Increased Rates of Rehospitalization for Severe Hyperbilirubinemia During Social Distancing

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Background: Stay-at-home mandates and social distancing guidelines were implemented in WNY in response to the COVID-19 pandemic. These public health measures have had unintended impacts on health care utilization due to avoidance of medical settings and changes in access to care. In addition, typical family and social support systems have been disrupted as households isolate. We observed an increase in hyperbilirubinemia readmissions to our NICU during the early stages of COVID-19 pandemic, raising concerns for inadequate access to critical support in the post-partum period. 

Objective: 1.To determine if social distancing and changes in behavior correlated with increased rates and severity of readmissions due to hyperbilirubinemia. 2. To identify possible risk factors associated with readmission during social distancing.

Design/Methods: A retrospective chart review was conducted including a total of 35 readmissions for hyperbilirubinemia between 1/18 and 4/20. Infants were grouped into a control (1/18-1/20) and social distancing cohort (2/20-4/20). Data on maternal and infant demographics as well as hospital course were collected. Regional birth rates were acquired from statewide data sources. Outcomes were compared using T-test or Fisher Exact. Additionally, a convenience sample of 15 outpatient pediatric clinics were surveyed regarding lactation support offered during social distancing. 

Results: Monthly rate of readmission to the NICU for hyperbilirubinemia during the control period was 0.90±0.91 per 1000 births and increased to 2.63±2.29 during social distancing (p = 0.015, 2.9 fold increase). No significant differences were noted in maternal or infant demographics with the exception of a younger mothers in the socially distanced cohort (31.3±4.7 versus 25.8±3.3 years, p = 0.005). Infants had comparable bilirubin levels as well as threshold for phototherapy at discharge from the nursery (Table 1). Data from readmissions suggests comparable severity of disease, with no difference in day of admission, degree of dehydration, rates of hemolytic disease, peak bilirubin, rates of exchangeable level, duration of phototherapy, use of IVIg or exchange transfusion, or length of hospital stay. (Table 2). High rates of primiparity and exclusive breastfeeding were noted in the socially distanced cohort. Of 15 clinics surveyed regarding lactation resources available during social distancing, 6 confirmed a telemedicine option with 4 offering video appointments. 

Conclusions: Rates of hyperbilirubinemia readmissions increased during social distancing with younger mothers at highest risk. High rates of primaparity and exclusive breastfeeding in this cohort raises concerns that lack of social and/or lactation support may contribute. These data suggest that improved capacity for virtual lactation services and proactive identification of mothers at high risk may be indicated.

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University at Buffalo
Jacobs School of Medicine and Biomedical Sciences
University of Washington
Loma Linda University

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