Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatrics. 2022 Jan 1;149(1). doi: 10.1542/peds.2021-053498.
To determine if birth hospitalization length of stay (LOS) and infant rehospitalization changed during the coronavirus disease 2019 (COVID-19) era among healthy, term infants.
Retrospective cohort study using Epic's Cosmos data from 35 health systems of term infants discharged ≤5 days of birth. Short birth hospitalization LOS (vaginal birth <2 midnights; cesarean birth <3 midnights) and, secondarily, infant rehospitalization ≤7 days after birth hospitalization discharge were compared between the COVID-19 (March 1 to August 31, 2020) and prepandemic eras (March 1 to August 31, 2017, 2018, 2019). Mixed-effects models were used to estimate adjusted odds ratios (aORs) comparing the eras.
Among 202 385 infants (57 110 from the COVID-19 era), short birth hospitalization LOS increased from 28.5% to 43.0% for all births (vaginal: 25.6% to 39.3%, cesarean: 40.1% to 61.0%) during the pandemic and persisted after multivariable adjustment (all: aOR 2.30, 95% confidence interval [CI] 2.25-2.36; vaginal: aOR 2.12, 95% CI 2.06-2.18; cesarean: aOR 3.01, 95% CI 2.87-3.15). Despite shorter LOS, infant rehospitalizations decreased slightly during the pandemic (1.2% to 1.1%); results were similar in adjusted analysis (all: aOR 0.83, 95% CI 0.76-0.92; vaginal: aOR 0.82, 95% CI 0.74-0.91; cesarean: aOR 0.87, 95% CI 0.69-1.10). There was no change in the proportion of rehospitalization diagnoses between eras.
Short infant LOS was 51% more common in the COVID-19 era, yet infant rehospitalization within a week did not increase. This natural experiment suggests shorter birth hospitalization LOS among family- and clinician-selected, healthy term infants may be safe with respect to infant rehospitalization, although examination of additional outcomes is needed.
确定在 COVID-19 时代，健康足月婴儿的住院分娩时长（LOS）和婴儿再入院是否发生变化。
这是一项使用 Epic 的 Cosmos 数据进行的回顾性队列研究，研究对象为出生后≤5 天出院的足月婴儿，共来自 35 个医疗系统。比较 COVID-19 时期（2020 年 3 月 1 日至 8 月 31 日）与流行前时期（2017 年、2018 年和 2019 年 3 月 1 日至 8 月 31 日）的短 LOS（阴道分娩<2 个午夜；剖宫产<3 个午夜）和婴儿再入院情况（分娩出院后≤7 天）。使用混合效应模型估计比较两个时期的调整比值比（aOR）。
在 202385 名婴儿中（COVID-19 时期有 57110 名），所有分娩的短 LOS 从 28.5%增加到 43.0%（阴道分娩：从 25.6%增加到 39.3%，剖宫产：从 40.1%增加到 61.0%），这一趋势在大流行期间持续存在，且在多变量调整后仍保持不变（所有：aOR 2.30，95%置信区间 [CI] 2.25-2.36；阴道分娩：aOR 2.12，95% CI 2.06-2.18；剖宫产：aOR 3.01，95% CI 2.87-3.15）。尽管 LOS 缩短，但婴儿再入院率略有下降（从 1.2%降至 1.1%）；调整分析结果相似（所有：aOR 0.83，95% CI 0.76-0.92；阴道分娩：aOR 0.82，95% CI 0.74-0.91；剖宫产：aOR 0.87，95% CI 0.69-1.10）。两个时期的再入院诊断比例没有变化。
COVID-19 时期，婴儿 LOS 短了 51%，但一周内婴儿再入院率并未增加。这项自然实验表明，对于选择家庭和临床医生认为健康的足月婴儿，缩短分娩住院时长可能是安全的，不会增加婴儿再入院率，但还需要进一步检查其他结果。
