Attending Northwell Cohens Children Medical Center New York, New York, United States
Background: Children with medical complexity (CMC) have multiple chronic conditions and require a high level of coordinated healthcare. The risk of COVID-19 among CMC is unclear, but likely to carry higher morbidity and mortality than healthy children.
Objective: The goal of this study was to identify and describe the prevalence and experience of COVID-19 among CMC during the first wave of the COVID-19 pandemic in the New York metropolitan area.
Design/Methods: We performed a cross-sectional study of children (0-21 years) enrolled in a structured clinical program for CMC at a large urban, academic general pediatrics practice in New York. All enrolled patients were contacted via telemedicine (audio +/- video) between March 17, 2020 and May 1, 2020 using a checklist that addressed clinical concerns including COVID and disruptions in care. Data was collected through chart review in our electronic medical record (EMR). The study was submitted to Northwell Health’s Institutional Review Board (IRB) and was considered exempt.
Results: A total of 132 patients were enrolled in the clinical program for CMC at the time of data collection. The most common chronic conditions were: developmental disability (81.8%), chronic lung disease (41.7%), and cardiac disease (32.6%). The majority were technology dependent with 56.8% requiring enteral feeding and 35.6% having respiratory support (tracheostomy/ventilator or non-invasive ventilation). In this patient population, 16 patients had a known exposure with parents being the most common exposure in 37.5% (n=6), followed by 25% (n=4) in home care providers (home health aid, nurse, or therapist). Additionally, 36 patients developed symptoms associated with COVID (11 of whom had a known exposure). There were no differences in demographic or clinical characteristics between those with and without a COVID exposure. Two patients were hospitalized for COVID. The remainder of patients with clinical symptoms of COVID were managed as an outpatient. Conclusion(s): This study provides characteristics and early outcomes of the COVID pandemic on an ambulatory, medically complex, pediatric population in New York during shelter in place orders. Very few of our CMC required hospitalization due to COVID. Common sources of COVID exposure were family members and home care providers. Almost all of our patients experienced interruption of medical care including missed therapies and visits. Next steps will include understanding the impact of the second wave of COVID-19 resurgence on CMC.
Authors/Institutions: Allison Driansky, Cohens Children Medical Center, New York, New York, United States; Mariecel Pilapil, Northwell Health, New Hyde Park, New York, United States; Kristina M. Bianco, Cohen Children's Medical Center, Queens, New York, United States; Caren Steinway, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, United States; Sophia Jan, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, United States
