Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019

Abstract

Objectives To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes. Study design A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability. Results Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybriddesign 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support. Conclusions Hospital restrictions have significantly limited parental presence for NICU admitted infants, although singlefamily room design may attenuate this effect.

Parental perceptions of the impact of neonatal unit visitation policies during COVID-19 pandemic

“…This pandemic has led to widespread restrictions on family visiting to the hospital, especially in intensive care units where the most critical patients are cared for. 17 NICUs present a unique setting where infants often stay for weeks to months and parents play a vital role in their care. There has been a paradigm shift in the parental role in the neonatal unit; parents are no longer considered ‘just visitors’ but rather an integral and essential part of care provision.…”

“…To control for multiple comparisons, the false discovery rate (FDR) correction was applied to all p values, assuming a FDR(q*) equal to 0.05. 17 18 All statistical analyses were performed in SAS V.9.4 (SAS Institute).…”

Unintended consequences of restrictive visitation policies during the COVID-19 pandemic: implications for hospitalized children

“…The consequences may be especially deleterious in settings such as the neonatal intensive care unit (NICU) where 24-h parental presence with extended intimate contact of the newborn has both physiological and psychological benefits to the newborn and parents. 7 A recent study by Darcy Mahoney et al 8 assessed the impact of restrictions on parental presence in the NICU before and during the COVID-19 pandemic. The cross-sectional survey of global NICUs identified a variety of visitation policies among 130 NICUs worldwide that restricted parental presence during the COVID-19 pandemic.…”

Promoting and Protecting Human Milk and Breastfeeding in a COVID-19 World

“…Globally, the birth and breastfeeding experiences of families have not been prioritized and care has changed in ways that may negatively impact birth outcomes and the establishment of breastfeeding. Some of these negative practices are: 1) women being forced to go through labor and birth without the presence of a partner or support person ( 34 , 35 ), 2) some NICUs not allowing any parental presence at the bedside while others are limiting either the amount of time that the parents can visit or allowing only one parent to be present at a time ( 36 ), 3) some hospitals continue to separate mothers who are COVID-19 positive or a Person Under Investigation (PUI) from their infants despite WHO recommendations to avoid this practice ( 37 ), 4) discouragement of skin to skin contact and direct breastfeeding ( 38 ), 5) early discharge following birth, as early 24 h post-birth for vaginal births and 48 h post-cesarean birth ( 39 , 40 ), 6) a lack of access to in person pediatric follow-up and hands-on technical breastfeeding assistance ( 2 ). Indeed, during the initial phase of the pandemic in Italy, there was concern that breastfeeding had actually been implicated as a “culprit or scapegoat,” despite available evidence suggesting that 1) few pregnant women have been severely affected by COVID-19, 2) evidence for transplacental transmission of the virus very rarely shows a clinical impact, and 3) infected neonates are generally asymptomatic, or have few symptoms, with similar infection rates with vaginal delivery or Cesarean section ( 41 , 42 ).…”