ABSTRACT
Background Our tertiary level neonatal unit has well-established transitional care facilities (TCU), which are co-located on the post-natal ward (PNW). As part of the ATAIN process, we noted an increase in term admission from TCU to the neonatal unit (NNU) between the first and second quarter of 2020. It was postulated such an effect, at least in part, could be an indirect consequence of stringent government mandated restrictions on hospital visiting, in line with COVID-19 policies. 1 2 On TCU, where mothers are resident, restrictions were such that women may have chosen to return home, leaving their baby on NNU instead, due to diminished access to familial support and/or isolation. On the NNU, we value our parents as partners in care, rather than visitors, and did not implement any such restrictions. Objectives To compare trends in TCU to NNU admissions prior to and during the COVID-19 pandemic and evaluate the presence of maternal request as a factor for deciding ultimate place of care rather than the classical resource dependant allocation and individual care requirements. Methods All admission from TCU in 2019 (Pre-COVID-19) and 2020 (COVID-19) were identified using the NNU admissions book. Patient characteristics were recorded, including gestation, birth weight, mode of delivery, reasons for admission to TCU, length of stay, seniority of review and ultimate decision to move patient to NNU. Data on these patients was collated from the electronic patient record, Badger software and patient hand-written notes. Patients were excluded if their trajectory between wards was incorrectly coded. Results More than double the number of patients were admitted to the NNU from TCU in 2020 compared to 2019 (table 1), yet overall demographics of gestation and birth weight remained very similar. When comparing the admission rates exclusively to coincide with the start of the UK lockdown, (April - December) there were 7 cases in 2019 compared to 22 in 2020. In 2019, there was a single case of a baby being admitted to NNU from TCU due to maternal choice. However, the circumstances are mitigating as the baby was a planned removal to social services. In 2020, 5 of the 24 NNU admission from TCU were due to maternal choice (21% vs. 9% in 2019). All cases occurred between June-October 2020 at the time of easing of lockdown measures for the first time since March [4]. Conclusions Decisions regarding admissions to NNU from TCU are often multifactorial and not always easy to determine in notes. More babies were admitted to the NNU from TCU during the COVID-19 pandemic, as hypothesised, given restrictions brough in due to the COVID-19 pandemic, a significant proportion of these were due to maternal choice.