Pediatric neurosurgery during the COVID-19 pandemic: update and recommendations from the Brazilian Society of Pediatric Neurosurgery

Abstract

OBJECTIVESCoronavirus disease (COVID-19) is a potentially severe respiratory illness that has threatened humanity globally. The pediatric neurosurgery practice differs from that of adults in that it treats children in various stages of physical and psychological development and contemplates diseases that do not exist in other areas. The aim of this study was to identify the level of knowledge and readiness of the healthcare providers, as well as to evaluate new preventive practices that have been introduced, psychological concerns, and the impact of the COVID-19 pandemic on pediatric neurosurgical units in Brazil.METHODSPediatric neurosurgeons were given an online questionnaire developed by the Brazilian Society of Pediatric Neurosurgery to evaluate the impact of the COVID-19 pandemic on their clinical practice.RESULTSOf a cohort of 110 active members of the Brazilian Society of Pediatric Neurosurgery, 76 completed the survey (69%). Ninety-six percent were aware of the correct use of and indication for the types of personal protective equipment in clinical and surgical practices, but only 73.7% of them had unrestricted access to this equipment. Ninety-eight percent of participants agreed or strongly agreed that the pandemic had affected their pediatric neurosurgical practice. The COVID-19 pandemic interfered with outpatient care in 88% of the centers, it affected neurosurgical activity in 90.7%, and it led to the cancellation of elective neurosurgical procedures in 57.3%. Concerning the impact of COVID-19 on surgical activity, 9.2% of the centers had less than 25% of the clinical practice affected, 46.1% had 26%–50% of their activity reduced, 35.5% had a 51%–75% reduction, and 9.2% had more than 75% of their surgical work cancelled or postponed. Sixty-three percent affirmed that patients had been tested for COVID-19 before surgery. Regarding the impact of the COVID-19 pandemic on the mental health of those interviewed, 3.9% reported fear and anxiety with panic episodes, 7.9% had worsening of previous anxiety symptoms, 60.5% reported occasional fear, 10.5% had sadness and some depressive symptoms, and 2.6% reported depressive symptoms.CONCLUSIONSThe COVID-19 pandemic has posed unprecedented challenges to healthcare services worldwide, including neurosurgical units. Medical workers, pediatric neurosurgeons included, should be aware of safety measures and follow the recommendations of local healthcare organizations, preventing and controlling the disease. Attention should be given to the psychological burden of exposure to SARS-CoV-2 in healthcare workers, which carries a high risk of anxiety and depression.

Psicologia e pandemia: possibilidades

“…O estudo foi realizado com 76 membros ativos da Sociedade Brasileira de Neurocirurgia Pediátrica (SBNPed) que responderam a um questionário online a fim de avaliar o impacto da pandemia na sua prática clínica. Este foi conduzido durante a pandemia, de março a julho de 2020 (BALLESTERO;FURLANETTI;.…”

Presidential address—the Black Swan: ISPN and pediatric neurosurgery in times of COVID-19

“…According to a survey conducted by Jean et al [20], one-half of the responders reported a drop of about 50% in total operative volume. A similar study conducted by the Brazilian Society of Pediatric Neurosurgery informed that 90.7% of the neurosurgical activity was compromised and overall elective neurosurgical procedures were cancelled or postponed in 57.3% of the cases [18].…”

“…Chemotherapy was temporarily delayed. Overall, there was a significant decrease in the volume of pediatric cases [18,20]. According to a survey conducted by Jean et al [20], one-half of the responders reported a drop of about 50% in total operative volume.…”

“…Critically or potentially ill patients had to be identified and non-urgent procedures were postponed, particularly if there was a high risk of prolonged stay in intensive care units. Outpatients clinics were closed and elective patients were evaluated remotely through phone calls, e-mails, or teleconsultation [18,19]. Several centers restricted activities to the care of trauma, shunt procedures, vascular surgeries, and cases of malignant tumors, and cord compression.…”

“…Societies and associations in most of the affected countries focused on recommendations that included triage, adaptation of neurosurgical departments, resident's education, and concerns on PPE correct use in current neurosurgical practice [10,18,35]. Although these recommendations are being gradually relaxed in countries that have already gained greater control over the pandemic, restrictions may need to be resumed to the crisis level and this has actually happened in many cities and countries.…”