125 - Early Discharge from the Well Newborn Nursery During the COVID-19 Pandemic at a Midwest Academic Medical Center

Poster Number: 125
Publication Number: 125.415

Kelly E. Wood, University of Iowa Carver College of Medicine, Coralville, IA, United States; Guru Bhoojhawon, University of Iowa Hospitals & Clinics, Iowa City, IA, United States; Anna Schmitz, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States

Background: The American Academy of Pediatrics (AAP) defines early and very early hospital discharge for a newborn as 48 and 24 hours, respectively. The COVID-19 pandemic changed the birth hospitalization experience 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).

Objective: The objective of our study was to determine the incidence of very early newborn discharges and to compare proportions before and after the start of the COVID-19 pandemic. Our secondary objectives were to analyze LOS over time and 28-day readmissions.

Design/Methods: This was a single center retrospective cohort study of all live newborns discharged from the well newborn nursery between 7/1/2015 and 6/16/2021; all newborns were born between 35 and 43 6/7 weeks gestation. Data was obtained from the electronic medical record. Pre-COVID-19 was defined as 7/1/2015 to 2/29/2020 and post-COVID-19 as 3/1/2020 to 6/16/2021 based on the first case reported in our state. Very early discharge was defined as less than or equal to 24 hours.

Results: A total of 10,589 newborns were included, 8,094 before, and 2,495 after the COVID-19 pandemic started. Overall, 43 newborns (0.41%) discharged very early, and 24 (0.23%) discharged at less than 24 hours of age. All were term newborns delivered vaginally. After the start of the pandemic, the proportion of very early discharges significantly increased from 0.23% (n=19) to 0.96% (n=24) (p < 0.001) with discharges at less than 24 hours increasing from 0.11% (n=9) to 0.60% (n=15) (p < 0.001). The distribution of length of stay (LOS) demonstrated a significant difference (p < 0.001) towards earlier discharge across the entire population. The median LOS declined from 52.0 (IQR, 43.0-64.0) to 45.0 (IQR, 37.0-56.0) (p < 0.001) hours. The 28-day readmission rate fell from 2.3% (n=182) to 1.3% (n=33) (p < 0.01).Conclusion(s): Since the start of the COVID-19 pandemic, the number of very early discharges at 24 hours or less has significantly increased at our institution without an increase in readmissions. Additionally, we observed a decrease in overall length of stay for the birth hospitalization. Larger studies are needed to evaluate changes in early newborn discharge and the impact on health outcomes including readmissions and breast-feeding rates.
Figure 1. Discharge Timing in the Pre-COVID-19 and COVID-19 era**Pre-COVID-19 was defined as 7/1/2015 to 2/29/2020, and post-COVID-19 as 3/1/2020 to 6/16/2021.
Figure 2. Proportion of Patients Discharged by Length of Stay (LOS)**Pre-COVID-19 was defined as 7/1/2015 to 2/29/2020, and post-COVID-19 as 3/1/2020 to 6/16/2021.