Post-Discharge Care Practices, Challenges and Outcomes in Newborn Infants of Mothers with SARS-CoV-2 Infection: Insights from Public Hospitals

Abstract

Background The data regarding the care at home and outcomes in infants of mothers infected with SARS-CoV-2 continues to evolve. There is a paucity of studies beyond the immediate newborn period. Our research aims to improve the understanding in these areas by studying the newborn population discharged from public hospitals in several boroughs of New York City (NYC) through the first year of the Covid-19 pandemic. Objective To assess parental perspective and describe post-discharge care practices, patterns of healthcare utilization, challenges obtaining care, and outcomes in infants between 6 to 12 months of age born to mothers infected with SARS-CoV-2 at the time of delivery. Methods We conducted an IRB-approved multi-center retrospective cohort study of infants born to SARS-CoV-2 positive mothers at 5 NYC public hospitals between March and December of 2020. Clinical and demographic data were collected from electronic medical records. A phone interview of the caregivers using a standard questionnaire was conducted to collect data about care at home, healthcare utilization patterns, and challenges with access to healthcare. Results Our study cohort included 216 infants born to SARS-CoV-2 positive mothers with 16 (7.4%) mothers being symptomatic at discharge. Ten infants tested positive and 2 showed symptoms before discharge. Two hundred and seven (95.8%) infants were discharged home and 202 (94%) were discharged to their parents. 138 (66%) infants had at least 1 visit to the emergency room for various complaints where 2 were found to have Covid-19 with 1 needing hospitalization. 172 (79.6%) families responded to the phone interview. Most mothers (78%) cohabitated with their infant at home and 70.3% elected to breastfeed. However, only 56.3% of mothers reported using all the recommended infection prevention practices at home. More than half (57%) of the families reported financial hardship related to the pandemic. Although 46.2% of patients missed their in-person health maintenance visits, telemedicine was highly utilized for follow up with most being phone visits (70.3%). The majority of the infants (95.5%) remained up-to-date with their routine immunizations. Results are summarized in tables 1–3. Conclusions Our results suggest that infants born to SARS-CoV-2 infected mothers showed increased utilization of medical care and telemedicine between 6–12 months of age. Mothers reported low adherence to infection prevention practices at home however infants rarely showed clinically significant SARS-CoV-2 infection while maintaining high breastfeeding rates after discharge.