Postpartum Care for Parents of Neonatal Intensive Care Unit Infants before and after Adoption of Telemedicine

Despite higher morbidity and mortality risks, parents of preterm infants miss postpartum visits more often than parents of full-term infants. Whether the introduction of telemedicine improved access to postpartum care among parents of infants in the neonatal intensive care unit (NICU) is unknown. We aimed to compare postpartum visit attendance and care comprehensiveness for NICU parents before and after the option of telemedicine.

We conducted a retrospective cohort study of postpartum parents without a history of hypertension who gave birth <32 weeks at two Philadelphia hospitals. We compared care receipt before and after implementation of telemedicine (2019 and 2023, respectively). Individuals with hypertension were excluded due to eligibility for a remote, text-based blood pressure monitoring program during the study period. Through manual chart review, we ascertained postpartum visit attendance and documentation of three core care elements: depression screening, contraception counseling, and blood pressure measurement.

The proportion of parents without postpartum visits was similar in 2019 (13/69, 18.8%) and in 2023 (7/45, 15.6%; p = 0.65). While telemedicine was not available in 2019, 42.1% (16/38) of postpartum visits in 2023 were conducted via telemedicine. In 2019 and 2023, the proportion of visits with missed depression screenings (10.7 vs. 0%, p = 0.08) and contraception counseling (0 vs. 18.4%, p = 0.001) were low. Missed blood pressure measurements increased significantly from 3.9% in 2019 to 36.8% in 2023 (p < 0.0001); all missed measurements were during telemedicine visits.

Despite the availability of telemedicine, approximately one in six NICU parents of preterm infants did not attend a postpartum visit. While telemedicine accounted for over one-third of visits in 2023, it was associated with gaps in essential care, specifically blood pressure measurements. Given the benefits of early detection and treatment for postpartum preeclampsia, supplementing telemedicine visits with in-person blood pressure measurements in NICUs may be warranted.

· Telemedicine did not change postpartum visit attendance for parents of NICU infants.. · Missed postpartum blood pressures increased significantly after adoption of telemedicine.. · NICU-based blood pressure monitoring may mitigate care gaps introduced by telemedicine visits..