Neonatal morbidity after the start of the pandemic: Disparate outcomes across two sites

ABSTRACT

Objective: During the early months of the pandemic, policies were implemented that sought to reduce in-person office visits. We sought to evaluate the neonatal outcomes associated with those policy changes across two disparate clinical sites. Study Design: We performed a cohort study of patients obtaining prenatal care at two clinics that were disparate in patient population and resources during two different 6 month intervals (Time I July 1, 2019 - December 31, 2019 and Time II March 23, 2020 - September 23, 2020). Both sites shared identical policies and leadership. Patients with known SARS-CoV-2 infection were excluded from the analysis. Medical records were reviewed for clinical and demographic characteristics. Neonatal morbidity was defined as any of the following stillbirth, neonatal death, preterm birth, NICU admission, low birthweight. Data was analyzed using chi square and Cochran Q test where appropriate. P< 0.05 was significant. Results: Site A’s prenatal visits decreased (Time I= 9,782 and Time II= 8,694) while Site B’s prenatal visits increased (Time I= 4,144 and Time II= 6,644). At baseline, Site A compared to Site B was more likely to have patients with commercial insurance (88.7 vs 12.9%, p< 0.001) and who self-identified as White race (66.6 vs 29.9%, p< 0.001). Patients from Site A were less likely to be Hispanic (18 vs 39.1%, p< 0.001) and had a lower neonatal morbidity rate (19 vs 26%, p< 0.001). In Time I, neither site was using telehealth. In Time II, Site A conducted 21.5% of prenatal visits by telehealth. Site B conducted 1.8% of visits by telehealth but experienced net transfer of patients whose physician offices were closed. In Time II, the neonatal morbidity disparity between the two sites persisted (18.7 vs 28%, p< 0.001), with Site B experiencing a slight increase in neonatal morbidity. Cochran's Q test indicates a statistically significant difference in the proportion of perinatal morbidity over time, χ2 (2) = 740.7, p< 0.001. Conclusion: Policies to reduce in-person visits are associated with an increased neonatal morbidity in lower resourced settings and higher risk populations.