The COVID-19 pandemic has been linked to widespread changes in the delivery of developmental services, which has the potential to affect long-term outcomes among children with acute provoked neonatal seizures, according to findings of a prospective cohort study published in Pediatric Neurology.
Speech, occupational, and/or physical therapy—known as developmental services—are offered through early public intervention programs, school, and privately, to optimize learning and mobility for children with a history of neonatal seizures. At school age, this patient population is at high risk for experiencing challenges with motor and cognitive functioning, the researchers explained. The delivery of these services has been disrupted due to school closings and limited in-person sessions due to the COVID-19 pandemic.
The objective of the current study was to determine the impact of the COVID-19 pandemic on developmental service delivery among children with a history of neonatal seizures.
The researchers conducted a prospective cohort study of children with acute provoked seizures enrolled in the Neonatal Seizure Registry (NSR)—a 9-center collaborative of pediatric centers in the US. The interruption of services among children who were born between October 2014 and December 2017 who were enrolled in the NSR were assessed. The current analysis was an ancillary study of the Neonatal Seizure Registry Developmental Functional EValuation (NSR-DEV; ClinicalTrials.gov identifier: NCT04337697).
Children were eligible for participation in NSR-DEV if they had a history of neonatal seizures due to an acute provoked cause, an onset of seizures before 44 weeks’ postmenstrual age, and were 3 to 6 years of age at the time of follow-up evaluation. Children enrolled in NSR-DEV from June 2020 to April 2021 were included in the analysis. Parents of all participating children completed COVID-19–specific survey questions as part of the enrollment process.
A total of 144 children were enrolled in the current study, with the following acute seizure etiologies: hypoxic ischemic encephalopathy, ischemic stroke, intracranial hemorrhage, infection, or other cause. Overall, 50% (72 of 144) of the participants were receiving developmental services at the time of evaluation. Of these children, 89% (64 of 72) experienced a disruption in the delivery of their developmental services because of the pandemic. In fact, 73% (47 of 64) of these families reported that in-person services were no longer available. Children born at term were more likely to experience a service interruption because services were no longer available (64%; 30 of 47) compared with children born preterm (36%; 17 of 47; risk ratio, 36%; 95% CI, 0.87 to 1.70).
Study findings showed that children who were receiving developmental services were more likely to be male and to have been born preterm. Further, children whose neonatal seizures were due to ischemic stroke or infection were more likely to receive developmental services than pediatric patients with other seizure etiologies. In contrast, children whose seizures were due to hypoxic ischemic encephalopathy were less likely to receive any developmental services.
Of the children who received developmental services, 64% (46 of 72) received more than 1 type of therapy. No significant differences were observed between those children who received only 1 service and those children who received more than 1 service. Overall, 74% (53 of 72) of the children received speech therapy, 63% (45 of 72) of them received occupational therapy, and 57% (41 of 72) of them received physical therapy.
A limitation of the study was the survey findings are potentially only generalizable to children who receive tertiary care in the US.
Longitudinal studies in this population are warranted, in order to better understand the long-term impact of neonatal seizures on child development, as well as the effects sustained because of the COVID-19 pandemic, the researchers stated.
“As children are able to resume developmental services, intensive targeted and functional developmental therapies may be needed to mitigate the effects of service disruption in children with neonatal seizures,” they concluded.
Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.
Peyton C, Girvan O, Shellhaas RA, et al; Neonatal Seizure Registry. Impact of COVID-19 pandemic on developmental service delivery in children with a history of neonatal seizures. Pediatr Neurol. Published online Januart 21, 2022. doi:10.1016/j.pediatrneurol.2022.01.004