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

Parents' Participation in Care during Neonatal Intensive Care Unit Stay in COVID-19 Era: An Observational Study

BACKGROUND

Parents play a crucial role in the care of infants during their stay in the neonatal intensive care unit (NICU). Recent studies have reported a decrease in parental participation due to the coronavirus disease (COVID-19) pandemic, which has led to restricted access policies in hospitals. The aim of this study was to describe the barriers to good parental participation during their stay in the neonatal intensive care unit in the COVID-19 era.

METHODS

This was a quantitative, observational study.

RESULTS

A total of 270 parents participated in this study. Mothers' participation in care was higher than that of fathers (p = 0.017). Parents who lived at the birth of their first child reported a better level of participation in care compared to those who lived at the birth of their second-born (p = 0.005). Parents of extremely preterm neonates reported a lower interaction with their infants than parents of term newborns (p < 0.001).

CONCLUSIONS

Some disadvantaged categories reported lower scores for cultural and linguistic minorities, parents of multiple children, and fathers. The COVID-19 pandemic has made several family-centred care activities impossible, with a higher impact on those who benefited most of these facilities. This study was prospectively approved by the IRB-CRRM of the University "G. d'Annunzio" Chieti-Pescara on 23 January 2024 (approval number CRRM: 2023_12_07_01).

Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit

OBJECTIVE

 This study aimed to examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single-center neonatal intensive care unit.

STUDY DESIGN

 Prospective cohort study with separate analyses performed based on insurance status (public vs. nonpublic) and "in effect" unit visitation restrictions. The three study epochs based on patient visitation restrictions were Epoch 1 (July to October 2019) with standard visitation restrictions, Epoch 2 (November 2019 to February 2020) with respiratory syncytial virus/influenza visitation restrictions, and Epoch 3 (March to June 2020) with coronavirus disease 2019 (COVID-19) visitation restrictions, respectively.

RESULTS

 Families of 357 infants used web-based cameras through most of the infant's hospitalization (median: 86.05%, Q3: 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p = 0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the COVID-19 pandemic (p = 0.03).

CONCLUSION

 Virtual visitation technology is well embraced by neonatal instensive care unit families; however, gaps in access and use among subgroups signals a form of social inequality that needs to be explored further.

KEY POINTS

· Virtual visitation technology can bridge the distance gap for families of hospitalized infants.. · Utilization of virtual technology is affected by socioeconomic factors and seasonal unit visitation restrictions.. · Factors influencing disparities in access and utilization of virtual technology need to be investigated further..

'Not a goal, but a given': Neonatal care participation through parents' perspective, a cross-sectional study

AIM

To explore parents' perspectives regarding participation in neonatal care, with focus on the family integrated care (FICare) model utilised as a tool to enhance parent-infant closeness. Additionally, we describe experiences in different architectural settings.

METHODS

An online survey, categorised by four FICare pillars, was distributed through social media to parents of newborns hospitalised to Dutch neonatal wards between 2015 and 2020. Quantitative findings were summarised using descriptive statistics, while open-ended responses were thematically analysed.

RESULTS

Among the 344 respondents (98% mothers), most reported feeling involved in care (315/340). However, 79% also felt separated from their infant (265/337). Irrespective of architectural settings, parents reported incomplete implementation of FICare pillars: 14% was invited to educational sessions (parent education), 51% discussed family-specific care plans (staff education), 21% was facilitated in connecting with veteran parents (psychosocial support) and 22% received couplet-care (environment). Although 65% of parents were invited to attend clinical rounds, 32% actively participated in decision making. Thematic analysis revealed fundamentals for feeling welcome on the ward, peer-to-peer support, psychosocial support and participation in clinical rounds.

CONCLUSION

Overall, parents expressed satisfaction with participation in neonatal care. However, structural implementation of FICare lacks. Regardless of architecture, expanding parent participation beyond presence requires attention.

No change in mother's own milk provision and breastfeeding rates in preterm infants during the COVID-19 pandemic

AIM

The aim of the study was to evaluate the duration of mother's own milk (MOM) provision to preterm very low-birth weight (VLBW, <1500 g) infants during the COVID-19 pandemic. We hypothesised that COVID-19 restrictions would reduce the duration of MOM provision.

METHODS

This retrospective study compared VLBW infants born at the Berlin university hospital during the pandemic (15 March 2020 to 14 March 2021, n = 108) with infants born in the pre-pandemic year (01 January 2019 to 31 January 2019, n = 121). We calculated the duration of MOM provision and analysed factors associated with its early cessation.

RESULTS

During the pandemic, the rate of primiparous mothers increased from 29% to 44% while the distribution of all other parental and infants' characteristics remained similar. There were no differences in the median duration of MOM provision (47 vs. 51 days), feeding type (MOM 67% vs. 65%) and breastfeeding rates at discharge (exclusive, 8% vs. 13%; partial 69% vs. 60%). Cox proportional hazard analysis revealed smoking during pregnancy and parental school education consistently as independent risk factors for early cessation of MOM provision.

CONCLUSION

Supply of MOM for VLBW infants can be upheld also during pandemic restrictions.

Breastfeeding rates in England during the Covid-19 pandemic and the previous decade: Analysis of national surveys and routine data

BACKGROUND

Few studies have compared breastfeeding rates before and during the pandemic using comparable data across time. We used data from two national maternity surveys (NMS) to compare breastfeeding rates in England before and during the pandemic.

METHODS

Analysis was conducted using the NMS from 2018 (pre-pandemic; n = 4,509) and 2020 (during the pandemic; n = 4,611). The prevalence of breastfeeding initiation, and 'any' breastfeeding and exclusive breastfeeding (EBF) at 6 weeks and 6 months were compared between these surveys. Data were interpreted in the context of underlying trends in these prevalences from previous NMS (from 2010 and 2014), and annual routine data for England (from 2009-10 to 2020-21). Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the effect of birth during the pandemic (2020 versus 2018) on breastfeeding, with adjustment for sociodemographic and birth-related factors.

RESULTS

Breastfeeding initiation and any breastfeeding at 6 weeks remained relatively constant in the NMS and the routine data. Birth during the pandemic was associated with a 3 percentage point decrease in EBF at 6 weeks in the NMS (aRR 0.92, 95%CI: 0.87, 0.98 for pandemic versus pre-pandemic), but a smaller decrease in the routine data. Birth during the pandemic was associated with a 3 percentage point increase in any breastfeeding at 6 months in the NMS (aRR 1.05, 95%CI: 1.00, 1.10). Breastfeeding varied across different groups of women in the NMS (i.e. marked inequalities), but the small changes observed between the pandemic and pre-pandemic NMS were broadly similar across the sociodemographic and birth-related factors examined (i.e. no change in inequalities).

CONCLUSION

Breastfeeding initiation and any breastfeeding at 6 weeks in England were unaffected by the pandemic, and the persistent inequalities in breastfeeding did not widen. Services should aim to reduce these inequalities in breastfeeding which have been documented since the 1970s.

