Increased ELBW Admissions During NYS Pause: a Regional Perinatal Center Experience

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ESPR251
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Abstract: :

Background: In reponse to the COVID-19 pandemic, the "New York State on PAUSE" order directing cessation of all non-essential activity was enacted in March 2020. There was a rapid drop in clinic/ER visits and inpatient admissions but premature (PT) NICU admissions, birth weight (BW) <1000g (extremely low birth weight/ELBW) seemed to increase at the Western New York Regional Perinatal Center(WNY RPC). We hypothesized that there were a disproportionately higher number of ELBW admissions during the "Pause" period and that these infants may have had decreased exposure to antenatal steroids(ANS) with higher neonatal morbidities resulting in longer NICU length of stay (LOS).

Objective: 1. To determine 5-year institutional and regional ELBW birth patterns 2. To determine differences in maternal and infant characteristics in ELBW (<1000g) neonates admitted to the WNY RPC NICU during March-June 2020 (NYS pause period) to the prior year (Control-Feb 2019-Feb 2020).

Methods: For epidemiological data, quarterly patterns in ELBW births over 5y was accessed from the WNY RPC database. A retrospective chart review compared ELBW infants born in the two periods. Data was analyzed using Graphpad prism statistical package using appropriate tests. The study was approved by the Institutional review board.

Results: Quarterly institutional ELBW births (per 1000 live births) were at an unprecedented high during the pause (Fig 1a). Regional ELBW birth pattern also demonstrated a smaller increase (Fig 1b). A disproportionately higher number of ELBW admissions to the RPC, both as a proportion of total NICU admissions (8.6% vs 4.4%) as well as PT admissions <35w gestation (21.5% vs 14.1%) were seen during the study period (Fig 2a and b). BW and gestational age were similar between groups. Contrary to our hypothesis, there was a higher rate of completed ANS during the pause and a similar rate of tocolytic administration, suggesting timely antenatal care (Table 1). Very few mothers reported infectious symptoms and very few were tested for SARS-CoV-2. Neonatal mortality, morbidity and LOS was statistically similar though slightly higher rates of mortality and severe IVH were observed (Table 2).

Conclusions: In the absence of overt illness leading to increased ELBW admissions, other effects of either the pandemic itself or of a statewide "pause" could lead to this observation. Asymptomatic SARS-CoV-2 infections are a possibility, since limited testing infrastructure was available at the time. Effects of stress on increasing PT births is reported (Hobel et al 2008). Interestingly, reports from Europe note a decrease in PT births during their lockdown (Been et al 2020) Socio-demographic factors, including differences in characteristics of the pandemic as well as regional variation in response could contribute to these observations. Large epidemiological national/registry studies are needed to assess national trends in birth rate and causes of such variation.







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University at Buffalo
University at Buffalo
University at Buffalo
Uneversity at Buffalo
University at Buffalo
University at Buffalo
University at Buffalo
University at Buffalo

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