Neonatal care during COVID restrictions

COVID restrictions had a negative influence on everything from perinatal care to skin-to-skin contact and mental health. What did researchers find?

Lockdown and social distancing during the COVID-19 pandemic have been important ways of preventing the spread of the virus - and keeping vulnerable people safe. Among the most vulnerable are low birthweight, ill and preterm newborns. So it would seem logical to follow the same COVID-19 restrictions for their care. And yet, researchers questioned the strictness of these restrictions - and whether this impacted the wellbeing of infants and their parents.

In an online survey of 2103 parents, Dutch and German researchers asked people in 56 countries - in 23 languages - about their experiences with birth during the pandemic, in a period starting from 1 December 2019. They were especially interested in parents or legal guardians with newborns that needed special care, including babies in neonatal intensive care units.

They found that the pandemic restrictions negatively influenced everything from access to perinatal care to mental health.

Of those surveyed, 33% had fewer perinatal appointments - and 6% reported that they had no pregnancy-related appointments whatsoever. And when these appointments were available, 42% said they were not allowed to bring their partner or support person with them. In 52% of the cases, going it alone also meant being on your own during birth.

Limited interactions

According to the infant and family-centered developmental care approach, feeding with human milk, early breastfeeding, skin-to-skin contact and the presence of parents is essential to neonatal care. The researchers found "an alarming rate of parents (>20%) were not permitted to be present with their newborn receiving special/intensive care."

In fact, most of the people surveyed reported that pandemic restrictions limited their presence or interaction with their newborn. This excluded these infants from skin-to-skin contact - and the chance to bond with their parents by experiencing their voices and the scent. The researchers also point out that this type of exclusion could cause problems with an infant's neurobehavioral development.

Thanks to the help of dedicated healthcare professionals, breastfeeding was less influenced by COVID-19 restrictions - with more than 85% reporting that their baby was fed mother's own milk (partially or exclusively) during the first weeks - starting either on the first day, or within the first week.

Zero separation policy

However, parents' mental health did suffer - with 92% worried about COVID-19 after their child's birth. A majority of these parents felt they were not well-informed, or did not receive the support needed to handle their mental health issues. All this while simultaneously dealing with a vulnerable newborn that demands extra care. Unfortunately, such stress can negatively affect the relationship between a mother and child, interfere with the child's development, and contribute to postpartum depression.

Studies show that newborns have a low risk of being infected with COVID-19 - and if they develop COVID-19, they only have mild symptoms. This fact has led the researchers to conclude that "implementing a zero separation policy is essential to avoid unnecessary suffering among the youngest and most vulnerable members of our society." They are joined in the call for zero separation by the World Health Organization, the European Foundation for the Care of Newborn Infants (EFCNI)² and infant and family-centered developmental care recommendations.

Although restrictions may be easing in some regions of the world, COVID-19 is still leading to lockdown and quarantine in other regions. Then there's possibility of new COVID-19 variants coming into play. As we face an uncertain future, it is vital to acknowledge the core needs of infants and their parents - and work towards finding ways to protect the vulnerable in ways that does no harm.

Download EFCNI's global study and project report, "Zero Separation. Together for better care! Infant and family-centered development care in times of COVID-19 - a global survey of parents' experiences."

EFCNI is the first European organisation that brings together parents, healthcare experts and scientists, with the aim of improving the long-term health of children through the best possible prevention, treatment and care.