Perceived Consequences of COVID-19 Restrictive Visitation Policy on Family Members at Rural Hospitals in Vhembe District: A Qualitative Study

From a public health standpoint, a stringent visitation policy was necessary during the COVID-19 pandemic, but it had unforeseen communicative and emotional health consequences for family members. This study explored family members' experiences regarding implementing a restricted visitation policy when a patient was admitted with COVID-19 at public hospitals in the Vhembe district. Researchers used an exploratory, descriptive, and contextual qualitative technique. Twelve family members made up the population. Unstructured telephone interviews were used to obtain the data, and open coding was used to analyse data. Ethics were consistently followed. Before taking part, participants provided verbal informed consent, acknowledging that they could withdraw from the study if necessary. Three themes emerged: inadequate measures for temporary communication channels and techniques, the mental health effects of COVID-19 admission, and poor/lack of standardised visitation policy during the COVID 19-pandemic. There was a need to balance safety from contracting COVID-19 infection and promoting family-centred care. Virtual visits through telecommunication solutions could reduce fear and anxiety as the family could be updated on the progress of the hospitalised relative. Alternatively, hospital managers must allocate a dedicated person in the unit to update families when they call and enquire about the conditions.

Parental Perspectives on Impact of Parental Presence Restrictions in the Neonatal Intensive Care Unit During the COVID-19 pandemic: A Cross-Sectional Study

PURPOSE

To describe parental experiences in the neonatal intensive care unit (NICU) during the COVID-19 restrictions. We explore what parents found most challenging, the impact these restrictions had on them and their infant, and how they coped.

METHODS

A cross-sectional online survey was completed by parents of infants who required care in a Canadian NICU during the early period of the COVID-19 pandemic. Data from 3 questions were coded using thematic analysis.

RESULTS

Participants ( n = 161) were primarily mothers (93%), with an average length of stay of 32.1 days. Three themes were identified from responses: (1) emotional and physical closeness of the parents to their infant; (2) physical and psychosocial well-being of the infant and parent; and (3) how parents coped, and strategies for moving forward. Parents reported that parental restriction policies adversely impacted their perceived physical and emotional closeness with their infant and their infant's physical and psychosocial well-being. Parents reported that being able to be present with their infant, having their partner able to be present with them, and effective communication helped them cope.

CONCLUSION

Despite the need for some restrictive policies to control the spread of the virus, the benefits and risks to the overall well-being of the parents and infants must be weighed.

The impact of restrictions to visiting in paediatric intensive care during the COVID-19 pandemic

BACKGROUND

Restrictions to hospital visiting were mandated during the COVID-19 pandemic, with variability in the degree of restriction imposed. At times, paediatric intensive care units (ICU) restricted visiting to one parent/carer. Views of parents/carers and ICU staff about changes in the visiting policy are not well understood.

STUDY DESIGN

This is a Service evaluation involving questionnaire survey incorporating rating scales and free-text comments. Inner-city specialist children's hospital. Parents/carers of children on ICU between December 2020-March 2021 and staff who were working on ICU during May-June 2021. Parents and staff on ICU were invited to complete a questionnaire focusing on their experience of being or working on ICU. Quantitative data were analysed descriptively and free-text comments were thematically analysed.

RESULTS

Completed questionnaires were received from 81/103 (79%) parents/carers and 217/550 (39%) staff. The majority of parents (n = 60;77%) and staff (n = 191;89%) understood the need for the one-parent visiting policy but acknowledged it was a source of considerable stress. More staff than parents agreed it was appropriate other relatives/friends visiting was not permitted (Z = 3.715;p < .001). There was no association between parents' satisfaction with their child's care and views about the visiting policy. However, staff were more likely to report an impact on their ability to deliver family centred care if they disagreed with the policy.

CONCLUSION

The COVID-19 visiting policy had a clear impact on parents and staff. In the event of any future threat to open-access visiting to children in hospital, the potentially damaging effect on children, parents, and staff must be considered.

RELEVANCE TO CLINICAL PRACTICE

Visiting policies need to take account of parents being partners in their child's care, rather than purely visitors to the unit where their child is being cared for. Visiting for two carers should always be facilitated, including during a crisis such as a pandemic.

"All I Can Say Is Thank You": A Qualitative Study of Gratitude in the NICU Before and During COVID-19

BACKGROUND

COVID-19-associated visitor restrictions altered parents' involvement in their infant's care in the neonatal intensive care unit (NICU).

PURPOSE

The purpose of this article is to explore how restrictions affected parents' perceptions of experience in the NICU and to build a conceptual model of communication flow during times of crisis.

METHODS

This qualitative study was set in a level III 52-bed NICU. Using data from an open-ended survey question, a multitiered thematic analysis was used.

RESULTS

Four broad themes emerged: communication, gratitude, release, and containment of emotionality. These 4 themes interacted codependently and manifested differently as COVID-related visitor policies were put in place. Parents' characterization of communication also varied depending on the visitation policies. Before COVID, parents were more likely to reflect on communication. During COVID, parents expressed more gratitude, while containing negative emotions-sometimes using gratitude to soften the blow of bad feedback.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Our theoretical model suggests that gratitude may serve as a form of "reciprocal care" to providers during a period of crisis and extreme stress. Use of high-quality communication between providers and parents in the NICU is necessary to understand parental concerns or negative experience.

Implementation of ESC QI Initiative in Neonatal Unit Setting and Adaptation During the Pandemic

OBJECTIVES

To improve outcomes in infants with neonatal opioid withdrawal syndrome (NOWS) admitted to NICU by implementing a quality improvement (QI) initiative incorporating "eat, sleep, console" (ESC) as a withdrawal evaluation tool and promotion of nonpharmacological interventions. Secondarily, we evaluated the impact of the coronavirus disease 2019 pandemic on QI initiative and outcomes.

METHODS

We included infants born ≥ 36 weeks gestation and admitted to NICU with a primary diagnosis of NOWS between December 2017 and February 2021. (preintervention; December 2017-January 2019, postintervention; February 2019-February 2021). We compared cumulative dose, duration of opioid treatment, and length of stay (LOS) as our primary outcomes.

RESULTS

The average duration of opioid treatment decreased from 18.6 days in the preimplementation cohort (n = 36) to 1.5 days in the first-year postimplementation (n = 44) with a reduction in cumulative opioid dose from 5.8 mg/kg to 0.6 mg/kg and decrease in the proportion of infants treated with opioids from 94.2% to 41.1%. Similarly, the average LOS decreased from 26.6 to 7.6 days. In the second-year postimplementation during the coronavirus disease 2019 pandemic (n = 24), there was an increase in average opioid treatment duration and LOS to 5.1 and 12.3 days respectively, but cumulative opioid dose (0.8 mg/kg) remained significantly lower than the preimplementation cohort.

CONCLUSIONS

ESC-based quality improvement initiative led to a significant decrease in LOS and opioid pharmacotherapy in infants with NOWS in NICU setting. Despite the impact of the pandemic, some of the gains were sustained with adaptation to ESC QI initiative.

North Thames multi-centre service evaluation: Ethical considerations during COVID-19

Objectives

During the COVID-19 pandemic, healthcare resources including staff were diverted from paediatric services to support COVID-positive adult patients. Hospital visiting restrictions and reductions in face-to-face paediatric care were also enforced. We investigated the impact of service changes during the first wave of the pandemic on children and young people (CYP), to inform recommendations for maintaining their care during future pandemics.

Design

A multi-centre service evaluation was performed through a survey of consultant paediatricians working within the North Thames Paediatric Network, a group of paediatric services in London. We investigated six areas: redeployment, visiting restrictions, patient safety, vulnerable children, virtual care and ethical issues.

