Am J Perinatol
DOI: 10.1055/a-1990-8571
Original Article

Impact of COVID-19 on Infants followed after Discharge from the Neonatal Intensive Care Unit Using a Telemedicine Model

1   Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2   University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Sebastián Gualy
3   Department of Pediatrics, Children's Hospital Los Angeles, California
Margaux Mazur
1   Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Matthew Huber
1   Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Michelle-Marie Peña
1   Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Sara B. DeMauro
1   Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2   University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Andrea F. Duncan
1   Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2   University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
› Author Affiliations
Funding M.-M.P. is supported by the National Institutes of Health (grant no.: T32HL098054–11). D.M.-W. is supported by the National Institutes of Health (grant no.: K23 HD102526).


Objective Coronavirus disease 2019 (COVID-19) continues to have a profound impact on infant health care and health outcomes. In this study, we aimed to characterize the social impact of the first COVID-19 lockdown on families in a neonatal follow-up program (NFP). Given the ongoing increased use of telehealth across the medicine, we also evaluated for patient-level differences in virtual visit rates to identify patients at risk of follow-up challenges.

Study Design To assess the impact of virtual health care utilization, we conducted a retrospective cohort study to describe challenges associated with telemedicine use in this vulnerable patient population during our telemedicine epoch (March 13, 2020–July 31, 2020). We also looked for patient-level factors associated with attending NFP visits as scheduled. Finally, we summarized caregiver responses to a COVID-19 Obstacles Assessment Survey and assessed for racial disparities in these responses.

Results When comparing patients who completed their virtual visit to those who did not, we found no differences by infants' sex, birthweight, gestational age at birth, or caregiver self-reported race and ethnicity. However, infants whose visits did not occur were more often discharged with equipment or covered by public insurance. Nine percent of families reported food insecurity.

Conclusion During the initial COVID-19 lockdown, families with infants discharged from a neonatal intensive care unit (NICU) faced significant obstacles caring for their infants and attending scheduled follow-up visits. Infants in families with lower socioeconomic status or with increased medical complexity faced increased challenges in attending virtual follow-up visits during this epoch. Given the ongoing reliance on telemedicine in health care and the need to better prepare for future epidemics/pandemics, this study offers critical information that can assist neonatal teams in bolstering transitions to home and creating stronger safety nets for their patients after discharge.

Key Points

  • Telemedicine works well for high-risk neonatal populations.

  • Infant medical complexity may be a risk factor for challenges attending neonatal follow-up visits.

  • NICUs should work to prevent food insecurity postdischarge.

Authors' Contributions

D. M.-W. and A. F. D. conceived the study. S. G., M. M., M. H., M. M.-P., and S. B. D. contributed to the design. S. G., M. M. and M. M.-P. were responsible for data collection. M. H. conducted the analyses. D. M.-W. wrote the first draft of the manuscript; all other authors provided critical review and feedback, and approve the manuscript as written.

Supplementary Material

Publication History

Received: 22 July 2022

Accepted: 15 November 2022

Accepted Manuscript online:
30 November 2022

Article published online:
16 January 2023

© 2023. Thieme. All rights reserved.

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