Psychiatric comorbidities and dehydration are more common in children admitted to the emergency department for eating disorders in the COVID-19 era

Abstract

Purpose Since the beginning of COVID-19 pandemic, social distancing and home confinement had a significant impact on children, especially on those with eating disorders (ED). The primary objective of this retrospective study was to describe and analyze the demographic and clinical profiles of children presenting with ED during the COVID-19 pandemic. Methods We conducted a retrospective review of clinical charts of patients with ED younger than 18 years who accessed the emergency department of the Bambino Gesù Children’s Hospital, Rome, between March 2019 and March 2021. Of these, we reported and compared the demographic, clinical and laboratory data before and after the COVID-19 pandemic and looked for predictors of ED severity. Results A total of 211 admissions for ED were recorded. The patients, mostly females (86.3%) were on average 14.1 years old. The mean weight loss on admission was 11 kg. Bradycardia was observed in 31.3% of the study sample. 16.6% of patients had an associated psychiatric disorder and 60.2% required psychotropic drugs. 68.7% of the patients required hospitalization. Respectively, 96 and 115 patients were admitted before and during the COVID-19 pandemic. The latter were hospitalized more (78.3 vs 57.3%; p = 0.001), yet for less time (19 vs 26 days; p = 0.004), had a higher mean serum creatinine (0.68 vs 0.47; p < 0.001) and were more frequently diagnosed with an associated psychiatric disorder (23.5 vs 8.3%; p = 0.003). Conclusion Our study shows a significant increase of hospitalizations of children with ED during the COVID-19 pandemic, along with a shorter length of stay, more psychiatric comorbidities, and some distinctive features at the laboratory work-up, such as an increase of serum creatinine and/or a reduction of serum albumin. Level of evidence III, evidence obtained from well-designed cohort or case–control analytic studies.

Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap

“…It is important to note that the COVID-19 pandemic and subsequent public health measures have resulted in a worsening of ED symptoms and an increase in psychological distress [ 24 ]. It is hard to measure the future impact of the pandemic on youth; however, data has consistently shown increased and worsening ED symptomatology since the onset of the pandemic which may represent greater incidence, prevalence, and/or acuity of EDs during the COVID-19 pandemic [ 25 , 26 , 27 ]. Finally, a recent study found a 60% increase of new onset AN or AAN diagnoses in youth compared to pre-pandemic rates, with the incidence of AN/AAN increasing from 24.5 to 40.6 cases per month [ 28 ].…”

Early echocardiographic evaluation in children with anorexia nervosa in the emergency department of a tertiary level children's hospital.

“…Our data showed this higher rate of pericardial involvement in patients with AN probably because, due to the COVID19 pandemic, patients with AN presented a more severe clinical status [25]. Conversely, none of our patients reported cardiac tamponade, which is considered a very rare complication in this group of patients in the literature [32].…”

“…In this setting, the increased number of young people requiring admission to health-care services because of ED has been linked to the onset of a real "ED epidemic" within the COVID-19 pandemic [23,24]. In particular, recent studies showed a more acute and severe ED onset during COVID-19 pandemic than in the recent past as well as an increased rate of psychiatric comorbidities and use of psychotropic drugs and a higher proportion of hospitalization [25,26].…”

Development of restrictive eating disorders in children and adolescents with long-COVID-associated smell and taste dysfunction

“…Well documented research has proven that patients with eating disorders, especially with anorexia nervosa, are at risk of many somatic and psychiatric comorbidities and higher mortality ( 15 , 27 – 30 ). Our study results show a positive correlation between restrictive eating behavior and symptoms of depression.…”

“…Moreover, the COVID pandemic has caused an increase in mental stress in children, adolescents, and their families worldwide. A rise in depression and anxiety disorders has been reported, as reflected by increased admissions due to severe eating disorders and suicide attempts ( 5 , 12 – 15 ).…”