Pediatr Emerg Med J.  2024 Jan;11(1):17-27. 10.22470/pemj.2023.00836.

Incidence, severity, and clinical characteristics of lower respiratory tract infections in children before and after the coronavirus disease 2019 lockdown: a Dutch single-center study

• Nagelkerke MCM
• Zagten Mv
• Sprij A
• Bekhof J
• Veen Mv
• Kruizinga MD

• KMID: 2549537
• DOI: http://doi.org/10.22470/pemj.2023.00836

Abstract

Purpose
Coronavirus disease 2019 (COVID-19) public health measures reduced the incidence of pediatric lower respiratory tract infections (LRTIs) in 2020. An inter-seasonal surge in the LRTI has occurred after relaxation of restrictions. We aimed to compare characteristics and disease severity of children with LRTI before, during, and after COVID-19 lockdown.
Methods
All LRTI-related visits to emergency department (ED) of a large pediatric hospital in the Netherlands between 2019 and 2021 were included. Variables were compared between 2019 and 2020, and between 2019 and 2021, respectively. The variables included demographic characteristics, condition upon ED arrival, diagnosis, applied treatment, and follow-up.
Results
In 2019, 2020, and 2021, numbers of the visits were 573, 280, and 519, respectively, comprising the study population (n = 1,372). In 2020, the patients were older, and showed higher frequencies of preterm birth history, co-occurring symptoms of obstructive lung disease, and salbutamol therapy in the ED, than in 2019. In 2021, the patients were younger, showed higher frequencies of desaturation, bronchiolitis, co-occurring symptoms of obstructive lung disease, salbutamol therapy, and hospitalization, and showed lower frequencies of respiratory ED visits or hospitalization in the past year, and antibiotic therapy. During hospitalization in 2020, the patients were older, and showed shorter duration of oxygen support and length of hospital stay, as well as lower frequencies of nasogastric tube insertion, compared to 2019. In 2021, compared to 2019, the patients showed a higher frequency of bronchiolitis and lower frequencies of underlying medical conditions and antibiotic therapy.
Conclusion
The children presenting with LRTIs in 2021 seem to have had a more severe clinical phenotype, possibly explained by immunity debt after the COVID-19 lockdown, stricter referral policy, or changes in healthcare-seeking behavior. Future research is needed to evaluate the long-term consequences of growing up during the lockdown.

Keyword

Bronchiolitis; COVID-19; Immunity; Lung Diseases, Obstructive; Pediatrics; Physical Distancing; Pneumonia; SARS-CoV-2

Figure

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  Fig. 1. Flowchart for selection of the study population. LRTI: lower respiratory tract infection, ED: emergency department.

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  Fig. 2. Monthly trends of LRTI-related ED visits from 2019 through 2021 (A) and detected viral pathogens in 2021 (B). (A) In 2019, the visits peaked in December. The start of the first lockdown in March 2020 (white arrow), coincided with a sharp decrease in visits. During the rest of the year, including after the start of the second lockdown (black arrow) and the first half of 2021, the visits remained low without a winter peak. An inter-seasonal LRTI epidemic began after the end of the second lockdown (April 2021) and peaked in July 2021. (B) Among the detected viral pathogens in 2021, RSV was most common. LRTI: lower respiratory tract infection, ED: emergency department, RSV: respiratory syncytial virus, SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Reference

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