Professor of Pediatrics Cohen Children's Medical Center/Zucker SOM at Hoftstra/Northwell Cohen Children's Medical Center Princeton, New Jersey, United States
Background: Earlier postpartum discharge during a COVID-19 surge limits in-hospital lactation support raising concern for fewer mothers breastfeeding (BF).
Objective: To evaluate healthcare utilization in support of BF among mothers delivering in a pandemic surge vs. same timeframe 1 year prior.
Design/Methods: In a single-center, retrospective, observational study, diverse mother-infant dyads presenting for first ambulatory postpartum visits April 7 (initiation of universal maternal COVID-19 screening) to June 30, 2020 (n = 285) were compared with 1 year prior (n = 199). Inclusion criteria were term singletons, postpartum lengths of stay <1 week, initial visit at 1-29 days of life, and no contraindications to BF. Delivery characteristics (gestational age, mode, gender, birth and discharge dates/times) and maternal demographics (age, race/ethnicity, parity, insurance) were collected. Infant feeding (BF only, BF and formula, or formula only) was collected at each contact (in-person, telehealth, telelactation, or telephone) during the first 90 days. Telehealth and telelactation visits used 2-way audiovisual technology; telephone visits were audio only. Analyses included Fisher’s exact tests for categorical data, Wilcoxon tests for continuous data and Poisson regression for count outcomes.
Results: Maternal demographics and delivery characteristics were not different between pandemic vs pre-pandemic cohorts. Populations [Black (31%); Asian (27%); White (12%); Multiracial/other (30%); Hispanic (17%)] were similar, as were mean maternal age (30 years), primigravids (46%), vaginal births (70%), and Medicaid (59%). Median lengths of stay were lower in 2020 (40 vs 56 hours; p<.0001). Although BF initiation and duration in first 90 days were similar between groups, exclusivity was less in 2020 (15% v 26%, p=.0035). In contrast, significant increases in health care utilization were noted for pandemic group in first 45 days - median number of health care encounters (5 v 3; p<.0001), percentage with > 1 telelactation visit (7% v 0%; P<.001) and > 1 telephone contact (71% v 22%; p<.0001). The number of in-person visits were similar between the 2 groups. During 46-90 days, the percentage with > 1 telephone contact doubled in 2020 (14% v 7%; p=.01), while no telelactation services were used by either group. Conclusion(s): BF initiation and duration was overall on par during the COVID-19 pandemic surge; exclusivity was less.Telemedicine contacts appear to have expanded connectivity between mother-infant dyads and our primary care practice in support of BF.
Authors/Institutions: Henry Bernstein, Cohen Children's Medical Center, New Hyde Park, New York, United States; Chisom Chigozie-Nwosu, Cohen Children's Medical Center, New Hyde Park, New York, United States; Abigail Coco, Cohen Children's Medical Center, New Hyde Park, New York, United States; Tara Mathias-Prabhu, Cohen Children's Medical Center, New Hyde Park, New York, United States; Hee Su Park, Cohen Children's Medical Center, New Hyde Park, New York, United States; Gloria Zhao, Cohen Children's Medical Center, New Hyde Park, New York, United States; Cathie Spino, University of Michigan, Ann Arbor, Michigan, United States