SARS-CoV-2 PANDEMIC

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We strongly recommend unrestricted skin-to-skin contact for parents and their infants in neonatal units during the SARS-CoV-2 pandemic.*

 

Aniko Deierl MD, PhD (1,4); Nadia Leake (2,4); Jayanta Banerjee MD (res; 1,3); Akhil Maheshwari MD (4); and Minesh Khashu (4,5).

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Professional affiliations of authors are shown above as numerals in parentheses.

1: Department of Neonatology, Imperial College Healthcare NHS Trust, London, UK

2: Patient and Public Involvement Representative

3: IRDB Imperial College Healthcare NHS Trust, London, UK

4: Global Newborn Society (https://www.globalnewbornsociety.org/)

5: University Hospitals Dorset NHS Foundation Trust

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During the current SARS-CoV-2 pandemic, many hospitals and neonatal units in different part of the world have placed restrictions on skin-to-skin contact (SSC) and parental involvement in neonatal care. This reduction in parental access is not based on strong evidence, and has been imposed without due consideration of harm that this might cause on multiple fronts. Based on current evidence, this ‘blanket ban’ on SSC by various maternity and neonatal services across the globe is unfortunate, not evidence-based, and needs to be reviewed on an urgent basis.

 

The World Health Organization (WHO) recommends skin-to-skin contact (SSC) following delivery in babies weighing 2000 grams or less at birth, as soon as they are clinically stable to prevent hypothermia (1). In low-resource settings, delayed initiation of SSC is an independent predictor of hypothermia, and can contribute to neonatal morbidity and mortality (2). The United Nations Children’s Fund Baby Friendly Hospital Initiative recommends immediate SSC after birth based on physiological, social, and psychological benefits for both the mother and baby (3).

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The risk of SARS-CoV-2 infection in neonates, both vertical and horizontal, is relatively low with no significant mortality (4, 5). However, the lack of SSC and parental involvement can actually increase mortality and cause additional adverse long-term outcomes (6). Several important systematic reviews and guidelines for treatment of COVID-19 positive mothers and their infants are already in place (7, 8).

 

All these restrictions, largely knee jerk reactions to the pandemic, will only serve to nullify a lot of the hard work invested in best practice guidance and standards outlined for both low and high income countries (7, 8, 9).

 

Recently, both professional and parent organizations have joined the call to re-establish parents as essential partners in care during the pandemic, and not to be considered as visitors, which they most definitely are not (10, 11).

 

We recommend that neonatal organisations, hospitals, and health services all across the world urgently advocate on this important issue and ensure that we encourage unrestricted SSC and zero separation of infants and parents, to prevent severe long-term collateral damage.

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References:

1. World Health Organization. (2015). WHO recommendations on interventions to improve preterm birth outcomes.

2. Moore ER, Bergman N, Anderson GC,et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016 Nov 25;11:CD0035193.

3. Brimdyr K, Cadwell K, Steevens J, Takahashi Y. An implementation algorithm to improve skin-to-skin practice in the first hour after birth. Matern Child Nutr. 2018;14(2):e12571.

4. Mullins E, Hudak ML, Banerjee J, et al. Pregnancy and neonatal outcomes of COVID-19: co-reporting of common outcomes from PAN-COVID and AAP SONPM registries. Ultrasound Obstet Gynecol. 2021 Feb 23. doi: 10.1002/uog.23619.

6. Bergman NJ. Birth practices: Maternal-neonate separation as a source of toxic stress. Birth Defects Res 2019; 111:1087–109.

7. RCPCH/BAPM Paediatric COVID-19 guidance. Available online: https://www.rcpch.ac.uk/resources/covid-19-guidance-paediatric-services

8. American Academy of Paediatrics: COVID-19 guidance. Available online: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/

9. EFCNI. European Standards of Care for Newborn Health. 2018.

10. WHO (World Health Organization). Survive & thrive: Transforming care for every small and sick newborn. 2019.

11. Global Alliance for Newborn Care - GLANCE [Internet]. [cited 2020 Jul 8]. Available online: https://www.glance-network.org/

9. British Association of Perinatal Medicine: Family Integrated Care for COVID-19. Available online:  https://hubble-live-assets.s3.amazonaws.com/bapm/redactor2_assets/files/422/FAQs_-_FIC_Covid19_-_version_2.docx.pdf

10. Bliss. Bliss Statement: COVID-19 and parental involvement on neonatal units. Available online: https://www.bliss.org.uk/health-professionals/information-and-resources/parental-access-covid19

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* the communication has been published online on EIN Presswire - Everyone's Internet News Presswire™. 

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