Missed Opportunities and the Impact of the Pandemic.
Missed Opportunities and the Impact of the Pandemic.
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DOI：
10.1097/dbp.0000000000001065
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发表时间：
2022-04-01
影响因子：
2.4
通讯作者：
Nyp, Sarah S.
中科院分区：
文献类型：
--
作者：
Sabapathy, Thusa;Bansal, Riya;Bojorquez, Lauren;Salley, Brenda;Gianakon, Julie Grace;Gelineau-Morel, Rose;Nyp, Sarah S.
本杰明是一名9个月大的前36周妊娠婴儿，在父母关心发育退化的情况下，他来到了高危婴儿随访诊所。他的母亲报告说，本杰明似乎正在发育，但在过去的两个月里，他失去了视觉跟踪物体的能力，不像以前那样与她相处，现在很少发出叽叽喳喳的声音。他的母亲还报告了他断断续续的四肢僵硬和短暂的凝视发作。本杰明的母亲形容他是一个“乖巧、安静的孩子”。她评论说，他过去笑和哭的频率更高了，但最近“非常平静和平静”。本杰明的母亲最近在一次纯音频远程健康访问中向他的儿科医生转达了她对发育退化的担忧。本杰明被转介到一位儿科神经科医生那里，咨询访问正在等待中。他的母亲是一位28岁的单亲母亲，怀孕期间患有先兆子痫、妊娠期糖尿病和焦虑。由于最初的喂养困难，本杰明要求住进新生儿重症监护病房。1周后，本杰明出院回家，并被转介接受早期干预服务。由于大流行，启动干预措施出现了延误，但最终提供了与婴儿发展项目代表的双月虚拟互动。本杰明的母亲对他可能会因为带儿子亲自去看医生而暴露在与大流行有关的疾病中的可能性表示了极大的担忧。事实上，由于她的担忧，在过去的6个月里，她只参加了虚拟的健康儿童儿科就诊。一份详尽的社会史记录显示，她曾是一名舞蹈工作室的教练。由于大流行，工作室关闭了，她失去了主要的收入来源。因此，她决定不把本杰明送到托儿所，并与大家庭成员保持隔离。在体检方面，相关发现包括躯干音调差，缺乏对声音的定向，以及有限的眼神接触。应用贝利婴幼儿发育量表第三版(Bayley-III)，结果表明所有发育领域都存在严重的发育迟缓，这与全球发育迟缓的诊断一致。本杰明在HRIF诊所的临床表现以及发育退化和间歇性身体运动的病史引起了对婴儿痉挛的关注。他被转移到急诊科进行评估和考虑进入神经科服务。脑电图证实癫痫样异常与婴儿痉挛相一致，他立即开始治疗。大流行对弱势/高危儿科患者的医疗保健的影响包括延迟接受早期干预服务，父母在寻求预防性护理时对可能接触大流行相关疾病的恐惧，更多地使用虚拟探视平台进行医疗护理和发展干预服务，等等。在向这些弱势/高危患者提供支助时，应考虑哪些因素？
Benjamin is a 9-month-old, former 36-week gestation infant who presented to the high-risk infant follow-up clinic with parental concern for developmental regression. His mother reported that Benjamin seemed to be developing typically, but over the past 2 months, he has lost the ability to visually track objects, is not as engaged with her as he once was, and now only rarely makes babbling sounds. His mother also reported episodes of intermittent “bursts” of stiffening of his extremities and brief staring spells. Benjamin’s mother described him as a “good, quiet baby.” She commented that he used to laugh and cry more frequently but has recently been “very peaceful and calm.” Benjamin’s mother recently relayed her concerns for developmental regression to his pediatrician during an audio-only telehealth visit. Benjamin was referred to a pediatric neurologist, and the consultation visit is pending. His mother is a 28-year-old single parent whose pregnancy was complicated by pre-eclampsia, gestational diabetes, and anxiety. Benjamin required admission to the neonatal intensive care unit because of initial feeding difficulties. After 1 week, Benjamin was discharged to home and was referred for early intervention services. Owing to the pandemic, there were delays with initiating intervention, but bimonthly virtual interaction with a representative from the infant development program was eventually provided. Benjamin’s mother expressed significant concerns regarding the potential of exposing him to a pandemic-related illness because of bringing her son to in-person medical visits. In fact, because of her concerns, she attended only virtual well-child pediatric visits over the past 6 months. A thorough social history revealed that she is a former dance studio instructor. The studio closed and she lost her primary source of income because of the pandemic. As a result, she decided to not send Benjamin to child care and maintained isolation from extended family members. On physical examination, pertinent findings included poor truncal tone, lack of orientation toward sounds, and limited eye contact. The Bayley Scales of Infant and Toddler Development–Third Edition (Bayley-III) was administered, and the results indicated severe delays across all developmental areas, consistent with a diagnosis of global developmental delay. Benjamin’s clinical presentation to the HRIF clinic and a history of developmental regression and intermittent body movements raised concerns for infantile spasms. He was transferred to the emergency department for evaluation and consideration for admission to the neurology service. An electroencephalogram confirmed epileptiform abnormalities consistent with infantile spasms, and he was immediately started on treatment. Impacts of the pandemic on the medical care of vulnerable/at-risk pediatric patients have included delayed receipt of early intervention services, parental fear regarding potential exposure to pandemic-related illness while seeking preventative care, increased use of virtual visit platforms for medical care and developmental intervention services, etc. What factors should be considered when providing support for these vulnerable/at-risk patients?