Jegatheesan Priya, Narasimhan Sudha Rani, Huang Angela, Nudelman Matthew, Song Dongli
Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States.
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.
Front Pediatr. 2023 Jul 7;11:1206036. doi: 10.3389/fped.2023.1206036. eCollection 2023.
Increasing evidence has shown that the COVID-19 pandemic has had a profound negative impact on vulnerable populations and a significant effect on maternal and neonatal health. We observed an increase in the percentage of infants admitted to NICU from 8% to 10% in the first year of the pandemic. This study aimed to compare the delivery room outcomes, NICU admissions and interventions, and neonatal outcomes two years before and during the pandemic.
This was a retrospective study in a public hospital between pre-COVID-19 (April 2018-December 2019) and COVID-19 (April 2020-December 2021). Data were obtained from all live births at ≥35 weeks gestation (GA). Maternal and neonatal demographics, delivery room (DR), and NICU neonatal outcomes were compared between the study periods using simple bivariable generalized estimating equations (GEE) regression. Multivariable GEE logistic regression analysis was performed to adjust for the effects of baseline differences in demographics on the outcomes.
A total of 9,632 infants were born ≥35 weeks gestation during the study period (pre-COVID-19 = 4,967, COVID-19 = 4,665). During the COVID-19 period, there was a small but significant decrease in birth weight (33 g); increases in maternal diabetes (3.3%), hypertension (4.1%), and Hispanic ethnicity (4.7%). There was a decrease in infants who received three minutes (78.1% vs. 70.3%, < 0.001) of delayed cord clamping and increases in the exclusive breastfeeding rate (65.9% vs. 70.1%, < 0.001), metabolic acidosis (0.7% vs. 1.2%, = 0.02), NICU admission (5.1% vs. 6.4%, = 0.009), antibiotic (0.7% vs. 1.7%, < 0.001), and nasal CPAP (1.2% vs. 1.8%, = 0.02) use. NICU admissions and nasal CPAP were not significantly increased after adjusting for GA, maternal diabetes, and hypertension; however, other differences remained significant. Maternal hypertension was an independent risk factor for all these outcomes.
During the COVID-19 pandemic period, we observed a significant increase in maternal morbidities, exclusive breastfeeding, and NICU admissions in infants born at ≥35 weeks gestation. The increase in NICU admission during the COVID-19 pandemic was explained by maternal hypertension, but other adverse neonatal outcomes were only partly explained by maternal hypertension. Socio-economic factors and other social determinants of health need to be further explored to understand the full impact on neonatal outcomes.
越来越多的证据表明，新冠疫情对弱势群体产生了深远的负面影响，并对孕产妇和新生儿健康产生了重大影响。我们观察到，在疫情的第一年，入住新生儿重症监护病房（NICU）的婴儿比例从8%上升到了10%。本研究旨在比较疫情前两年和疫情期间的产房结局、NICU收治情况及干预措施，以及新生儿结局。
这是一项在一家公立医院进行的回顾性研究，研究对象为新冠疫情前（2018年4月至2019年12月）和新冠疫情期间（2020年4月至2021年12月）。数据来自所有孕周≥35周（GA）的活产儿。使用简单的双变量广义估计方程（GEE）回归比较研究期间的孕产妇和新生儿人口统计学特征、产房（DR）及NICU新生儿结局。进行多变量GEE逻辑回归分析以调整人口统计学基线差异对结局的影响。
研究期间共有9632例孕周≥35周的婴儿出生（新冠疫情前=4967例，新冠疫情期间=4665例）。在新冠疫情期间，出生体重略有但显著下降（33克）；孕产妇糖尿病（3.3%）、高血压（4.1%）和西班牙裔（4.7%）比例增加。接受三分钟延迟脐带结扎的婴儿比例下降（78.1%对70.3%，P<0.001），纯母乳喂养率上升（65.9%对70.1%，P<0.001），代谢性酸中毒（0.7%对1.2%，P=0.02）、NICU收治率（5.1%对6.4%，P=0.009）、抗生素使用（0.7%对1.7%，P<0.001）和鼻持续气道正压通气（nCPAP）使用（1.2%对1.8%，P=0.02）。在调整孕周、孕产妇糖尿病和高血压后，NICU收治率和鼻持续气道正压通气使用没有显著增加；然而，其他差异仍然显著。孕产妇高血压是所有这些结局的独立危险因素。
在新冠疫情期间，我们观察到孕周≥35周出生的婴儿的孕产妇发病率、纯母乳喂养率和NICU收治率显著增加。新冠疫情期间NICU收治率的增加可由孕产妇高血压解释，但其他不良新生儿结局仅部分可由孕产妇高血压解释。需要进一步探索社会经济因素和其他健康社会决定因素，以了解对新生儿结局的全面影响。
