ObjectivesTo ascertain parental perceptions of the impact of restricted visiting policies to neonatal intensive care units during the current COVID-19 pandemic.DesignCross-sectional survey of parents impacted by visitation policies.SettingSix tertiary level neonatal units, four from the UK and two from the USA, participated in the study.ParticipantsParents and families of infants hospitalised in the participating centres between 1 May 2020 and 21 August 2020.MethodsOnline-based and/or paper-based survey, querying the visitation policies and their impact on parents’ ability to visit, care for and bond with their infants.ResultsA total of 231 responses were received. Visitation limited to a single visitor with no restrictions on duration was the most frequently reported policy; 140/217 (63%). Visitation policies were perceived as being restrictive by 62% (138/219) of the respondents with 37% (80/216) reporting being able to visit less often than desired, 41% (78/191) reporting being unable to bond enough and 27% (51/191) reporting not being able to participate in their baby’s daily care. Mild to severe impact on breast feeding was reported by 36% (75/209) of respondents. Stricter policies had a higher impact on families and were significantly associated with a lack of bonding time, inability to participate in care and an adverse impact on breast feeding.ConclusionsVisitation policies during the COVID-19 pandemic varied between centres and over time with stricter restrictions implemented earlier on in the pandemic. Parents reported significant impacts on their ability to visit, care for and bond with their infants with perceived severity of impact worse with stricter restrictions.

Congenital heart diseases are the most common birth defects and have variable levels of severity. Some studies showed that CHD increases the odds of COVID-19 realted complications; however, others suggested that there is no such a correlation. Due to the aforementioned lack of evidence, we aim in this review to provide a comprehensive overview of the impact of COVID-19 infection on CHD patients. For that, an extensive literature search of Medline, Cochrane, and EMBASE databases was performed using the medical subject headings or a combination of all possible related terms. Patients diagnosed with both CHD and COVID-19 infection has reported that CHD patients, especially those with a genetic syndrome, are at high risk to develop moderate to severe symptoms. Moreover, CHD surgeries were postponed or even canceled, with a decline in overall admission days, due to hospital protocol or pateints’ decisions. Also, the findings suggested that congenital heart surgeries can be safely done during the pandemic when there is case volume limitation, with the safety precautions are followed by both surgical staff and patients. In conclusion, the scarce evidence along with the variety in CHD types and their different clinical presentations; makes it hard to predict the outcomes and to manage CHD-COVID-19 co-morbid children. More studies are needed to guide management plans in this particular context.

Pain assessment and management have shown great advances in recent decades regarding the treatment protocols and the various assessment approaches that have been developed and validated to specific for pediatric patients. In this literature review, we aim to shed more light on the assessment of pain in pediatric patients and the challenges that healthcare workers might face during the process in primary healthcare centers. In neonates, the crying, require O2 to reach a saturations more than 95%, increasing vitals, expressionless, and sleepless score shows the greatest advantage over other scores (COMFORT and distress for mechanically ventilated neonates), while in infants the face, leg, activity, cancelability, and cry scale shows promising results. In older children, self-reporting by the visual analogue scale should be standardized whenever possible or facial, and behavioral assessment should be used. Assessment of pain in patients with cognitive and intellectual disabilities might be challenging, and therefore, it should be interpreted carefully not to be misdiagnosed, in addition to trying to obtain relevant information from a well-trained accompanying caregiver. Further investigations are needed, however, to standardize these scores and to spread awareness among clinicians and caregivers about the importance of appropriate pain assessment.