Impact of COVID-19 pandemic on the management of paediatric inflammatory bowel disease: An Italian multicentre study on behalf of the SIGENP IBD Group

doi:10.1016/j.dld.2020.12.011

Multicenter Study

. 2021 Mar;53(3):283-288.

doi: 10.1016/j.dld.2020.12.011. Epub 2020 Dec 26.

Impact of COVID-19 pandemic on the management of paediatric inflammatory bowel disease: An Italian multicentre study on behalf of the SIGENP IBD Group

Serena Arrigo¹, Patrizia Alvisi², Claudia Banzato³, Matteo Bramuzzo⁴, Rosaria Celano⁵, Fortunata Civitelli⁶, Giulia D'Arcangelo⁷, Anna Dilillo⁸, Valeria Dipasquale⁹, Enrico Felici¹⁰, Maurizio Fuoti¹¹, Simona Gatti¹², Daniela Knafelz¹³, Paolo Lionetti¹⁴, Federica Mario¹⁵, Antonio Marseglia¹⁶, Stefano Martelossi¹⁵, Chiara Moretti¹⁷, Lorenzo Norsa¹⁸, Roberto Panceri¹⁹, Sara Renzo¹⁴, Claudio Romano⁹, Erminia Romeo²⁰, Caterina Strisciuglio²¹, Massimo Martinelli²²

Affiliations

¹ Pediatric Gastroenterology and Endoscopy Unit, Institute 'Giannina Gaslini', Genoa, Italy.
² Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy.
³ Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy.
⁴ Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy.
⁵ Fondazione IRCCS Ca' Grande, Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, Milan, Italy.
⁶ Department of Gender diseases, Child and Adolescent health, Pediatric unit, Sant'Eugenio Hospital, Rome, Italy.
⁷ Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy.
⁸ Pediatric and Neonatology Unit, Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy.
⁹ Paediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adult and Developmental Age ``Gaetano Barresi'', University of Messina, Italy.
¹⁰ Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy.
¹¹ Pediatric Gastroenterology and GI Endoscopy, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Italy.
¹² Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy.
¹³ Hepatology and Gastroenterology Unit, Bambino Gesù Hospital, Rome, Italy.
¹⁴ University of Florence-Meyer Hospital, Florence, Italy.
¹⁵ Pediatric Unit, Ca' Foncello's Hospital, Treviso, Italy.
¹⁶ Fondazione IRCCS Casa Sollievo della Sofferenza, Division of Pediatrics, San Giovanni Rotondo, Italy.
¹⁷ Paediatrics Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁸ Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
¹⁹ Department of Pediatrics, University of Milano-Bicocca, Foundation MBBM/San Gerardo Hospital, Monza, Italy.
²⁰ Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
²¹ Department of Woman, Child and General and Specialistic Surgery, University of Campania ``Luigi Vanvitelli'', Naples, Italy.
²² Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Italy. Electronic address: massimo.martinelli@unina.it.

PMID: 33388247
PMCID: PMC7832380
DOI: 10.1016/j.dld.2020.12.011

Multicenter Study

Impact of COVID-19 pandemic on the management of paediatric inflammatory bowel disease: An Italian multicentre study on behalf of the SIGENP IBD Group

Serena Arrigo et al. Dig Liver Dis. 2021 Mar.

. 2021 Mar;53(3):283-288.

doi: 10.1016/j.dld.2020.12.011. Epub 2020 Dec 26.

Authors

Affiliations

¹ Pediatric Gastroenterology and Endoscopy Unit, Institute 'Giannina Gaslini', Genoa, Italy.
² Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy.
³ Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy.
⁴ Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy.
⁵ Fondazione IRCCS Ca' Grande, Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, Milan, Italy.
⁶ Department of Gender diseases, Child and Adolescent health, Pediatric unit, Sant'Eugenio Hospital, Rome, Italy.
⁷ Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy.
⁸ Pediatric and Neonatology Unit, Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy.
⁹ Paediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adult and Developmental Age ``Gaetano Barresi'', University of Messina, Italy.
¹⁰ Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy.
¹¹ Pediatric Gastroenterology and GI Endoscopy, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Italy.
¹² Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy.
¹³ Hepatology and Gastroenterology Unit, Bambino Gesù Hospital, Rome, Italy.
¹⁴ University of Florence-Meyer Hospital, Florence, Italy.
¹⁵ Pediatric Unit, Ca' Foncello's Hospital, Treviso, Italy.
¹⁶ Fondazione IRCCS Casa Sollievo della Sofferenza, Division of Pediatrics, San Giovanni Rotondo, Italy.
¹⁷ Paediatrics Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁸ Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
¹⁹ Department of Pediatrics, University of Milano-Bicocca, Foundation MBBM/San Gerardo Hospital, Monza, Italy.
²⁰ Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
²¹ Department of Woman, Child and General and Specialistic Surgery, University of Campania ``Luigi Vanvitelli'', Naples, Italy.
²² Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Italy. Electronic address: massimo.martinelli@unina.it.

PMID: 33388247
PMCID: PMC7832380
DOI: 10.1016/j.dld.2020.12.011

Abstract

Background: IBD management has been significantly affected during the COVID-19 lockdown with potential clinical issues.

