![]() The total births, preterm births, and NICU admissions in each of these analyses is enumerated in Supplementary Table 2. We assessed these three windows (☑, ☒, and ☓ months) before and after each calendar date to test for sensitivity to time interval choice for the reopening analysis, we limited the largest window to the start date of lockdown measures (i.e., 2.75 months before and after reopening). Comparing the trends of these short time intervals to the trends in prior years limits the influence of confounding variables, such as seasonal preterm birth changes. We compared 1-, 2-, and 3-month epochs before and after the calendar dates of the two pandemic response measures in 2020 to the same short time periods in 2012–2019. We used a quasi-experimental difference-in-difference (DiD) logistic regression to test for associations between NYC lockdown measures or reopening and our two primary outcomes, preterm birth and NICU admission rates (model in Supplementary Methods). 1 We used Jas the date of reopening because it was the official date of the implementation of NYC phase one reopening. We used Maas the first calendar date of lockdown measures because it had the largest drop in mobility and was the date of NYC’s public school system closure (Supplementary Fig. ![]() 1) and research was approved by the Mount Sinai Institutional Review Board. Data were obtained from electronic health records (Supplementary Fig. Our final cohort totalled 43,963 singleton neonates, including 3348 live births since the implementation of COVID-19 lockdown measures (Supplementary Fig. 2 We defined preterm birth as gestational age (GA) 41 + 6 weeks, excluding late-term neonates from our analysis. We also excluded 3430 neonates from multiple births and 184 neonates born to COVID-19 positive mothers, which are potential risk factors for preterm birth. ![]() We excluded 22,400 neonates, the majority of whom had a primary residence outside NYC and may have experienced different lockdown measures and reopening timelines (Supplementary Fig. There were 66,363 neonates born at the Mount Sinai Hospital between Januand November 25, 2020. We, therefore, assessed if the NYC COVID-19 lockdown measures or NYC phase one reopening were associated with changes in preterm birth or NICU admission rates in a large and diverse cohort at the Mount Sinai Hospital. Both of these neonatal outcomes may also be influenced by NYC phase one reopening, which was associated with additional policy and behavioral changes. Furthermore, neonatal intensive care unit (NICU) admissions, which are related to but not exclusively modified by preterm birth rates, may also be impacted by lockdown measures. 2, 3, 4, 5, 6 To date, this link has not been assessed in NYC, one of the hardest hit and most populous, diverse cities in the United States. Several reports linked COVID-19 lockdown measures to reduced rates of preterm birth, providing possible mechanisms for preterm birth prevention. ![]() ![]() 1 These public health interventions were initially instituted to curb transmission of the virus, but have provided insights into associations between lockdown measures and health outcomes. New York City (NYC) emerged as the epicenter of the COVID-19 pandemic in the United States, prompting lockdown measures including school closings, stay-at-home orders, and a shift to working from home. ![]()
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