Impact of the COVID-19 pandemic on developmental care practices for infants born preterm

Abstract

Objectives To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm. Methods We analyzed electronic medical record data from 129 infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children’s Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n = 67) and the analogous period in 2019 ( n = 62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates. Results Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 ( p =.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p =.001), resulting in fewer minutes per day (77.5 vs. 130.0; p =.001). In 2020, developmental care activities were 5 minutes shorter, on average, than in 2019, p =.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies. Conclusions The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.

Parents’ experiences regarding neonatal care during the COVID-19 pandemic: country-specific findings of a multinational survey

“…The COVID-19 pandemic and related restrictions have resulted in severe limitations in neonatal care provision, 18 especially regarding acknowledged elements of IFCDC. 15 21–27 The frequently implemented separation of parents and their newborns has negative implications for the health outcomes of newborns, 28–30 interfering with acknowledged practices such as KMC, skin-to-skin contact 31 and breast feeding. 32 The reduction of parental presence in the neonatal intensive care units (NICU) has led to increased stress and mental health problems among parents and families, raising the risk of postnatal depression and post-traumatic stress syndrome and limited opportunities for parent–infant bonding, 14 15 while staff shortages and the lack of available guidelines have led to high levels of stress and anxiety among health professionals.…”

Effective Communication About Pregnancy, Birth, Lactation, Breastfeeding and Newborn Care: The Importance of Sexed Language

“…For example, during the COVID-19 pandemic, Neonatal Intensive Care Unit policies commonly restricted visiting to a single person for a limited period per day ( 135 ). Visiting policies that referred to “parents”, and did not differentiate between fathers and mothers or prioritize mothers, resulted in increased mother-infant separation with an associated adverse impact on breastfeeding and the mother-infant relationship ( 135 , 136 ).…”

“…New “parents” do not have the same health needs or experiences as new “mothers” although language in publications or research design that does not distinguish between these groups can suggest that they do [e.g. ( 136 )]. Research on women's health or maternal and child health that is de-sexed may be more difficult to find as search terms disappear and so result in it being overlooked in indexing for initiatives such as the United Nations Sustainable Development Goals ( 142 ).…”

Adaptation of infant mental health services to preterm infants and their families receiving neonatal intensive care unit services during the COVID‐19 pandemic

“…Family presence at bedside is vital for family engagement, parent-infant attachment, shared decisionmaking/family-team communication, and medical care and discharge readiness for the infant. (Scala et al, 2021). Furthermore, as disparities in ability to be present at bedside have existed even prior to the pandemic, they have become more pronounced and exacerbated during the pandemic (Pang et al, 2021).…”

“…During COVID‐19, these challenges were exacerbated with an increase in financial difficulties, schools and childcare settings closing for in‐person services, and reduced availability of resources (e.g., ability for parents and siblings to stay in Ronald McDonald house). Practitioners from one US hospital reported that in comparison to the same period a year before, during March through May 2020, families visited less frequently (47% of days in comparison to 97% the year before) and infants received less frequent developmental care activities and for a shorter duration from both families and staff (Scala et al., 2021 ). Furthermore, as disparities in ability to be present at bedside have existed even prior to the pandemic, they have become more pronounced and exacerbated during the pandemic (Pang et al., 2021 ).…”