Reductions in hospital care among clinically vulnerable children aged 0–4 years during the COVID-19 pandemic

Abstract

ObjectiveTo quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic.DesignBirth cohort.SettingNational Health Service hospitals in England.Study populationAll children aged <5 years with a birth recorded in hospital administrative data (January 2010–March 2021).Main exposureClinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks’ gestation) or low birth weight (<2500 g).Main outcomesReductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020–2021).ResultsOf 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 vs 73 per 1000 child years), planned admissions (55 vs 10) and unplanned admissions (105 vs 79). Clinically vulnerable children accounted for 50.1% of the reduction in outpatient attendances, 55.0% in planned admissions and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to prepandemic levels for infants with chronic conditions but not older children. Reductions in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic.ConclusionOne in six clinically vulnerable children accounted for one-third to one half of the reduction in hospital care during the pandemic.

Impacts of health care service changes implemented due to COVID‐19 on children and young people with long‐term disability: A mapping review

“…Three papers reported on medical services for children with neurodevelopmental disabilities 17,39,40 . A study of adolescents with special educational needs used linked education, health, and social care data, which identified that a greater proportion of adolescents with special educational needs had outpatient appointments offered to them via telehealth compared to their peers 39 . One survey reported that 30.9% of follow‐up appointments for children with neurodisability with a paediatrician were carried out via telehealth 17 …”

“…17,39,40 A study of adolescents with special educational needs used linked education, health, and social care data, which identified that a greater proportion of adolescents with special educational needs had outpatient appointments offered to them via telehealth compared to their peers. 39 One survey reported that 30.9% of follow-up appointments for children with neurodisability with a paediatrician were carried out via telehealth. 17 Two papers described successful remote telemonitoring of children and young people's ventilation and continuous EEG, reducing the need for children and young people to travel into hospital or be admitted for monitoring.…”

Evaluation of variation in special educational needs provision and its impact on health and education using administrative records for England: umbrella protocol for a mixed-methods research programme

“…Lockdowns in England affected children’s access to school and the frequency of hospital contacts captured in ECHILD data. Planned and unplanned admissions, and outpatient appointments reduced substantially during the COVID-19 pandemic, with the largest reductions in children with indicators of vulnerability (such as preterm birth, a chronic condition, recorded SEN or social care record) 12 40. School attainment measures were not collected during the pandemic to help reduce the burden on educational and care settings.…”

Childhood and adolescence, pediatricians and the pediatric practice after the COVID-19 pandemic

“…3 Health care services were also disrupted by the pandemic. The drop in scheduled health care activities, urgent and emergency care services, 4,5 and hospitalizations, even for children with chronic conditions, 6 means that a number of children and adolescents who needed health care did not seek it, resulting in delays in diagnosis and treatment.…”