Background Covid-19 is a novel disease which has had an impact on the delivery of health care services, including postnatal care. Term newborns may often require additional clinical input varying from postnatal wards to the neonatal intensive care unit.
Objectives To review the admissions of term neonates to a level 2 neonatal intensive care unit (NICU) and transitional care (TC) ward (a postnatal ward) during the COVID-19 period.
Methods A retrospective audit was carried out of term neonatal admissions to NICU and TC during 1st March 2019–31st August 2019 (Period 1) and compared with 1st March 2020–31st August 2020 (period 2; Covid – 19 period). Babies born at term (>37/40) were included. Babies who were premature (<37/40) or repatriated from other hospitals were excluded. This also included reviewing term babies re-admitted from home within 7 days of birth.
Results Admissions to NICU had reduced by 1/3 (143 during period 1, 97 during period 2). Similarly, there was a marked reduction in admissions related to respiratory distress (64 in period 1, 42 in period 2) and infection (14 in period 1, 4 in period 2). There were only 2 direct admissions due to Covid-19. There were similar numbers of admissions from home (31 in period 1, 35 in period 2). There was an increase in the number of babies admitted from D4-5 of life, yet NICU admissions from home had nearly halved (21 in Period 1, 11 in period 2). There was an increase in admissions to the TC ward instead (10 in Period 1, 24 in Period 2), including more babies requiring treatment for jaundice. The admissions to the TC ward were mostly not in line with the existing ‘readmission from home policy’ however there were no complications from these admissions. There was a reduction in the readmissions from home due to hypernatremic dehydration and infection.
Conclusions Although overall delivery numbers were similar between the two time periods, Elective C-sections occurred off site which may explain the reduction in admissions for respiratory distress. The improvement in isolation and infection protocols could explain the reduction in admissions due to infection. Similarly isolation at home and perhaps reduced visits from friends and relatives may have improved feeding success and explain the reduced admissions due to hypernatremic dehydration. Using TC services reduced the admission load on NICU, whilst also allowing mums and babies to stay together on the postnatal ward. In doing so, we will now review the readmission from home policy and capacity of TC to allow more babies to be kept together with their mums on re-admission, as we have demonstrated this can be done in a clinically safe manner. It is also a useful strategy for further waves of Covid-19, should there be more direct Covid-related admissions. With a reduction in community services we need to offer more support to parents with monitoring jaundice.
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