394 - Early Nursery Discharge (ED) During Cov-19 and Hyperbilirubinemia Readmissions (RA)

Poster Number: 394
Publication Number: 394.314

Pinchi Srinivasan, Icahn School of Medicine at Mount Sinai, NEW HYDE PARK, NY, United States; Lincoln J. Ferguson, Icahn School of Medicine at Mount Sinai, Oceanside, NY, United States; Ditian Li, Icahn School of Medicine at Mount Sinai, JERSEY CITY, NJ, United States; Emilia Bagiella, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Warren Rosenfeld, Mount Sinai South Nassau, New York, NY, United States

Background: During the Covid-19 pandemic (Cov-19), many hospitals adopted policies with Early Discharge (ED) with ↓ LOS for mothers and babies. ED from the nursery has been associated with an increased risk for readmission (RA), especially for hyperbilirubinemia (HB).

Objective: To determine whether the ↓ LOS during the Cov-19 would result in increased RA, and to evaluate how the prospective data during Cov-19 compared to Pre Covid historical data from the years 2017-2019 when ED was infrequent.

Design/Methods: Within our hospital system a shortened LOS policy was instituted and terminated several times in a Cov-19 setting where patient demographics and hospital practices in NB care remained the same. ED policy in effect during 2 peak periods (Fig 1) of COV-19 (04/20-06/20 and from 01/21-03/21). Data collected and analyzed for Cov-19 and pre-Cov-19 period. Inclusion criteria: GA >36 wks, NSVDs, nursery admissions. Exclusion: CS,NICU admissions. The primary outcome was RA in the first 2 weeks of life for treatment of HB. Other variables of interest included postnatal LOS (hrs), breast-feeding, GA and sex. ED for NBs is defined by the AAP as LOS ≤48 hrs. Data in this study was analyzed for discharges for different LOS (≤24, ≤36, and ≤48 hrs).

Results: During Cov-19,1714 NBs met inclusion criteria. 578 (34%) were discharged ≤36 hrs and 1225 (71%) ≤48 hrs. For NBs discharged ≤36 hrs, there were 5 RA (0.9%) which was significantly less than 28 (2.5%) discharged >36 hrs [OR 0.35(0.13, 0.90) (p=0.03)]. 20 NBs (1.6%) discharged ≤48 hrs were readmitted compared to 13 (2.3%) discharged >48 hrs [OR0.61(0.31, 1.23) (p=0.17)] (Tables 1 & 2). Univariate analysis of outcome RA was performed by Logistic regression for variable LOS ≤36 hrs and ≤48 hrs separately, in both 2017-2019 and 2020-2021 datasets. When the 2017-2019 retrospective data was compared to the Cov-19 prospective data, the overall RA rates were similar (1.9% to 2.2%). Comparing the LOS (Hrs) for ED groups during Cov-19 to Pre Covid, they were significantly shorter for the Cov-19 period for ≤36 hrs (30.3±3.4 hrs vs 33.0±4 hrs, p< 0.0001) and for ≤48 hs (36.6±6.8 vs 42.6±4 hrs, p< 0.0001) groups (Table3). 

Conclusion(s): ED was not associated with an increase in RA for HB with DC ≤36 and ≤48 hours. During the Cov-19 the LOS for the ≤36 hrs ED group was significantly shorter, and the rate of RA was significantly lower than those discharged at >36 hrs. Past concerns about negative effects of ED may not be as significant with present day hospital practices including universal screening, discharge planning, early follow-up visits, and strengthened breast feeding support.