Results

Survey responses were received from 47 paediatricians across six National Health Service Trusts. Children's right to health was largely believed to be compromised by the prioritisation of adults during the pandemic (81%; n = 33). Sub-optimal paediatric care due to redeployment (61%; n = 28) and the impact of visiting restrictions on CYP's mental health (79%; n = 37) were reported. Decreased hospital attendances of CYP were associated with parental fear of COVID-19 infection-risks (96%; n = 45) and government 'stay at home' advice (89%; n = 42). Reductions in face-to-face care were noted to have disadvantaged those with complex needs, disabilities and safeguarding concerns.

Conclusion

Consultant paediatricians perceived that paediatric care was compromised during the first wave of the pandemic, resulting in harm to children. This harm must be minimised in subsequent pandemics. Recommendations for future practice which were developed from our findings are provided, including maintaining face-to-face care for vulnerable children.

The Effect of Maternal SARS-CoV-2 Infection on Neonatal Outcome

(1) Background: Neonates born to SARS-CoV-2 positive mothers are at risk of infection, as well as adverse outcomes due to the infection. The aim of our study was to analyze the impact of maternal SARS-CoV-2 infection on neonatal outcome. (2) Methods: We conducted a prospective, longitudinal study. We collected data on maternal symptomatology upon admission and their correlation with the development of the infant. Through a questionnaire we analyzed the impact on breastfeeding of the separation of the mother from the newborn, as well as the maternal psycho-emotional effect. (3) Results: Ninety infants were enrolled in the study, from one twin pregnancy and the rest singleton pregnancies. Out of the 89 mothers, 34 showed symptoms. Neonates from mothers with anosmia and ageusia had a higher value of WBC and lymphocytes (p = 0.06 and p = 0.04). Breastfeeding was started in 57.3% of mothers after their discharge from hospital and only 41.6% of the whole study group continued at the follow-up visit. Mothers who described a negative experience during hospitalization associated a 2.42 times higher risk of not continuing breastfeeding. (4) Conclusion: None of the infants enrolled in the study had SARS-CoV-2 infection either at birth or within the first two months of life. Breastfeeding was started with more than half newborns after discharge from hospital. The negative experience generated by the separation from their babies influenced breastfeeding.

Experiences of Mothers of Preterm Infants in the Neonatal Intensive Care Unit During the COVID-19 Pandemic

BACKGROUND

The neonatal intensive care unit (NICU) stay following the birth of a preterm infant can be stressful and traumatic for families. During the COVID-19 pandemic, the NICU environment changed precipitously as infection control and visitor restriction measures were implemented.

PURPOSE

Our study aimed to examine the impact of the pandemic policies on the experiences of mothers of preterm infants during their stay in the NICU.

METHODS

Semistructured interviews were conducted with mothers of preterm infants hospitalized in a Canadian tertiary-level NICU. Informed by interpretive description methodology, interview content was transcribed and analyzed using a thematic analysis approach. The identified themes were validated, clarified, or refined using investigator triangulation.

RESULTS

Nine English-speaking mothers, aged 28 to 40 years, were interviewed. Four themes emerged from the analysis of their experiences: (1) disrupted family dynamic, support, and bonding; (2) physical and emotional isolation; (3) negative psychological impact compounded by added concerns, maternal role change, and survival mode mentality; and (4) positive aspects of the pandemic management measures.

IMPLICATIONS FOR PRACTICE

During the pandemic, the way that care was provided in the NICU changed. This study helps to explore how neonatal clinicians can foster individual and organizational resilience to keep patients and families at the center of care, even when the healthcare system is under intense stress.

IMPLICATIONS FOR RESEARCH

: Our results show that these changes heightened mothers' distress, but also had a modest positive impact. Further research about long-term consequences of pandemic policies on the mother and preterm infant after NICU discharge is warranted.

Parental Perceptions of the Impact of NICU Visitation Policies and Restrictions Due to the COVID-19 Pandemic: A Qualitative Study

BACKGROUND

The COVID-19 pandemic has impacted parents' ability to participate in their infants' care during the neonatal intensive care unit (NICU) stay in unprecedented ways.

PURPOSE

The purpose of this study was to explore the lived experience of parents whose infants was in the NICU during the COVID-19 pandemic.

METHODS

A qualitative telephone interview survey was conducted. Participants included parents of preterm infants who were born less than 34 weeks' gestation during the first wave of the COVID-19 pandemic (March 2020-August 2020). Telephone surveys were conducted through open-ended questions. A thematic content analysis identifying themes was performed after interviews were completed and transcribed.

RESULTS

A total of 8 mothers completed the telephone survey. Key themes from this study include parents experiencing increased stress due to the restricted visitation policies, limited opportunities to care for their infant, lack of support, and inconsistent communication regarding their infant status and COVID-19 protocols.

IMPLICATIONS FOR PRACTICE

Suggestions provided to enhance NICU services during the pandemic include increasing parental engagement opportunities to care for their infant in the NICU, enhanced empathy and compassion from the neonatal team, and open and transparent communication.

IMPLICATIONS FOR RESEARCH

Further research investigating cultural impact on parents' perspectives, perspectives of fathers, long-term impact of how parents coped after discharge from the NICU, and emotional impact on NICU staff members may be beneficial to aid improvements in NICU service delivery during the ongoing and future pandemic.

Sociodemographic factors affecting depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic

Purpose

This study aimed to determine the sociodemographic factors affecting the depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic.

Design

and Methods: This descriptive cross-sectional study was conducted between March and October 2021. The sample consisted of 93 parents. Data were collected using a descriptive questionnaire, the Depression Anxiety Stress Scale (DASS- 42), and Coping Style Scale (CSS).

Results

Participants had mean DASS "depression," "anxiety," and "stress" subscale scores of 13.69 ± 8.86, 12.11 ± 8.37, and 19.09 ± 9.24, respectively. They had mean CSS "self-confident," "optimistic," "helpless," "submissive coping," and "seeking of social support" subscale scores of 2.71 ± 0.65, 2.57 ± 0.59, 2.29 ± 0.62, 2.25 ± 0.49, and 2.38 ± 0.52, respectively. Fathers had lower mean CSS "helpless" and "submissive" subscale scores than mothers. Participants who were briefed about their babies' condition by nurses had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with higher education had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with spouses with bachelor's or higher degrees had a higher median CSS "optimistic" subscale score than those with literate spouses or spouses with primary school degrees. Participants who were worried about the "no visitors" policy had a lower median CSS "self-confident" subscale score than those who were not.

Conclusions

Parents who are not allowed to see their babies due to the "no visitors" policy during the COVID-19 pandemic experience more psychosocial problems. Though not a result of the present study, the "no visitors" policy seems to affect the mother-infant attachment adversely.

Practice implications

Healthcare professionals should brief parents about what a neonatal intensive care unit is like. They should also warn them that they may not be too happy about how their baby looks before seeing them. Therefore, they should use therapeutic communication techniques to talk to them and explain the situation in a way they can understand. Moreover, they should provide parents with psychological empowerment training programs to help them adopt active coping strategies to deal with challenges in times of crisis.

Encouraging Our NICU to "Read-a-Latte": Leveraging a Read-a-Thon to Launch a Quality Improvement Initiative

BACKGROUND

Preterm infants have known impairments in language development relative to infants born at full term, and the language-poor environment of the neonatal intensive care unit (NICU) is a contributing factor. Adapting outpatient literacy programs for the NICU is a potential evidence-based intervention to encourage adult speech exposure to infants through reading sessions during NICU hospitalization.

