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Respiratory admissions and impact of COVID-19 lockdowns for children with severe cerebral palsy
Susan M Reid1,2,3, Moya Vendeleur4, Danielle Wurzel4,5,6
1Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Insights
COVID-19 lockdowns reduced respiratory hospitalizations in children with severe cerebral palsy (CP). Viral infections decreased during lockdown, but bacterial infections remained significant, suggesting a need for personalized care strategies.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Neurology
Background:
- Children with severe cerebral palsy (CP) experience significant respiratory morbidity.
- Understanding factors influencing respiratory admissions is crucial for improving patient outcomes.
- The COVID-19 pandemic and associated social restrictions provide a unique opportunity to study these factors.
Purpose of the Study:
- To investigate the impact of COVID-19 social restrictions on respiratory admission rates in children with severe CP.
- To compare respiratory hospitalization patterns before, during, and after the lockdown period.
- To identify contributing factors to respiratory illness burden in this vulnerable population.
Main Methods:
- An observational study design utilizing data from a state-wide cerebral palsy register.
- Comparison of three 2-year cohorts: pre-lockdown, lockdown, and post-lockdown.
- Manual review of medical records for respiratory hospitalizations and associated details.
Main Results:
- Respiratory hospitalizations per 100 children decreased significantly during lockdown (24) compared to pre-lockdown (37) and post-lockdown (47) periods (p < 0.001).
- Detection of respiratory viruses (excluding picornaviruses) dropped during lockdown (7%) versus pre-lockdown (24%) and post-lockdown (30%).
- Bacterial findings included Gram-positive in 6% and Gram-negative in 18% of admissions with sputum sampling (34%).
Conclusions:
- Viral infections play a dynamic role in respiratory illnesses among children with severe CP.
- Personalized management strategies, informed by individual risk factors for recurrent admissions, may improve outcomes.
- Further research into specific predisposing factors is warranted to optimize care pathways.
Aim:
To explore factors contributing to the burden of respiratory admissions in children with severe cerebral palsy (CP) by comparing admissions to a single tertiary paediatric hospital before, during, and after the period of social restrictions implemented to reduce transmission of COVID-19 (lockdown period).
Method:
For this observational study, three severe CP cohorts (pre-lockdown, lockdown, post-lockdown) were identified from a state-wide cerebral palsy register and linked to patient-level clinical and demographic data. Medical records were manually searched to identify respiratory hospitalizations. Frequency and details of admissions were compared across the three 2-year periods.
Results:
During the lockdown period, there were 24 hospitalizations for respiratory illness per 100 children compared to 37 and 47 in the pre-lockdown and post-lockdown periods (p < 0.001). Respiratory viruses (excluding picornaviruses) were detected in only 7% of lockdown admissions compared to 24% pre-lockdown and 30% post-lockdown. Sputum sampling was performed in 34% of admissions with gram-positive bacteria cultured in 6% admissions and gram-negative bacteria only in 18%.
Interpretation:
The study findings highlight an important dynamic contribution of viral infections to respiratory illnesses in children with severe CP and the potential to improve outcomes with personalized approaches based on defining individual factors predisposing to recurrent respiratory admissions.
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