INFANTS WITH HYPERBILIRUBINEMIA PRESENTING TO THE EMERGENCY DEPARTMENT IN THE COVID-19 ERA

ABSTRACT

Purpose of Study Amidst the COVID 19 pandemic, hospitals implemented changes in labor and delivery practice, including limiting maternal and neonatal length of stay. A key aspect of neonatal care during the first few days of life is trending bilirubin. Modifications in newborn length of stay may lead to premature infant discharge before bilirubin rises enough to require phototherapy. The purpose of this study is to determine if there was a significant increase in the number of neonates presenting to our Emergency Department and admitted for hyperbilirubinemia in the COVID 19 era. Methods Used A retrospective chart review of infants 0-7 days old presenting to the Emergency Department (ED) with jaundice from March 01-November 01 of 2017, 2018, 2019 and 2020 was completed. Data collected included gestational age, day of life (DOL) at presentation, peak serum bilirubin level, presence of hyperbilirubinemia and neurotoxic risk factors, and length of stay (LOS). Chi square and t-tests determined differences between the study periods. Logistic regression was used to describe associations between COVID era and management of hyperbilirubinemia after adjusting for gestational age and peak serum bilirubin. Summary of Results Our analysis included 209 infants, 144 from the pre-pandemic period (48/year) and 65 after the onset of the pandemic. There was a statistically significant increase in the number of infants presenting to the ED with hyperbilirubinemia in the COVID era (p=0.04, table 1). A larger proportion of infants presenting with hyperbilirubinemia were admitted in the COVID era (41% vs 20%, p=0.001). A higher percentage of patients had a LOS of 2 or more days in the COVID era as compared to pre-pandemic (21.5% vs 6.3%, p=0.001). After adjusting for gestational age or peak serum bilirubin, infants presenting to the ED with hyperbilirubinemia had higher odds of being admitted (OR 2.8, 95% CI 1.5-5.2) and having a LOS of 2 or more days (OR 3.5, 95% CI 1.5-9.9). Conclusions Our study indicates that the number of patients presenting to the emergency department with hyperbilirubinemia in the first week of life increased following the onset of the pandemic. These patients had a higher likelihood of admission and longer length of stay compared to pre-pandemic visits. While some of these results may be attributable to earlier post-partum discharge, this was not due to variations in gestational age or peak bilirubin levels. Further studies show examine causes for these changes, particularly around decisions to admit infants with hyperbilirubinemia and the inability to perform home nursing visits during the early days of the pandemic. (Table Presented).