P4A090: A Curious Trend: Prolonged Length of Stay for Infants with Hyperbilirubinemia During the Viral Surge

Background: Neonatal hyperbilirubinemia (NH) is diagnosed in a majority of term newborn infants within the first two weeks of life. When admitting for phototherapy to treat NH, goals include maximizing an infant’s time under lights and promoting frequent feeds in order to bring serum bilirubin levels down to discharge thresholds as safely and quickly as possible. Accomplishing these goals is reliant on nurses and care partners investing significant time at the bedside to support families in establishing an effective feeding regimen and setting up the phototherapy technology. Starting in late summer and continuing into the end of 2022, children’s hospitals across the country experienced record numbers of admissions for viral illnesses. This surge necessitated stretching our pediatric healthcare resources, including the time nurses and care partners could spend on individual patient care.

Methods: A retrospective chart review was conducted to obtain baseline data regarding LOS for infants admitted with NH starting in November 2021 through December 2022 (N=170). This was done as part of a current state analysis for a planned quality improvement initiative involving NH admissions. Three months of prospective LOS data was also collected starting in January 2023 (N=30). The Mann-Whitney U Test was used to analyze differences in median LOS before and during the viral surge.

Results: Median LOS (in hours) within chronologically grouped cohorts of ten infants each was plotted on a line graph (Figure 1). Median LOS prior to surge was 20 hours (IQR 1.25) whereas during the surge LOS was 24.5 hours (IQR 3), p=.002. Pre-surge median LOS fluctuated within a range of 2 hours whereas during surge median LOS steadily increased to a maximum of 27 hours in December 2022. Median LOS began to shorten again post-surge in early 2023.

Conclusion: The period of prolonged LOS for NH admissions coincided with the viral surge of 2022 when pediatric admissions across the country were spiking. Per institutional policy, only staff members can re-start phototherapy when an infant who was removed for a feed is ready to go back under lights, not family. For this reason, time under phototherapy relies heavily on having readily available staff. During the viral surge, staffing constraints may have contributed to delays in resuming phototherapy for NH infants.

NH admissions are unique in that various external human factors as well as physical technology contribute significantly to LOS. This is in comparison to other diagnoses, such as bronchiolitis or dehydration, in which the natural history of the disease often dictates readiness for discharge. These results show that a surge in viral illnesses may have unexpected secondary effects for patients admitted for non-viral diagnoses, such as NH.