Supporting the Regional Network for Children with Burn Injuries in a Pediatric Referral Hospital for COVID-19.

Gloria Pelizzo,Armando De Angelis,Elena Zoia,Paola Tommasi,Elettra Vestri,Anna Camporesi,Giulia Del Re,Valeria Calcaterra,Claudia Filisetti,Gianvincenzo Zuccotti,Monica Osti,Dario Rizzo

doi:10.3390/healthcare9050551

Abstract

Considerable reorganization of the regional network for pediatric burn treatment during the pandemic was required to cope with severe burn injuries in small children. In support of the emergency network for burns during the COVID-19 pandemic, we referred to regional indications for centralization in our hospital for all children aged less than 5 years who presented with severe burns, >15% of total body surface area (TBSA), or who necessitated admittance to the pediatric intensive care unit (PICU). A new service with a dedicated management protocol was set up to treat pediatric burns in our SARS-CoV-2 pediatric hospital during the lockdown period. A multidisciplinary burn treatment team was set up to offer compassionate and comprehensive burn care. Patient’s clinical data, burn features, treatment and follow up were recorded. A higher number of admissions was recorded from February to December 2020 compared with the same period in 2019 (52 vs. 32 admissions). Eighteen patients were admitted to the COVID-19 Service (10 M/8 F; 3.10 ± 2.6 yrs); ten children (55.5%) were hospitalized in the ward and eight in the ICU (44.5%). Fifty percent of the cases presented with lesions extending over >15% TBSA; in one case, TBSA was 35%. All patients suffered 2nd-degree burns; while five patients also had 3rd degree lesions covering more than 15% TBSA. All of the injuries occurred at home. No major secondary infections were recorded. Successful treatment was achieved in 94.4% of cases. The average length of stay was 15.2 ± 12.6 days. A proactive, carefully planned service, involving a multidisciplinary team, was created to ensure appropriate care in a pediatric hospital during the COVID-19 period, despite the effective pandemic associated challenges. Better health promotion in pediatric burn cases should also include dedicated TBSA assessment and a database of children’s burn characteristics.

Highlights

The COVID 19 pandemic has affected every phase of patient care, including emergency diagnosis and management, emergency surgery, anesthesia, and peri- and post-operative management in pediatrics [1]
The aim of this study was to report a strategy for the management of children with burns and the protective measures adopted at the “Vittore Buzzi” Children’s Hospital, located in Milan, in the Lombardy Region, the epicenter of Italy’s coronavirus outbreak
Children aged less than five years presenting with severe burns and/or requiring pediatric intensive care unit (PICU) were admitted according to the Regional Burn Center guidelines

Summary

Introduction

The COVID 19 pandemic has affected every phase of patient care, including emergency diagnosis and management, emergency surgery, anesthesia, and peri- and post-operative management in pediatrics [1]. Increased activity at home has led to increased exposure to possible burn situations, explaining the significant increase in the rate of burn injures during this time in the pediatric field [2]. While a significant increase in the rate of burn injures was recorded in adults during the COVID-19 period and admissions and hospitalization were often necessary due to the severity of the lesions [1], face-to-face consultation with general pediatricians was not possible during the pandemic, and fears of contracting COVID-19 in hospitals led to a decrease in parents seeking immediate attention for their child. Considerable reorganization of the regional network for pediatric burn cases during the pandemic was necessary to cope with severe burn injuries in small children

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