Published on in Neonatology Update
The COVID-19 pandemic forced hospitals to change policies and procedures around childbirth, including expediting discharges for healthy term infants. This provided a natural experiment that allowed us to compare outcomes before and during the pandemic.
A new study led by researchers on our team found that full-term infants born during the COVID-19 pandemic had substantially shorter hospital stays than those born before the pandemic, with no change in hospital readmissions after discharge. The study was conducted with our colleagues at the Yale School of Medicine, Nemours Children’s Hospital, and Epic Systems Corporation.
Our findings, recently published in Pediatrics, suggest that shorter hospital stays after birth among healthy term infants may be safe outside of a pandemic scenario with respect to infant rehospitalization. Examination of additional outcomes is needed, but these initial results have positive implications for healthcare costs and best practices.
To compare hospital stays and rehospitalizations before and during the pandemic, we analyzed data using Epic Systems Corporation’s Cosmos research platform, an application that aggregates electronic health record (EHR) data submitted voluntarily by health systems for research. We pulled data from 35 health systems and compared short hospital length-of-stay following birth (defined as 2 nights or less following a vaginal birth and 3 nights or less following a cesarean birth) and infant rehospitalization within a week of discharge from the hospital between the COVID-19 era (March 1, 2020 to August 31, 2020) and the pre-pandemic era (defined as March 1 to August 31 in 2017, 2018, and 2019).
Evaluating a total of 202,385 infants during the pre-pandemic and pandemic periods, we found that short hospital stays were 51% more common during the COVID-19 era. The proportion of infants with a short hospital stay increased from 28.5% to 43.0% for all births during the pandemic (vaginal: 25.6% to 39.3%, cesarean: 40.1% to 61.0%). For vaginal births, there was an increase in those discharged after 1 night during the pandemic and a decline in those staying for 2 nights. Similarly, there was an increase in 2-night stays for cesarean deliveries and reductions of 3- and 4-night stays during the pandemic.
Despite shorter hospital stays, infant rehospitalizations within a week of discharge from the hospital decreased slightly during the pandemic (1.2% to 1.1%). The association between short birth hospitalization length-of-stay and infant rehospitalization did not differ significantly between eras.
These findings suggest that shared decision-making between families and clinicians, as was likely the case during COVID-19, resulted in safe earlier discharge with respect to infant hospitalization. Further study of mitigating factors such as home services, telemedicine visits, and other supports that may have changed during the pandemic are warranted. Additionally, investigation of the pandemic’s impacts on other infant and maternal outcomes are critical before changing birth hospitalization policy.
Handley et al. Birth hospital length of stay and rehospitalization during COVID-19. [Published online ahead of print Oct. 12, 2021] Pediatrics