Am J Perinatol
DOI: 10.1055/s-0044-1782145
Original Article

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

Kristen Ronca
1   Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
,
Laura Vazquez
1   Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
,
Eleanor Bathory
1   Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
,
Suhas Nafday
1   Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
› Author Affiliations
Funding None.

Abstract

Objective This study aimed to compare rehospitalization rates, diagnoses, and well-baby nursery (WBN) length of stay (LOS) among rehospitalized infants born during the COVID-19 pandemic to those born prior.

Study Design A retrospective comparison of 215 infants rehospitalized from March 1, 2019 to March 1, 2021 was performed in an urban academic center. Rates of readmission were determined for all infants using an unadjusted odds ratio. Among infants rehospitalized at ≤30 and ≤7 days, key cohort characteristics were analyzed using chi-square analysis, Fisher's exact test, independent t-test, and nonparametric testing as applicable. Differences in readmission diagnoses determined by International Classification of Diseases (ICD) code and chart review were evaluated with multivariable logistic regression comparing infants born during the pandemic to the year prior.

Results Pandemic infants had a 51% increased odds of rehospitalization ≤7 days of discharge from WBN compared with prepandemic infants (95% Confidence Interval (CI) 1.09–2.09). Rehospitalized infants born during the pandemic had shorter WBN LOS; infants rehospitalized ≤30 days had LOS of 54.3 ± 18.6 versus 59.6 ± 16.2 hours (p = 0.02) and infants rehospitalized ≤7 days had LOS of 53.8 ± 17.8 versus 60.8 ±17.0 hours (p = 0.02). The pandemic group of infants had a 3.5 increased odds of being readmitted for hyperbilirubinemia compared with other diagnoses after adjusting for biological sex, ethnicity, percent weight lost at time of discharge, gestational age, and mode of delivery (CI 1.9, 6.4).

Conclusion Rehospitalization ≤7 days post-WBN discharge was more common in infants born during the pandemic. Infants rehospitalized during the pandemic were more likely to have shorter WBN LOS and to be rehospitalized for hyperbilirubinemia. Retrospective analyses limit conclusions about causation but suggest that being born during the pandemic increased risk of rehospitalization for hyperbilirubinemia among infants in urban, under resourced setting warranting further investigation.

Key Points

  • Newborns rehospitalized during the pandemic had a shorter newborn nursery stay.

  • Newborns in the pandemic had a higher rate of rehospitalization within 7 days of birth compared to year prior.

  • More infants who required readmission during the pandemic were hospitalized for hyperbilirubinemia.

Supplementary Material



Publication History

Received: 02 May 2022

Accepted: 05 February 2024

Article published online:
12 March 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Rochelson B, Nimaroff M, Combs A. et al. The care of pregnant women during the COVID-19 pandemic - response of a large health system in metropolitan New York. J Perinat Med 2020; 48 (05) 453-461
  • 2 American Academy of Pediatrics. Management of Infants Born to Mothers with Suspected or Confirmed COVID-19. 2020 . Accessed November 15, 2022 at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/
  • 3 Patel S, Lorenzi N, Smith T, Carlson BR, Sternberg Jr P. Critical insights from patients during the Covid-19 pandemic. NEJM Catal 2020;1(04):
  • 4 Danielsen B, Castles AG, Damberg CL, Gould JB. Newborn discharge timing and readmissions: California, 1992-1995. Pediatrics 2000; 106 (1 Pt 1): 31-39
  • 5 Centers for Medicare & Medicaid Services (CMS gov). Newborns' and Mother's Health Protection Act (NMHPA). Retrieved June 1996 ; 26. Updated 2017 . Accessed November 18, 2022 at: https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/nmhpa_factsheet
  • 6 Mosen DM, Clark SL, Mundorff MB, Tracy DM, McKnight EC, Zollo MB. The medical and economic impact of the Newborns' and Mothers' Health Protection Act. Obstet Gynecol 2002; 99 (01) 116-124
  • 7 Edmonson MB, Stoddard JJ, Owens LM. Hospital readmission with feeding-related problems after early postpartum discharge of normal newborns. JAMA 1997; 278 (04) 299-303
  • 8 Kotagal UR, Atherton HD, Eshett R, Schoettker PJ, Perlstein PH. Safety of early discharge for Medicaid newborns. JAMA 1999; 282 (12) 1150-1156
  • 9 Paul IM, Lehman EB, Hollenbeak CS, Maisels MJ. Preventable newborn readmissions since passage of the Newborns' and Mothers' Health Protection Act. Pediatrics 2006; 118 (06) 2349-2358
  • 10 Bayoumi YA, Bassiouny YA, Hassan AA, Gouda HM, Zaki SS, Abdelrazek AA. Is there a difference in the maternal and neonatal outcomes between patients discharged after 24 h versus 72 h following cesarean section? A prospective randomized observational study on 2998 patients. J Matern Fetal Neonatal Med 2016; 29 (08) 1339-1343
  • 11 Jones E, Taylor B, MacArthur C, Bradshaw S, Hope L, Cummins C. Early postnatal discharge for infants: a meta-analysis. Pediatrics 2020; 146 (03) e20193365
  • 12 Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database Syst Rev 2002; x (03) CD002958
  • 13 Jones E, Stewart F, Taylor B, Davis PG, Brown SJ. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database Syst Rev 2021; 6 (06) CD002958
  • 14 Tomashek KM, Shapiro-Mendoza CK, Weiss J. et al. Early discharge among late preterm and term newborns and risk of neonatal morbidity. Semin Perinatol 2006; 30 (02) 61-68
  • 15 Ruth CA, Roos NP, Hildes-Ripstein E, Brownell MD. Early term infants, length of birth stay and neonatal readmission for jaundice. Paediatr Child Health 2014; 19 (07) 353-354
  • 16 Lain SJ, Roberts CL, Bowen JR, Nassar N. Early discharge of infants and risk of readmission for jaundice. Pediatrics 2015; 135 (02) 314-321
  • 17 Handley SC, Gallagher K, Breden A. et al. Birth hospital length of stay and rehospitalization during COVID-19. Pediatrics 2022; 149 (01) e2021053498
  • 18 Wood KE, Schmitz A, Bhoojhawon G. Early discharge from a newborn nursery in the United States during the COVID-19 pandemic. COVID 2022; 2 (03) 379-388
  • 19 Schwirtz M, Cook LR. These N.Y.C. neighborhoods have the highest rates of virus deaths. New York Times. May 18, 2020. Accessed December 5, 2022 at: https://www.nytimes.com/2020/05/18/nyregion/coronavirus-deaths-nyc.html
  • 20 County Health Rankings & Roadmaps. 2020 County Health Rankings Report: New York. 2020 . Accessed December 1, 2022 at: https://www.countyhealthrankings.org/sites/default/files/media/document/CHR2020_NY_0.pdf
  • 21 Feijóo-Iglesias MB, Chicharro Chorro L, Ballester Escolar I, Suárez Pascual A, Aglaya De la Peña Rodríguez M, Alba Diego R. Alta precoz y visita domiciliaria puerperal durante la pandemia por la COVID-19 en el Hospital Universitario La Paz (Madrid). Rev Esp Salud Pública 2021; 95 (01) e1-e18