Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a ‘natural experiment’ allowing analysis of data from the prior two decades

  1. Roy K Philip
  2. Helen Purtill
  3. Elizabeth Reidy
  4. Mandy Daly
  5. Mendinaro Imcha
  6. Deirdre McGrath
  7. Nuala H O'Connell
  8. Colum P Dunne

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Abstract

Aetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland’s response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants.

Methods

Regional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020.

Results

Poisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001–2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500–600 range.

Conclusion

An unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.03.20121442: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics Approval: University Hospital Limerick Research Ethics Committee approval was granted for the study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableThis period of national lockdown and the pre-lockdown weeks of extra healthcare vigilance and restrictions resulted in holistic alterations to the wellbeing of pregnant women.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    21,22,23 All data were analysed using IBM SPSS Statistics V.26.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations, Interpretations and Generalisability: The following limitations are acknowledged: 1. Inherent reservations posed by retrospective nature of the birth cohort data spanning over two decades; 2. Even though the vast majority of the VLBW infants would be premature, rarely severe intrauterine growth restriction (IUGR) at term could be included. However, such an inclusion consistently over two decades should reduce the bias and the weight-based inclusion criteria would allow comparison to national data by CSO, NPEC and internationally through VON; 3. Inclusion of January 2020, when there was no official lockdown or enhanced pre-lockdown public health measures. This was required to make comparison with the two decades of trends including the first four months; 4. Completion of the study prior to the official finish of lockdown was to facilitate ease of comparison against the coded historical monthly data, timely data completion and analysis; 5. ELBW category could only be analysed with limitations considering the small number of births on a monthly basis; 6. We caution the ‘no abortion policy’ that Ireland followed till late 2018, when making international comparisons; 7. The lockdown could have deferred what should have been medically offered early during pregnancy as well, thus arguably postponing the gestational age of intervention. Thus it could be viewed that the potential for reduced monitoring opportunities or early foeto-maternal interventions during the lockdow...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1136/bmjgh-2020-003075
  3. ScreenIT

    SciScore for 10.1101/2020.06.03.20121442: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementEthics Approval University Hospital Limerick Research Ethics Committee approval was granted for the study.Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableeffect, a national lockdown and have possibly influenced the health and wellbeing of pregnant women and unborn infants.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    21,22,23 All data were analysed using IBM SPSS Statistics V.26.
    SPSS
    suggested: (SPSS, SCR_002865)

    Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.06.03.20121442v1 on medRxiv