COVID 19: Downstream effects on developmental care - A case report

Abstract

Introduction: COVID-19 pandemic has had a global impact resulting in increased demand on health systems worldwide. This has invariably resulted in major downstream effects to paediatric developmental care that focuses on identifying and making early interventions to optimize the developmental potential of infants with neurological impairment. Here we present a patient with global developmental delay who had unacceptable delays in getting access to intervention programs due to COVID-19. Case study: A 14-month old girl is admitted with fever and two episodes of right-sided focal convulsions. She was born to healthy non-consanguineous parents without perinatal complications. She had subtle dysmorphism, central hypotonia, microcephaly and global developmental delay. Her developmental age was 6-8 months. Biochemical and microbiological investigations, including SARSCoV- 2 PCR and cerebrospinal fluid analysis, were negative. Her EEG showed theta waves suggesting a structural brain pathology. Further questioning revealed that the baby had not attended well-baby clinics as the clinics were not held due to the COVID-19 pandemic. The mother had identified the baby's developmental delay and had gone to a paediatric tertiary care centre three times. However, she was sent back without a proper assessment claiming that the baby's condition is non-urgent and advised to come back when the COVID-19 pandemic ends. Conclusions/ Lessons learnt: This case illustrates the impact of the COVID-19 pandemic on chronic disabling conditions of children. To minimise these downstream effects, the public health sector should create programs to improve family visits and increase the availability of staff-delivered developmental care.