-April 2019 (non-COVID-19).
• Statistical analysis to determine significant changes in visit volume and characteristics.

Main Results:

• Overall PED visits decreased by 67% during the COVID-19 lockdown (3159 to 1039).
• Communicable diseases, especially respiratory infections, dropped significantly (49.1% to 27.7%).
• Minor neonatal visits, primarily for feeding issues, slightly increased (56.4% to 81.4%), while accident-related visits became the most common reason for attendance (16.9% to 29.7%).
• Hospital admissions decreased by 58.9%, and pediatric intensive care unit (PICU) admissions fell by 59.3%, with a similar admission rate (10.1%) in both periods.
• No PICU admissions were due to respiratory diseases during the lockdown period.

Conclusions:

• The strict COVID-19 lockdown substantially reduced overall pediatric emergency department visits, largely driven by a decrease in respiratory infections.
• An unexpected rise in minor neonatal visits for feeding-related issues was observed, highlighting a potential shift in parental concerns or access to primary care.
• Accidents emerged as the leading cause for PED visits during the lockdown, necessitating continued focus on injury prevention strategies.