O1038: Neonates Have Preserved Hospitalization Volume and Indications for Admission Throughout the Coronavirus 2019 (COVID-19) Pandemic

Background: Pediatric hospitalizations declined early during the coronavirus 2019 (COVID-19) pandemic, but it is unclear how they have continued to fluctuate. Previous analyses have not specifically investigated differential health care usage during the pandemic by age group, particularly for neonates who may be uniquely affected by prenatal and perinatal conditions. Therefore, we sought to determine how hospitalizations and admitting diagnoses for neonates and infants changed longitudinally during the pandemic.

Methods: This retrospective cohort study used the Pediatric Hospital Information System database to analyze inpatient admissions of children aged 1 day to 18 years (n= 1,624,755) across 45 Children’s Hospitals from 1/1/17 to 6/30/21. Birth hospitalizations and interhospital transfers were excluded. Admitting diagnoses were grouped using Clinical Classification Software Refined (CCSR) categories. Admissions and diagnoses counts in the COVID-19 era (March 2020 - June 2021) were compared to the averaged counts from the same months from 2017 – 2019 (pre-COVID-19 era) to account for secular trends. Monthly incident rate ratios were calculated, using binomial probability tests to determine statistical significance. Linear regression models evaluated change in admission counts overall and after stratifying by age.

Results: Overall, monthly admissions declined by 25.3% (95% CI: 25.0 – 25.6%) in the COVID-19 era compared to the pre-pandemic period, but this varied temporally for all age groups (Figure 1). Hospitalizations for neonates 1-14d decreased only by 8.2% (95% CI: 6.5 – 10.0%). Hospitalizations for neonates 15-29 days and infants 1 – 12 months declined more than any other age group (39.1% [95% CI 37.3 – 40.7%] and 38.1% [95% CI 37.5 – 38.7%], respectively). For patients < 1 year old, hospitalizations had recovered to 99.2% (p = 0.6045) of pre-pandemic averages by June 2021. For neonates 1-14 days, there was no difference between eras in hospitalizations for the most common diagnoses: jaundice, perinatal respiratory conditions, feeding disorders or other perinatal conditions; admissions for perinatal infections decreased by 23.2% in the COVID era (Table 1). In contrast, neonates 15-29 days had significant declines in perinatal infections (by 43.9%) and respiratory infections (by 83.7%) during the pandemic. Infants 1-12 months old had significant declines in respiratory infections (by 76.1%).

Conclusion: Neonates 1-14 days had relatively preserved hospitalizations during the pandemic compared to other age groups, with stability in the most common diagnoses, such as jaundice and feeding difficulties. In the COVID-19 era, neonates 15-29 days and infants 1-12 months had the greatest decline in overall hospitalizations, primarily due to profound decreases in respiratory infections, which likely reflects public health measures that interrupt typical pathogen transmission. Notably, hospitalization for perinatal infections declined during the COVID-19 era. Future work should focus on determining if this observation is due to changing care practices either perinatally or in pediatric centers, or differences in parental behaviors.