PURPOSE

To evaluate implementation of a 10-day NICU Read-a-Thon and potential barriers and facilitators of a year-round program aimed at increasing reading sessions for NICU patients.

METHODS

We established an implementation team to execute a Read-a-Thon and evaluated its impact utilizing quantitative and qualitative approaches. Quantitative methodology was used to report number of donated books and infant reading sessions. Qualitative methodology inclusive of interviews, surveys, and source document reviews was used to evaluate the Read-a-Thon.

RESULTS

We received approximately 1300 donated books and logged 663 reading sessions over the 10-day Read-a-Thon. Qualitative evaluation of the Read-a-Thon identified 6 main themes: motivation, emotional response to the program, benefits and outcomes, barriers, facilitators, and future of literacy promotion in our NICU. Our evaluation informed specific aims for improvement (eg, maintaining book accessibility) for a quality improvement initiative to sustain a year-round reading program.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Neonatal units can leverage Read-a-Thons as small tests of change to evaluate barriers, facilitators, and change processes needed to implement reading programs. Process maps of book inventory and conducting a 5 W's, 2 H's (who, what, when, where, why, how, how much) assessment can aid in program planning.

Impact of the COVID-19 Pandemic on the Experiences of Hospitalized Patients: A Scoping Review

OBJECTIVE

This study aimed to identify the factors that exerted an impact on the experiences of hospitalized patients during the COVID-19 pandemic from the quality and safety perspectives.

METHOD

A scoping review that followed the 5 stages described by Arksey and O'Malley was used. A systematized search of original studies was conducted in 9 databases: PubMed/MEDLINE, BDENF, CINAHL, LILACS, SciELO, Embase, Scopus, Web of Science, and Google Scholar. The factors that exerted an impact on patients' experiences were summarized, considering the perspective of quality and patient safety in health institutions. The factors were categorized using the Content Analysis technique.

RESULTS

A total of 6950 studies were screened, and 32 met the eligibility criteria. The main factors that exerted an impact on the patients' experience were as follows: caregiver/family concern with the patients' well-being during hospitalization, search for alternative communication and interaction means between the patients and their family, and changes in health care organization. The restrictions inherent to the policy regarding visits and companions exerted a negative impact on the experiences, increasing the patients' feelings of loneliness and isolation. Negative impacts were also evidenced in the hospital admission and discharge process and in the limitation of treatment possibilities offered to the patients, because of contact restrictions.

CONCLUSIONS

The factors that exerted an impact on the patients' experiences permeate communication between professionals, patients, and family members, with implications for health care quality.

Neonatal Pictures in a NICU as a Mode of Nursing Intervention to Enhance Parent-Infant Bonding: Parents' Experience during the COVID Pandemic

INTRODUCTION

Neonatal departments around the world have changed their policies to prevent the spread of infection during the COVID-19 pandemic. The birth of an extremely premature baby can disrupt physical contact between the mother/parent and the baby. This situation affects the bonding process between mother and child. The aim of the study was to investigate the opinions of parents who receive photographs or videos of their children electronically on the usefulness of this intervention, as well as the emotional reaction of parents to the photos or videos received, and potential ways to improve the intervention.

METHODS

The study used a qualitative approach and relied on phenomenology, which is a research method used to study experience as experienced from the subjective point of view. Pilot interviews were conducted in January and February 2021, and the final study ran from March to June 2021.

RESULTS

The uploaded photographs and videos provided a useful communication tool. The parents' emotions at the proposal to send photographs of the child and while viewing the first photographs were strong and marked by considerable ambivalence.

CONCLUSIONS

This study showed how important it is to ensure communication between the parent and the medical staff. Despite the positive reception, in the future obtaining consent from the legal guardian for taking pictures should be considered, whether this form will be accepted, and to ensure the presence of medical staff while the parent is watching the photographs/videos, as this method of communication will not fully ensure direct skin-to-skin contact to build bonds between the parent and the infant. Neonatal intensive care units need to find strategies to mitigate the impact of separation on parental experiences and bonds should a similar situation arise in the future.

The Impact of Parental Presence Restrictions on Canadian Parents in the NICU During COVID-19: A National Survey

The purpose of this research was to explore parental perspectives on the impact of parent restrictions imposed in response to the COVID-19 pandemic across Canadian Neonatal Intensive Care Units (NICUs). A co-designed online survey was conducted targeting parents (n = 235) of infants admitted to a Canadian NICU from March 1, 2020, until March 5, 2021. Parents completed the survey from 38 Canadian NICUs. Large variation in the severity of policies regarding parental presence was reported. Most respondents (68.9%) were classified as experiencing high restrictions, with one or no support people allowed in the NICU, and felt that policies were less easy to understand, felt less valued and respected, and found it more challenging to access medicine or health care. Parents reported gaps in care related to self-care, accessibility, and mental health outcomes. There is significant variation in parental restrictions implemented across Canadian NICUs. National guidelines are needed to support consistent and equitable care practices.

Heartbreak and Loneliness Due to Family Separations and Limited Visiting during COVID-19: A Qualitative Study

The COVID-19 pandemic has greatly impacted the healthcare system. In the pediatric unit, stress, uncertainty, and many unexpected challenges for many parents were frequently reported. Research has shown that parents had less contact with their children during the pandemic due to hospital restrictions. However, it is unknown how parents perceived their experiences in a pediatric unit. This study aimed to describe the lived experiences of parents who had a child in the pediatric unit during the pandemic. A qualitative descriptive approach was used to investigate parents' experiences of having children admitted to the pediatric unit during the pandemic in Hong Kong. Eight Chinese parents participated in the interview. Three major themes emerged: (1) parents' pediatric ward experiences during COVID-19 were emotionally isolating and overwhelming, (2) the family and family-centered care were disrupted, and (3) interactions with pediatric providers intensified or alleviated emotional distress. Integrating the above themes of experiences of emotional distress was the main characteristic of the parents' experiences during the pandemic. Therefore, policymakers should understand the lived experiences of parents of children diagnosed with COVID-19 and should make prompt decisions to deal with both parental concerns and safety issues.

Predictors of Healthcare Workers' Compassionate Care Amid the COVID-19 Pandemic: A Cross-Sectional Study from Patients' Perspective in Kelantan, Malaysia

Background: Compassionate care served by healthcare workers (HCWs) has been recognized as one of the most critical aspects of high-quality care. Unfortunately, there is still an unmet need for the assessment of compassionate care from the patient’s perspective. During the COVID-19 pandemic, many new rules were enacted to tackle the raging pandemic, which raised concerns about its effect on compassionate care. Methods: A cross-sectional study involving 315 patients from three public hospitals was conducted during the conditional movement control order (CMCO). A self-administered Malay version of the Relational Aspect of Care Questionnaire (RAC-QM) was used to assess compassionate care. Multiple linear regression was used to determine the predictors. Results: More than 90% of the patients were Malays, Muslims, and fell under the B40 household income category. Companions were present for 51.7% of the patients, but 75.2% had no visitors. All hospitals received scores of more than 90%. Occupation (student, p = 0.032), dependency level (total dependent, p < 0.001), and household income level (M40, p = 0.027) were the statistically significant predictors for compassionate care. Conclusions: The current study revealed that compassionate care to patients was not compromised during the pandemic. Patients with disabilities or financial constraints are more likely to experience less compassionate care, while students are generally more satisfied. This study may provide clues for hospital administrators and policymakers regarding the vulnerable group of patients. It also provides opportunities for future research to study the perspective of HCWs.

