Respiratory admissions and impact of COVID-19 lockdowns for children with severe cerebral palsy.

Aim: To explore factors contributing to the burden of respiratory admissions in children with severe cerebral palsy (CP) by comparing admissions to a single tertiary paediatric hospital before, during, and after the period of social restrictions implemented to reduce transmission of COVID-19 (lockdown period).

Method: For this observational study, three severe CP cohorts (pre-lockdown, lockdown, post-lockdown) were identified from a state-wide cerebral palsy register and linked to patient-level clinical and demographic data. Medical records were manually searched to identify respiratory hospitalizations. Frequency and details of admissions were compared across the three 2-year periods.

Results: During the lockdown period, there were 24 hospitalizations for respiratory illness per 100 children compared to 37 and 47 in the pre-lockdown and post-lockdown periods (p < 0.001). Respiratory viruses (excluding picornaviruses) were detected in only 7% of lockdown admissions compared to 24% pre-lockdown and 30% post-lockdown. Sputum sampling was performed in 34% of admissions with gram-positive bacteria cultured in 6% admissions and gram-negative bacteria only in 18%.

Interpretation: The study findings highlight an important dynamic contribution of viral infections to respiratory illnesses in children with severe CP and the potential to improve outcomes with personalized approaches based on defining individual factors predisposing to recurrent respiratory admissions.