Impact of COVID-19 on Infants Followed After Discharge from the Neonatal Intensive Care Unit via a Telemedicine Model

Background: While the prevalence of SARS-CoV-2 has remained low among newborns, there is increasing evidence that the COVID-19 pandemic impacted healthcare for families with infants in the neonatal intensive care unit (NICU). However, little is known about the impact of COVID-19 on families with infants discharged from the NICU. During the initial pandemic shutdown, our Neonatal Follow-Up Program (NFP) transitioned to a virtual platform and implemented a survey about new/worsened obstacles families might be facing due to the pandemic as standard of care. We aimed to: 1) evaluate for patient-level differences in virtual neonatal follow-up visit rates; and 2) characterize the social impact of the pandemic on families followed via a large, urban NFP.

Methods: All infants scheduled for NFP visits during our telemedicine epoch (March 13, 2020-July 31, 2020) were eligible for inclusion. We compared the family demographics and medical history of infants whose televisits occurred to those for whom televisits did not occur as scheduled. Secondly, we conducted a descriptive analysis of caregiver responses to the pandemic-specific challenges survey. Given the known disproportionate impact of SARS-CoV-2 on communities of color, we also assessed for differences in responses by self-identified race. Data was manually extracted by three coders from the electronic medical record who showed high interrater agreement.

Results: After excluding visits cancelled by the provider team, we found 499 clinic encounters for 678 scheduled visits during the study period (i.e. a show-rate of 73.6%). When comparing patients who completed their virtual visit to those who did not, we found no differences in infants’ sex, birthweight or gestational age at birth, nor in their reliance on medical technology at discharge (Table 1). There were also no differences by caregiver self-reported race/ethnicity, but infants whose visits did not occur were more often covered by public insurance (Table 1). In addition, 43.9% of caregivers reported that their employment had changed since the onset of the shutdown and 6.1% reported housing changes (Table 2). Eight percent of families endorsed having trouble accessing at least one basic infant necessity (i.e. formula, diapers or medical supplies) due to cost issues and 10% of families endorsed having trouble accessing such necessities due to availability. Non-Hispanic Black caregivers reported this challenge and other infant food-related challenges more often than non-Hispanic White caregivers.

Conclusion: We found socioeconomic disparities with respect to virtual follow-up visit rates after discharge from the NICU during the initial COVID-19 shutdown. In addition to navigating the discharge of their infant, families also reported pandemic-enhanced stressors related to difficulty accessing basic infant needs as well as employment and housing changes. Our study highlights the importance of proactive strategies to screen for and mitigate the unique economic vulnerabilities of families discharged from the NICU even beyond the pandemic.