NeoConnect: The Design, Implementation, and Impact of a Virtual Family-Centered NICU Program

BACKGROUND

Familial involvement in the neonatal intensive care unit (NICU) reduces parental stress and strengthens parental-infant bonding. However, parents often face barriers to in-person visitation. The coronavirus disease-2019 COVID-19 pandemic has exacerbated limitations to parental bedside presence.

OBJECTIVE

To design, implement, and evaluate a technology-based program to connect NICU babies with their families during the COVID-19 pandemic.

METHODS

We created NeoConnect at our level IV NICU, which included parental audio recordings and video chats between parents and their babies. Parental and NICU staff input on NeoConnect was gathered via preimplementation surveys. Inaugural families and staff members completed a postparticipation survey.

RESULTS

Prior to implementation, all parents who were surveyed (n = 24) wished they could be more involved in their baby's care. In the first 3 months of NeoConnect, 48 families participated in the audio recording project and 14 families participated in the video chat initiative. Following implementation, 85% of surveyed staff (28/33) reported that the patients became calmer when listening to their parents' recorded voice and 100% of surveyed parents (6/6) reported that video chats reduced their stress level.

CONCLUSION

Harnessing technology as a tool to increase parental involvement in the NICU is feasible and beneficial for NICU patients and their families.

Giving Birth in Unpredictable Conditions: Association between Parents' COVID-19 Related Concerns, Family Functioning, Dyadic Coping, Perceived Social Support and Depressive Symptoms

BACKGROUND

The way postpartum parents' COVID-19-related concerns are associated with the family environment, support resources and depressive symptoms areunder-investigated.

METHODS

Two hundred and forty-three new parents (132 mothers, 111 fathers) completed self-report questionnaires within an 8-week period after birth. Parental concerns for COVID-19-related life changes were assessed with the COVID-19 Questionnaire, perceived social support with the Multidimensional Scale of Perceived Social Support, perceived family functioning with the Family Adaptability and Cohesion Evaluation Scales IV Package, dyadic coping behaviors with the Dyadic Coping Inventory and maternal/paternal postnatal depression with the Edinburgh Postnatal Depression Scale.

RESULTS

(a) Higher levels of COVID-19-related concerns about daily life were associated with lower levels of family communication, satisfaction and increased depressive symptomatology in both parents, and with lower levels of family functioning in mothers; (b) Maternal health care COVID-19-related concerns were linked with lower levels of family communication, lower perceived social support and with an increase in maternal depressive symptoms; and (c) COVID-19-related concerns about neonate hospitalization were associated with increased maternal depressive symptoms.

CONCLUSION

Τhese findings suggest that COVID-19-related concerns had a common negative effect on both postpartum mothers' and fathers' mental health and on certain aspects of family functioning.

Impact of the COVID-19 pandemic on expectant and new parents' experience of pregnancy, childbirth, breast feeding, parental responsiveness and sensitivity, and bonding and attunement in high-income countries: a systematic review of the evidence

OBJECTIVES

To review the evidence on how pregnancy, birth experience, breast feeding, parental responsiveness and sensitivity, and bonding and attunement were impacted by COVID-19.

METHODS

We searched eight literature databases and websites of relevant UK-based organisations. The review focused on evidence during pregnancy and the early years (0-5 years). Studies of any study design published in English from 1 March 2020 to 15 March 2021 and conducted in high-income countries were included. Screening and data extraction were undertaken in duplicate. Evidence was synthesised using a narrative approach. Study quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

The search yielded 9776 publications, of which 26 met our inclusion criteria. Significant knowledge gaps on how COVID-19 affected pregnancy and breast feeding limited healthcare providers' ability to provide consistent evidence-based information and care at the start of the pandemic. There was an enduring sense of loss about loved ones being restricted from taking part in key moments. Parents were concerned about the limitations of virtual healthcare provision. Some parents reported more opportunities for responsive breast feeding and improved parent-infant bonding due to reduced social and work pressures. Women from minoritised ethnic groups were less likely to continue breast feeding and attributed this to a lack of face-to-face support.

CONCLUSIONS

The evidence suggests that new and expectant families have been both negatively and positively impacted by the COVID-19 pandemic and the resulting restrictions. The impacts on parents' opportunities to bond with their young children and to be attuned to their needs were felt unequally. It is important that emergency response policies consider the mother and the partner as a family unit when making changes to the delivery of maternal and child health and care services, so as to mitigate the impact on the family and existing health inequalities.

PROSPERO REGISTRATION NUMBER

CRD42021236769.

Psychosocial Difficulties Experienced By Parents Of Babies Treated In A Neonatal Intensive Care Unit During The Coronavirus Pandemic

AIM

This study had two objectives: (1) to investigate the psychosocial difficulties experienced by parents of babies treated in a neonatal intensive care unit during the coronavirus pandemic and (2) to determine parent-infant attachment.

MATERIALS AND METHODS

This study adopted phenomenology, a qualitative research design in order to answer the research questions design. The sample consisted of 20 parents of babies treated in the neonatal intensive care unit (NICU) of a City Hospital in Turkey between July and August 2021. Participation was voluntary. Data were collected using a sociodemographic characteristics questionnaire and a semi-structured qualitative interview form. Each participant was interviewed face to face. Each interview was recorded and transcribed. The data were analyzed using content analysis.

RESULTS

Participants had a mean age of 32.2 ± 3.61 years and at least secondary school degrees. Babies were admitted to the NICU for congenital anomalies (n = 3) or preterm birth (n = 7). Participants experienced anxiety, worry, and loneliness and produced less milk because they could not see and touch their babies. Their greatest source of support was their spouses.

CONCLUSION

Parents of babies treated in the NICU during the COVID-19 pandemic experience anxiety, sadness, unhappiness, and loneliness. The preventive measures against the pandemic affect parents psychosocially. Healthcare professionals should plan and implement care practices and establish effective communication with parents to identify their physiological, psychological, and social needs and help them produce breastmilk and bond with their babies.

Trauma-Informed Care in the Neonatal Intensive Care Unit: Through the Lens of the COVID-19 Pandemic

Trauma is rooted in an individual's experience of an event that leads to physical or mental harm and can have a long-lasting, unfavorable effect on their well-being and functioning. Being aware of the effects of trauma, recognizing its signs, understanding how it informs individual responses, and actively trying to prevent re-traumatization are the tenets of trauma-informed care. Admission to the neonatal intensive care unit (NICU) is widely considered to be an extremely stressful time for parents and infants alike. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, there were significant changes in healthcare delivery. Widespread closures, restrictions due to infection control measures, the spread of misinformation, increased psychosocial hardships, and amplification of cultural, gender, and racial biases intensified NICU-related stressors. Adoption of the principles of trauma-informed care, as defined by the Substance Abuse Mental Health Services Administration, to the NICU can help buffer some of these stressors. We present a review of these principles viewed through the lens of the COVID-19 pandemic. The lessons learned will help inform practices and policies and allow us to navigate similar challenges more effectively in the future.

