22 - Healthcare Utilization during COVID-19 pandemic among children born preterm

Poster Number: 22
Publication Number: 22.338

Elisabeth McGowan, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Monica McGrath, Johns Hopkins University, Baltimore, MD, United States; Michael O’Shea, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Judy L. Aschner, Hackensack Meridian Health, Hackensack, NJ, United States; Courtney K. Blackwell, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Rebecca Fry, UNC-Chapel Hill, Chapel Hill, NC, United States; Jody M. Ganiban, George Washington University, Washington, DC, United States; Rosemary D. Higgins, George Mason University, Fairfax, VA, United States; Andrew Law, Johns Hopkins Bloomberg School of Public Health, Balitimore, MD, United States; Amy Margolis, Columbia University Vagelos College of Physicians and Surgeons, New york, NY, United States; Sheela Sathyanarayana, University of Washington School of Medicine/Seattle Children's Research Institute, Seattle, WA, United States; Genevieve Taylor, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Barry Lester, The Warren Alpert Medical School of Brown University, Providence, RI, United States

Background: Worldwide, the COVID-19 virus targets vulnerable populations and strains healthcare resources.  Pediatric cases, although typically less frequent and severe than adult cases, contribute to resource utilization.  Identifying groups of “high risk” children may allow public health efforts to become more efficient and targeted.    

Objective: Investigate differences in medical care use during the COVID-19 pandemic among children born preterm (PT; < 37 weeks) compared to children born term.

Design/Methods: 52 cohorts in the NIH Environmental Influences on Child Health Outcomes (ECHO) study with COVID-19 questionnaires completed April 2020 - August 2021 and known gestational age (GA) were eligible.  Variables harmonized included maternal demographics, maternal history of psychiatric disorders, child sex, birth GA, and child respiratory diagnosis of bronchopulmonary dysplasia (BPD) and/or asthma.  Primary outcomes included medical care utilized due to COVID-19 concerns, symptoms that prompted care, and missed medical appointments.  Differences between children born PT vs term were analyzed; generalized linear mixed models assessed risks for  medical care utilized and symptomatology, controlled for prematurity, maternal age, education and psychiatric disorder, child BPD/asthma, timing and child age at questionnaire completion.

Results: 1708 mother-infant pairs were analyzed.  The majority of children born PT were  < 28 weeks GA, and groups differed between maternal race, age and education (Table 1).  Among all PT born, 72% had a prior BPD or asthma diagnosis. 51.3% of children born PT received medical care due to COVID-19 concerns (Table 2). And on adjusted analyses, results showed that children born PT are 1.72 times more likely (aOR 1.72;CI 1.27-2.34) to receive medical care due to COVID-19 concerns compared to term born children (Table 3).   While a BPD/asthma diagnosis was a risk factor for symptomatology prompting care, being born PT independently predicted evaluation due to respiratory symptoms (aOR 1.51;CI 1.10-2.08) or any symptoms (aOR 1.72;CI 1.27-2.34).  A maternal history of psychiatric disorder was an additional independent risk factor for child healthcare utilization (aOR 1.42; CI 1.16-1.75).Conclusion(s): During the COVID-19 pandemic, children born PT received medical care more frequently than those born term, independent of a respiratory history.  Importantly, maternal psychiatric disorders also contributed to child healthcare utilization.   Identification of such family risk factors allows providers to focus care, target resources and formulate strategies to mitigate healthcare resource burdens. 
Table 1. Description of Cohort (Children with completed COVID-19 questionnaire by preterm vs term birth)
2. Child Healthcare Utilization by preterm vs term birth