Early Discharge from a Newborn Nursery in the United States during the COVID-19 Pandemic

Abstract

The COVID-19 pandemic changed birth hospitalization, with many hospitals implementing restrictions. Little is known about the impact of the COVID-19 pandemic on rates of early newborn discharge and length of stay (LOS). The primary objective was to compare rates of early discharge before and after the start of the COVID-19 pandemic. Secondary objectives included 28-day readmissions and LOS. A single-center retrospective cohort study was undertaken of all live newborns discharged from a well newborn nursery in the United States between 1 July 2015 and 18 June 2021. The pre-COVID-19 era was defined as 1 July 2015 to 29 February 2020, and the COVID-19 era as 1 March 2020 to 18 June 2021, based on the first case reported in our state. Early discharge was defined as less than or equal to 24 h. A total of 10,589 newborns were included: 8094 before and 2495 after the COVID-19 pandemic started. Overall, 43 newborns (0.41%) were discharged early. In the COVID-19 era, early discharges significantly increased from 0.23% (n = 19) to 0.96% (n = 24) (p < 0.001). Median LOS declined from 52.0 (IQR, 43.0–64.0) to 45.0 (IQR, 37.0–56.0) hours (p < 0.001). The 28-day readmission rate decreased from 2.3% (n = 182) to 1.3% (n = 33) (p < 0.01). Since the start of the COVID-19 pandemic, the number of early discharges has significantly increased at our institution without an increase in readmissions. Additionally, overall decrease in length of stay for the birth hospitalization was observed. Potential reasons include changes in hospital unit policies including visitor limitations to reduce COVID-19 infection risk to patients and staff and/or parental concern for iatrogenic acquisition of the virus.

Rehospitalization Following Discharge from Newborn Nursery during Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic

“…This was expected due to hospital policy changes that encouraged earlier discharge and is consistent with prior studies. 17,18 Our data showed that among readmitted infants, those in the pandemic group were more likely to be rehospitalized within 7 days of discharge from the newborn nursery, but this was no longer true for infants readmitted at 30 days. This suggests differences between the prepandemic and pandemic groups were more likely to be due to factors in the first 1 to 2 weeks of life.…”

“…17 Similarly, a small retrospective cohort study in Iowa found infants born during the pandemic had fewer rehospitalizations and shorter newborn nursery LOS. 18 Though not achieving statistical significance, both studies demonstrated trend toward different rates of rehospitalization diagnosis. 17,18 Further studies are needed to examine if there are similar findings in an urban, underserved community, particularly in one that was disproportionally affected early in the pandemic.…”

“…18 Though not achieving statistical significance, both studies demonstrated trend toward different rates of rehospitalization diagnosis. 17,18 Further studies are needed to examine if there are similar findings in an urban, underserved community, particularly in one that was disproportionally affected early in the pandemic. The Bronx has the lowest scores on health factors and health outcomes in the state, and in the spring of 2020, had the highest rate of COVID-19 cases, hospitalizations, and deaths in NYC.…”

Newborn readmissions and virtual primary care delivery: a population-based case-control study

“…Pandemic-specific factors may have contributed to our findings as the risk of newborn rehospitalization may have changed during this time. While some studies suggest that the frequency of overall post-discharge newborn rehospitalization did not change during the pandemic [28,29], there have been reports of increased rehospitalization risk in some subgroups such as those born to nulliparous mothers [30] and those readmitted for hyperbilirubinemia [31]. One nation-wide study from England found that while acute care presentations decreased by 16.7% overall during vs. before the pandemic, attendance for feeding problems and neonatal jaundice increased by 7.5% and 12.8% respectively [32].…”