The Effect of Hospital Visitor Policies on Patients, Their Visitors, and Health Care Providers During the COVID-19 Pandemic: A Systematic Review

Health care policymaking during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has questioned the precedent of restricting hospital visitors. We aimed to synthesize available data describing the resulting impact on patient, family/visitor, and health care provider well-being. We systematically reviewed articles from the World Health Organization COVID-19 Global Literature on Coronavirus Disease Database published between December 2019 through April 2021. Included studies focused on hospitalized patients and reported 1 or more prespecified main or secondary outcome (coronavirus disease 2019 [COVID-19] disease transmission, global well-being, mortality, morbidity, or health care resource utilization). Two authors independently extracted data into a standardized form with a third author resolving discrepancies. A total of 1153 abstracts were screened, and 26 final full-text articles were included. Ten studies were qualitative, with 7 cohort studies, and no randomized controlled trials. Critically ill patients were the most represented (12 out of 26 studies). Blanket hospital visitor policies were associated with failure to address the unique needs of patients, their visitors, and health care providers in various clinical environments. Overall, a patient-centered, thoughtful, and nuanced approach to hospital visitor policies is likely to benefit all stakeholders while minimizing potential harms.

Assessing the impact of the COVID-19 pandemic on parental satisfaction in two European neonatal intensive care units

BACKGROUND

Neonatal units across the world have altered their policies to prevent the spread of infection during the COVID-19 pandemic. Our aim was to report parental experience in two European neonatal units during the pandemic.

METHODS

Parents of infants admitted to each neonatal unit were asked to complete a questionnaire regarding their experience during the COVID-19 pandemic. At King's College Hospital, UK (KCH), data were collected prospectively between June 2020 and August 2020 (first wave). At the Hospital Clínic Barcelona (HCM), data were collected retrospectively from parents whose infants were admitted between September 2020 and February 2021 (second and third wave).

RESULTS

A total of 74 questionnaires were completed (38 from KCH and 36 from HCM). The parents reported that they were fully involved or involved in the care of their infants in 34 (89.4%) responses in KCH and 33 (91.6%) responses in HCM. Quality time spent with infants during the pandemic was more negatively affected at KCH compared with HCM (n=24 (63.2%) vs n=12 (33.3%)). Parents felt either satisfied or very satisfied with the updates from the clinical care team in 30 (79.0%) responses at KCH and 30 (83.4%) responses in HCM. The parents felt that the restrictions negatively affected breast feeding in six (15.8%) responses at KCH and two (5.6%) responses in HCM. Travelling to the hospital was reported overall to be sometimes difficult (39.2%); this did not differ between the two units (14 (36.8%) respondents at KCH and 15 (41.6%) from HCM). Furthermore, the self-reported amount of time spent giving kangaroo care also did not differ between the two countries.

CONCLUSION

Restrictive policies implemented due to the COVID-19 pandemic had a negative impact on the perception of quality of time spent by parents with their newborns admitted to neonatal units.

The COVID-19 Pandemic and Pregnancy: Impact on Mothers and Newborns

The severe acute respiratory syndrome coronavirus 2 pandemic has markedly, and likely permanently, changed health care. This includes changing the obstetric and perinatal care of mothers and infants, and by extension, the care of their families. Infection during pregnancy is associated with an increased risk for severe coronavirus disease 2019 illness and related complications that can significantly impact maternal health and the health of the neonate. Viral transmission from mother to fetus is possible, but rare during pregnancy, and current health care policies focusing on maternal masking, and hand washing allows infected mothers to safely care for neonates (including nursing or feeding with expressed breast milk). The newly developed vaccines have been shown to be safe and effective for pregnant and breast-feeding mothers, with measurable antibody levels in cord blood and breast milk potentially providing a level of passive immunity to neonates. While studies looking at short-term outcomes for neonates have been reassuring, it is critical that we continue to work to understand and improve the care of pregnant woman and newborns with coronavirus disease 2019 to optimize long term outcomes. Although the knowledge base continues to evolve, the available evidence influencing the care of pregnant women and their infants is summarized in this focused review.

Parental perceptions on the impact of visiting restrictions during COVID-19 in a tertiary neonatal intensive care unit

AIM

During the first wave of coronavirus disease 2019 (COVID-19), visiting guidelines in neonatal units changed to maintain the health and safety of staff, neonates, and families. In the neonatal intensive care unit/special care nursery (NICU/SCN), restrictions were placed on parental contact and extended family excluded. Our team was interested in evaluating the effect of these restrictions on parental stress and discharge confidence.

METHODS

A prospective descriptive study utilising survey methodology was undertaken. The survey was developed and previously used by the NICU research group to evaluate parental knowledge and understanding, parental role, communication, and parental stress (admission/discharge). We have also included a section regarding COVID19 visiting restrictions (ETH.2020.LRE.00124). The survey used a five-level Likert scale. Statistical analysis was completed using SPSS version 21.

RESULTS

Notably, 33 surveys were returned. Results showed visiting restrictions reduced social contact between partners 26/33 (84%), with their other children 14/16 (87.5%) and extended family 28/33 (84.8%). Parents indicated that they had high levels of confidence in understanding their babies' medical needs (78-93%) and gaining hands-on experience caring for their baby (87-100%). However, 11/33 (33%) of parents reported concerns with discharge processes and gaining consistent information as challenges during their baby's admission. Notably, 17/33 (51.5) stated their NICU/SCN experience had been very to extremely stressful. Parents openly described how the restrictions had affected their mental/emotional health identifying the need to treat parents as one unit, and a gap in the psychological support available for families.

CONCLUSION

Support services and consistency of communication with NICU/SCN families need to be enhanced and prioritised during periods of restrictions, especially peri-discharge.

Comparison of Effects of Mothers' and Mozart's Lullabies on Physiological Responses, Feeding Volume, and Body Weight of Premature Infants in NICU

Objectives

The purpose of this study was to compare the effects of mothers' and Mozart's lullabies on physiological parameters, feeding volume, and body weight of premature infants in a neonatal intensive care unit (NICU).

Methods

This study used a non-equivalent control group, non-synchronized design as a quasi-experimental study. Two intervention groups (recorded mother's lullaby and Mozart's lullaby) and a control group were formed from a total of 65 premature infants: a mother's lullaby group of 22 infants, a Mozart's lullaby group of 22 infants, and a control group of 21 infants not provided with any lullabies. Their physiological parameters included heart rate, blood pressure, respiratory rate, and O2 saturation. The infants' feeding volume and body weight were measured as indicators related to the growth of premature infants. The mother's and Mozart's lullabies were played on a speaker in an incubator for 15 min for 7 consecutive days per group.

Results

There were significant differences in the mean difference before and after intervention in neonatal heart rate (χ2 = 45.03, P < 0.001), systolic pressure (F = 43.29, P < 0.001), diastolic pressure (χ2 = 33.01, P < 0.001), respiratory rate (F = 76.06, P < 0.001), and O2 saturation (χ2 = 40.82, P < 0.001) between the three groups. The mean differences of both mother's and Mozart's lullaby groups were significantly higher than those of the routine care group in all physiological parameters, and those of the mother's lullaby group was significantly higher when compared with the Mozart's lullaby group. In repeated-measures ANOVA, there was a significant interaction between time and group in feeding volume (F = 2.46, P = 0.041). However, body weight did not significantly differ in an interaction between time and group (F = 1.75, P = 0.151).

Conclusion

This study showed beneficial effects of mother's lullaby and Mozart's lullaby on physiological parameters. Especially, the mother's lullaby was found to significantly improve all physiological parameters and feeding volume of premature infants in the NICU compared to Mozart's lullaby group. Therefore, we recommend the regular integration of the mother's lullaby into supportive care of premature infants in the NICU, as this intervention highlights the need for mothers to participate in their care.

