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

Abstract

ObjectivesTo 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 delivered by both families and clinical staff.MethodsWe analyzed electronic medical record data from 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 May 31, 2020) and the analogous period in 2019. Our final sample consisted of 52 infants (n=27, 2019 cohort; n=25, 2020 cohort). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for GA at start of study period.ResultsResults indicated that families of infants in the 2020 cohort visited less frequently (47% of available days) than those in the 2019 cohort (97%; p=0.001). Infants received developmental care activities less frequently in the 2020 cohort (3.51 vs. 4.72 activities per day; p=0.04), with a lower number of minutes per day (99.91 vs. 145.14; p=0.04) and a shorter duration per instance (23.41 vs. 29.65; p=0.03). Similar reductions occurred in both family- and staff-delivered developmental care activities.ConclusionsThe 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.

Neonatal care during the COVID-19 pandemic - a global survey of parents’ experiences regarding infant and family-centred developmental care

“…A smaller study of 231 parents with infants hospitalized in NICUs in the UK and the USA showed that a large percentage (41%) reported to be unable to bond and only 37% were able to be present with their infant as often as desired [10] . Comparisons of the pre- and pandemic status in one NICU clearly link limited parental presence abilities to the COVID-19 pandemic [5] ; and a large global survey of 1120 neonatal care providers, from 62 countries, concluded that restrictions during the pandemic have led to a general separation between the mother-infant dyads [4] , which was also suggested for the entire family [6] . Our results confirm this limited ability to be present with the hospitalized newborn now on a global level and show the magnitude of the impact of implemented restrictions.…”

“…Together with sick and low birthweight infants, these newborns require specialised care to prevent mortality, support adequate growth and development, and to reduce the risk of morbidities in later life. Yet, their needs have not been considered adequately during the COVID-19 pandemic, which has created exceptional challenges and disrupted healthcare provision across the globe even more [3] , [4] , [5] , [6] . Several measures were put in place to reduce social interaction and the risk for virus transmission, especially in hospital settings including maternity and newborn care units [7] .…”

“…Recent research demonstrates that the COVID-19 pandemic and related restrictions are affecting both provision and quality of neonatal care [4] with a severe impact on infant and family-centred developmental care (IFCDC) [ 6 , 8 ]. Few studies have been conducted focusing on how the mother's presence with the newborn, frequency of parental presence, and developmental care practices have been influenced [ 5 , 9 , 10 ], or mothers’ experiences on receiving support for breastfeeding during lockdown [11] . Studies are highlighting that implemented measures have resulted in a limitation of some of the core elements of IFCDC, such as parental presence and family access for infants admitted to NICUs, as parents were routinely separated from their newborn [ 5 , 12 , 13 ].…”

“…Few studies have been conducted focusing on how the mother's presence with the newborn, frequency of parental presence, and developmental care practices have been influenced [ 5 , 9 , 10 ], or mothers’ experiences on receiving support for breastfeeding during lockdown [11] . Studies are highlighting that implemented measures have resulted in a limitation of some of the core elements of IFCDC, such as parental presence and family access for infants admitted to NICUs, as parents were routinely separated from their newborn [ 5 , 12 , 13 ]. Within a developmental care framework, parents, however, provide an essential initial platform for early communication and interaction with the newborn [14] .…”

Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors

“…inconsistencies due to the ever-changing nature of the hospital care systems. We suspect this to be especially true following the COVID-19 pandemic, in which many units have reallocated staffing to fit hospital-wide demands [45], resulting in reduced consistency of FTE data [46]. This study collected information on the number of approved NICU beds to define NICU size/volume, which does not account for the NICU census.…”