Delay in Paediatric Care due to Covid-19: A Nationwide Exploration

Background: during the Covid-19 epidemic, of all specialisms, paediatrics in the Netherlands experienced the largest drop in the number of emergency referrals and showed the fewest signs of recovery in this. The decrease in referrals may be the result of discouragement or doubts about the safety of health care use, which has led to collateral damage in some patients.

Objective: to explore the collateral damage in Dutch children and adolescents caused by a delay in paediatric care due to COVID-19.

Methods: Two weeks after the start of the Dutch ‘intelligent lockdown’ (end of March), all paediatricians in the Netherlands were requested – via the website of the Dutch Paediatric Society – to report if a child in their eyes presented itself "too late" due to concerns about COVID-19. This concerned acute care as well as regular and chronic care.

Results: the Dutch Paediatric Society received 51 reports of collateral damage between the end of March and the beginning of July. 54% of collateral damage involved neonates, infants and children aged 1 to 4 years. The collateral damage from neonatal care delay was mainly related to hyperbilirubinemia and weight-related problems (low birth weight and severe weight loss). In the somewhat older children, collateral damage included diabetic ketoacidosis, subdural hematoma, mastoiditis, acute renal failure and an abscess after appendicitis.

Conclusion: While the results of this inquiry among paediatricians reveal a worrying situation, it is probably only the tip of the iceberg as it is an exploration in which the data has not been systematically collected. However, our results show that delay in care due to COVID-19 can lead to seriously ill children and life-threatening situations. To avoid delays in healthcare and thus collateral damage at a possible second peak of Corona, primary care professionals and paediatricians must join forces.