Trial Registration

ClinicalTrials.gov, identifier: KCT0004842 (https://cris.nih.go.kr).

Factors Affecting Nurses' Internal Transfer Intentions after the Introduction of COVID-19-Related Family Visiting Restrictions

Hospitals have established visiting restrictions to block coronavirus disease 2019 (COVID-19) external transmission routes. This study investigated factors associated with nurses' internal transfer intentions and changes in their workloads, burdens, and daily lives owing to pandemic-related family visiting restrictions. Participants were nurses from three medical institutions designated for infectious diseases in Ishikawa Prefecture, Japan. An original self-report questionnaire was developed based on previous studies and a web-based survey conducted. Responses were received from 152 nurses and 84 were included in the analysis. Factors influencing internal transfer intentions were age ≥30 years [odds ratio (OR): 6.54, 95% confidence interval (CI): 1.19-35.83]; ≥11 years of experience (OR: 12.57, 95% CI: 2.32-68.02); and longer working hours (OR: 4.51, 95% CI: 1.48-13.72). The effect of visitation restrictions on daily life and internal transfer intentions was greater in nurses with ≥11 years of experience (OR: 4.31, 95% CI: 1.09-17.04), those with increased night awakening (OR: 3.68, 95% CI: 1.33-10.18), and those who desired to receive counseling (OR: 4.38, 95% CI: 1.07-17.91). In conclusion, excessive working hours may affect nurses' internal transfer intentions during the COVID-19 pandemic. Nocturnal awakening and desire to receive counseling may predict nurses' internal transfer intentions.

COVID-19 Pandemic-Related Restrictions: Factors That May Affect Perinatal Maternal Mental Health and Implications for Infant Development

This review aims to discuss the factors that may affect maternal mental health and infant development in COVID-19 pandemic condition. Toward this direction, the two objectives of this review are the following: (a) to discuss possible factors that may have affected negatively perinatal mental health through the pandemic-related restrictions; and (b) to present the implications of adversely affected maternal emotional wellbeing on infant development. We conclude that the pandemic may has affected maternal mental health with possible detrimental effects for the infants of the COVID-19 generation. We highlight the need for evidence-based interventions to be integrated within the health system for prenatal and postpartum care in an effort to promote maternal mental health and infant development.

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

OBJECTIVES

The COVID-19 pandemic has disrupted healthcare systems, challenging neonatal care provision globally. Curtailed visitation policies are known to negatively affect the medical and emotional care of sick, preterm and low birth weight infants, compromising the achievement of the 2030 Development Agenda. Focusing on infant and family-centred developmental care (IFCDC), we explored parents' experiences of the disruptions affecting newborns in need of special or intensive care during the first year of the pandemic.

DESIGN

Cross-sectional study using an electronic, web-based questionnaire.

SETTING

Multicountry online-survey.

METHODS

Data were collected between August and November 2020 using a pretested online, multilingual questionnaire. The target group consisted of parents of preterm, sick or low birth weight infants born during the first year of the COVID-19 pandemic and who received special/intensive care. The analysis followed a descriptive quantitative approach.

RESULTS

In total, 1148 participants from 12 countries (Australia, Brazil, Canada, China, France, Italy, Mexico, New Zealand, Poland, Sweden, Turkey and Ukraine) were eligible for analysis. We identified significant country-specific differences, showing that the application of IFCDC is less prone to disruptions in some countries than in others. For example, parental presence was affected: 27% of the total respondents indicated that no one was allowed to be present with the infant receiving special/intensive care. In Australia, Canada, France, New Zealand and Sweden, both the mother and the father (in more than 90% of cases) were allowed access to the newborn, whereas participants indicated that no one was allowed to be present in China (52%), Poland (39%), Turkey (49%) and Ukraine (32%).

CONCLUSIONS

The application of IFCDC during the COVID-19 pandemic differs between countries. There is an urgent need to reconsider separation policies and to strengthen the IFCDC approach worldwide to ensure that the 2030 Development Agenda is achieved.

Postpartum depression and associated risk factors during the COVID-19 pandemic

Objective

To describe postpartum depression and associated risk factors among postpartum patients in the United States (US) between February and July 2020. This study used a cross-sectional descriptive design to collect survey data from a convenience sample of postpartum patients who lived in the US and delivered a live infant after the US declared COVID-19 a public health emergency.

Results

Our sample included 670 postpartum patients who completed an online survey inclusive of the Edinburgh Postnatal Depression Scale (EPDS) and selected demographic items (e.g. NICU admission status, infant gestational age, infant feeding method). In our sample, 1 in 3 participants screened positive for postpartum depression and 1 in 5 had major depressive symptoms. Participants who fed their infants formula had 92% greater odds of screening positive for postpartum depression and were 73% more likely to screen positive for major depressive symptoms compared to those who breastfed or bottle-fed with their own human milk. Participants with infants admitted to a NICU had 74% greater odds of screening positive. Each 1 week increase in weeks postpartum increased the odds of screening positive by 4%. Participants who worried about themselves and their infants contracting COVID-19 had 71% greater odds of screening positive.

Evaluating Pediatric Families’ Understanding of and Reactions to COVID-19 Visitor Restrictions

The COVID-19 pandemic led to changes in hospital visitor policies and little is known about the impact on patients and their families. This study evaluated families’ understanding of and reactions to COVID-19-related visitor restriction policy at an academic children's hospital. We conducted a cross-sectional study with families of patients admitted to the pediatric ICU and general pediatric wards from September 2020 to November 2020. Parents (n = 73) completed a survey assessing communication, understanding of and satisfaction with visitor policies, strategies of coping with illness, and Hospital Anxiety and Depression Scale (HADS) scores. Descriptive analyses were performed to summarize data. Associations between outcomes and participant characteristics were examined. A majority (88%) of respondents reported hospital visitor restrictions were explained, usually in-person (94%), and understood the policy “very well” (68%), but none correctly identified all reasons for visitation restrictions. Eighty-five percent reported other family/friends would have visited, however minority families were more likely to report they would have had fewer visitors if restrictions were not in place (P = 0.0385). A majority (69%) were satisfied with how the hospital handled visitor polices, and parents of older children were more satisfied (P < .0001). HADS scores were consistent with anxiety or depression in about half of respondents. Forty percent of respondents believed restrictions affected their own and their child's ability to cope during hospitalization. Parents expressed satisfaction with and understanding of visitor policies but did not understand the rationale for visitor restrictions. Visitor restrictions may impact parental and child coping and mental health outcomes.

Association of a Zero-Separation Neonatal Care Model With Stress in Mothers of Preterm Infants

IMPORTANCE

Active participation in care by parents and zero separation between parents and their newborns is highly recommended during infant hospitalization in the neonatal intensive care unit (NICU).

OBJECTIVE

To study the association of a family integrated care (FICare) model with maternal mental health at hospital discharge of their preterm newborn compared with standard neonatal care (SNC).

DESIGN, SETTING, AND PARTICIPANTS

This prospective, multicenter cohort study included mothers with infants born preterm treated in level-2 neonatal units in the Netherlands (1 unit with single family rooms [the FICare model] and 2 control sites with standard care in open bay units) between May 2017 and January 2020 as part of the AMICA study (fAMily Integrated CAre in the neonatal ward). Participants included mothers of preterm newborns admitted to participating units. Data analysis was performed from January to April 2021.