Aims: The aim of this study was to analyse the impact of COVID-19 pandemic on the Italian paediatric IBD cohort.

Methods: This was a multicentre, retrospective, cohort investigation including 21 different Italian IBD referral centres. An electronic data collection was performed among the participating centres including: clinical characteristics of IBD patients, number of COVID-19 cases and clinical outcomes, disease management during the lockdown and the previous 9 weeks.

Results: 2291 children affected by IBD were enrolled. We experienced a significant reduction of the hospital admissions [604/2291 (26.3%) vs 1281/2291 (55.9%); p < 0.001]. More specifically, we observed a reduction of hospitalizations for new diagnosis (from n = 44 to n = 27) and endoscopic re-evaluations (from n = 46 to n = 8). Hospitalization for relapses and surgical procedures remained substantially unchanged. Biologic infusions did not significantly vary [393/2291 (17.1%) vs 368/2291 (16%); p = 0.3]. Telemedicine services for children with IBD were activated in 52.3% of the centres. In 42/2291(1.8%) children immunosuppressive therapies were adapted due to the concurrent COVID-19 pandemic.

Conclusion: Due to the several limitations of the lockdown, cares for children with IBD have been kept to minimal standards, giving priorities to the urgencies and to biologics' infusions and implementing telemedicine services.

Keywords: COVID-19; Inflammatory Bowel Disease; Paediatrics; immunosuppression; lockdown; telemedicine.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflict of interests to declare with regards to this manuscript.

Figures

Fig 1 — **Fig. 1**
Number and type of hospital admissions 9 weeks before and during the COVID-19 lockdown phase; Fisher Exact Test (*p < 0.05; **p < 0.01; ***p < 0.001).

Fig 2 — **Fig. 2**
Number and type of inpatients’ visits 9 weeks before and during the COVID-19 lockdown phase.

See this image and copyright information in PMC

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References

1. Rosenbaum L. Facing Covid-19 in Italy - ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med. 2020;382:1873–1875. - PubMed
1. John Hopkins University; 2020. Coronavirus Resource Center coronavirus COVID-19 global cases. https://coronavirus.jhu.edu/map.htmlaccessed August 27th 2020.
1. Occhipinti V, Pastorelli L. Challenges in the care of IBD patients during the CoViD-19 pandemic: report from a “Red Zone” Area in Northern Italy. Inflamm Bowel Dis. 2020;26:793–796. - PMC - PubMed
1. Danese S, Cecconi M, Spinelli A. Management of IBD during the COVID-19 outbreak: resetting clinical priorities. Nat Rev Gastroenterol Hepatol. 2020;17:253–255. - PMC - PubMed
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[1] Rosenbaum L. Facing Covid-19 in Italy - ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med. 2020;382:1873–1875. - PubMed

[2] Rosenbaum L. Facing Covid-19 in Italy - ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med. 2020;382:1873–1875. - PubMed

[3] John Hopkins University; 2020. Coronavirus Resource Center coronavirus COVID-19 global cases. https://coronavirus.jhu.edu/map.htmlaccessed August 27th 2020.

[4] John Hopkins University; 2020. Coronavirus Resource Center coronavirus COVID-19 global cases. https://coronavirus.jhu.edu/map.htmlaccessed August 27th 2020.

[5] Occhipinti V, Pastorelli L. Challenges in the care of IBD patients during the CoViD-19 pandemic: report from a “Red Zone” Area in Northern Italy. Inflamm Bowel Dis. 2020;26:793–796. - PMC - PubMed

[6] Occhipinti V, Pastorelli L. Challenges in the care of IBD patients during the CoViD-19 pandemic: report from a “Red Zone” Area in Northern Italy. Inflamm Bowel Dis. 2020;26:793–796. - PMC - PubMed

[7] Danese S, Cecconi M, Spinelli A. Management of IBD during the COVID-19 outbreak: resetting clinical priorities. Nat Rev Gastroenterol Hepatol. 2020;17:253–255. - PMC - PubMed

[8] Danese S, Cecconi M, Spinelli A. Management of IBD during the COVID-19 outbreak: resetting clinical priorities. Nat Rev Gastroenterol Hepatol. 2020;17:253–255. - PMC - PubMed

[9] Martinelli M, Strisciuglio C, Fedele F, Miele E, Staiano A. Clinical and psychological issues in children with inflammatory bowel disease during COVID-19 pandemic. Inflamm Bowel Dis. 2020;26:e95–e96. - PMC - PubMed

[10] Martinelli M, Strisciuglio C, Fedele F, Miele E, Staiano A. Clinical and psychological issues in children with inflammatory bowel disease during COVID-19 pandemic. Inflamm Bowel Dis. 2020;26:e95–e96. - PMC - PubMed

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Impact of COVID-19 pandemic on the management of paediatric inflammatory bowel disease: An Italian multicentre study on behalf of the SIGENP IBD Group

Affiliations

Impact of COVID-19 pandemic on the management of paediatric inflammatory bowel disease: An Italian multicentre study on behalf of the SIGENP IBD Group

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