A study examines the impact of COVID-19 on children’s mental health

New research from pediatricians at UT Southwestern and Children’s Health reveals the impact of COVID-19 on children’s mental health. Separately, a study funded by a $2.5 million grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) will examine the ideal way to use oxygen during resuscitation of babies born prematurely.

COVID-19 and mental health

A study led by Dr. Jacqueline Bolt, a UTSW pediatric emergency medicine fellow, examined how patterns and outcomes of pediatric mental and behavioral health (MBH) visits to the emergency department (ED) at Children’s Medical Center Dallas have changed before the pandemic and after it started. Dr. Bolt and her colleagues collected information from electronic medical records of patients who visited the ED from March to September between 2017 and 2019 to examine pre-pandemic trends, then compared the same period between 2019 and 2020

Researchers report in Pediatric emergency that ED visits for pediatric MBH gradually increased in the years before the pandemic, mirroring nationwide trends. Although total ED visits for MBH decreased in 2020, the proportion of total visits jumped 42.8%. Demographic groups with the largest increases in MBH visits included females, adolescents between the ages of 15 and 17, and non-Hispanic patients. Pediatric patients who came to the emergency department in 2020 for treatment of MBH were significantly more likely to be admitted or transferred for inpatient psychiatric care than in previous years.

These findings highlight specific areas in pediatric MBH care that may benefit from targeted interventions. Future research is needed to examine longer-term trends as well as effective prevention and intervention strategies.”

Jacqueline Bolt, MD, UTSW Pediatric Emergency Medicine Fellow

Other UTSW and Children’s Health researchers who contributed to the study include Faisalmohemed Patel, Laura Stone, Divya Pandian, Matthias Manuel and Nakia Gaines.

Oxygen and premature babies

The NICHD grant will fund a multicenter randomized controlled trial in preterm infants that will be led by Vishal Kapadia, MD, UT Southwestern Associate Professor of Pediatrics. It builds on a pilot study conducted at UTSW that tested the optimal target range of oxygen saturation that reduces oxygen toxicity and allows the lungs of vulnerable premature babies to better adapt to the environment outside the womb.

Dr. Kapadia explained that supplemental oxygen is often needed to maintain normal blood oxygen levels in extremely premature babies because their lungs are not well developed. Excessive use of oxygen at birth is associated with oxygen toxicity, which can cause damage to immature organs, including the lungs and brain. Using too little oxygen at birth can lead to respiratory failure and organ damage due to low blood oxygen levels.

To achieve this balance, the National Neonatal Resuscitation Program guidelines recommend that resuscitation be initiated at low mixed air-oxygen levels and the oxygen level adjusted to achieve target blood oxygen levels. These levels are based on expert opinion and data involving healthy full-term infants who likely did not experience delayed cord clamping. Recent research shows that healthy full-term babies who undergo delayed cord clamping have higher blood oxygen levels at birth than previously reported.

Dr. Kapadia’s team conducted a pilot study to identify the optimal blood oxygen levels at birth for premature babies, which would reduce oxygen toxicity and allow the babies’ lungs to better adapt to the environment outside the womb. A pilot study of 75 preterm infants born at Parkland Memorial Hospital showed that when delivered oxygen was adjusted to achieve higher blood oxygen levels than currently recommended (similar to healthy term infants undergoing delayed-clamping cord), these newborns begin to breathe faster; previously reached a heart rate above 100 beats per minute; there was better oxygenation of the brain; suffer from less oxidative stress; and were more likely to survive without chronic lung disease than those with currently recommended blood oxygen levels.

The new study, led by Dr. Kapadia, aims to test these findings in a much larger sample of 800 premature babies born in medical centers across the country.

“This research has the potential to transform delivery room management of preterm infants worldwide and provide a simple and inexpensive way to reduce mortality and lung morbidity in this population,” said Dr. Kapadia.

source:

UT Southwestern Medical Center

Journal reference:

Bolt, J., et al. (2022) Impact of COVID-19 on Pediatric Mental and Behavioral Health Emergency Department Visits. Pediatric emergency. doi.org/10.1097/PEC.0000000000002794.

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