EXPOSURES

FICare model in single family rooms with complete couplet-care for the mother-newborn dyad during maternity and/or neonatal care.

MAIN OUTCOMES AND MEASURES

Maternal mental health, measured using the Parental Stress Scale: NICU (PSS-NICU). Secondary outcomes included survey scores on the Hospital Anxiety and Depression Scale, Postpartum Bonding Questionnaire, Perceived Maternal Parenting Self-efficacy Scale, and satisfaction with care (using EMPATHIC-N). Parent participation (using the CO-PARTNER tool) was assessed as a potential mediator of the association of the FICare model on outcomes with mediation analyses.

RESULTS

A total of 296 mothers were included; 124 of 141 mothers (87.9%) in the FICare model and 115 of 155 (74.2%) mothers in SNC responded to questionnaires (mean [SD] age: FICare, 33.3 [4.0] years; SNC, 33.3 [4.1] years). Mothers in the FICare model had lower total PSS-NICU stress scores at discharge (adjusted mean difference, -12.24; 95% CI, -18.44 to -6.04) than mothers in SNC, and specifically had lower scores for mother-newborn separation (adjusted mean difference, -1.273; 95% CI, -1.835 to -0.712). Mothers in the FICare model were present more (>8 hours per day: 105 of 125 [84.0%] mothers vs 42 of 115 [36.5%]; adjusted odds ratio, 19.35; 95% CI, 8.13 to 46.08) and participated more in neonatal care (mean [SD] score: 46.7 [6.9] vs 40.8 [6.7]; adjusted mean difference, 5.618; 95% CI, 3.705 to 7.532). Active parent participation was a significant mediator of the association between the FICare model and less maternal depression and anxiety (adjusted indirect effect, -0.133; 95% CI, -0.226 to -0.055), higher maternal self-efficacy (adjusted indirect effect, 1.855; 95% CI, 0.693 to 3.348), and better mother-newborn bonding (adjusted indirect effect, -0.169; 95% CI, -0.292 to -0.068).

CONCLUSIONS AND RELEVANCE

The FICare model in our study was associated with less maternal stress at discharge; mothers were more present and participated more in the care for their newborn than in SNC, which was associated with improved maternal mental health outcomes. Future intervention strategies should aim at reducing mother-newborn separation and intensifying active parent participation in neonatal care.

TRIAL REGISTRATION

Netherlands Trial Register identifier NL6175.

Variation in United States COVID-19 newborn care practices: results of an online physician survey

Background

Newborn care practices that best promote the health and well-being of mother-infant dyads after birth while minimizing transmission of COVID-19 were uncertain at the onset of the COVID-19 pandemic.

Objective

Examine variation in COVID-19 newborn care practices among U.S. birth hospitals and by hospital characteristics (U.S. census region, highest level of neonatal level of care, and Baby-Friendly hospital status).

Study Design

We surveyed physicians via American Academy of Pediatrics email listservs and social media between 5/26/2020-6/8/2020. Physicians identified the birth hospital in which they provided newborn care and their hospital’s approach to obstetrical and newborn care related to COVID-19. Chi-square tests were used to examine variation in hospital practices by U.S. census region, highest level of neonatal care, and Baby-Friendly hospital status.

Results

Four hundred thirty three physicians responded from 318 hospitals across 46 states. Variation in care of SARS-CoV-2 positive mother-infant dyads was greatest for approaches to location of newborn care (31% separation, 17% rooming-in, and 51% based on shared-decision making), early skin-to-skin care (48% prohibited/discouraged, 11% encouraged, and 40% based on shared-decision making) and direct breastfeeding (37% prohibited/discouraged, 15% encouraged, and 48% based on shared-decision making). Among presumed uninfected dyads, 59% of hospitals discharged at least some mother-infant dyads early. We found variation in practices by U.S. census region.

Conclusion

Approaches to newborn care and breastfeeding support for mother-infant dyads with positive SARS-CoV-2 testing differed across U.S. birth hospitals during the COVID-19 pandemic. Early discharge of presumed uninfected mother-infant dyads was common.

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

Multiple changes and stressors at the family, hospital, and societal levels have resulted from the COVID‐19 pandemic that impact the early social environment of infants in Neonatal Intensive Care Unit (NICU) settings. This manuscript reviews these pandemic‐related adversities, including hospital‐wide visitor restrictions, mask requirements that interfere with caregiver facial expressions, parental anxiety about virus transmission, and reduced support services. We will further describe adaptations to mental health service delivery and approaches to care in the NICU to mitigate increased risk associated with pandemic‐related adversities. Adaptations include integration of technology, staff education and support, and delivery of activity kits to encourage parent–infant bonding. Data was collected as part of routine program evaluation of infant mental health services from one 50‐bed NICU setting and describes family concerns, barriers to visitation, and utilization of mental health services during the pandemic. Concerns related to COVID‐19 rarely emerged as the primary presenting issue by the families referred for infant mental health services from April through December of 2020. However, a number of families indicated that infection concerns and visitation restrictions posed significant challenges to their parenting and/or coping. There were significant discrepancies noted between the visitation patterns of families with public and private insurance. Several adaptations were developed in response to the multiple challenges and threats to infant mental health present during the COVID‐19 pandemic.

Neonates and COVID-19: state of the art : Neonatal Sepsis series

The SARS-CoV-2 pandemic has had a significant impact worldwide, particularly in middle- and low-income countries. While this impact has been well-recognized in certain age groups, the effects, both direct and indirect, on the neonatal population remain largely unknown. There are placental changes associated, though the contributions to maternal and fetal illness have not been fully determined. The rate of premature delivery has increased and SARS-CoV-2 infection is proportionately higher in premature neonates, which appears to be related to premature delivery for maternal reasons rather than an increase in spontaneous preterm labor. There is much room for expansion, including long-term data on outcomes for affected babies. Though uncommon, there has been evidence of adverse events in neonates, including Multisystem Inflammatory Syndrome in Children, associated with COVID-19 (MIS-C). There are recommendations for reduction of viral transmission to neonates, though more research is required to determine the role of passive immunization of the fetus via maternal vaccination. There is now considerable evidence suggesting that the severe visitation restrictions implemented early in the pandemic have negatively impacted the care of the neonate and the experiences of both parents and healthcare professionals alike. Ongoing collaboration is required to determine the full impact, and guidelines for future management. IMPACT: Comprehensive review of current available evidence related to impact of the COVID-19 pandemic on neonates, effects on their health, impact on their quality of care and indirect influences on their clinical course, including comparisons with other age groups. Reference to current evidence for maternal experience of infection and how it impacts the fetus and then neonate. Outline of the need for ongoing research, including specific areas in which there are significant gaps in knowledge.

Provision of mother's own milk for preterm infants during the COVID-19 pandemic: Differential effect of insurance

Mother-infant dyads faced many challenges during the COVID-19 pandemic; however, the impact was different depending on socio-economic determinants. This study aims to investigate the impact of the COVID-19 pandemic on maternal provision of mother's own milk (MOM) at neonatal intensive care unit (NICU) discharge among preterm infants. We hypothesized that fewer infants would be discharged home on any MOM during the pandemic period compared to a pre-pandemic period. This is a retrospective analysis of infants born <34 weeks' gestation admitted to the Women and Infant's Hospital NICU. Infants born pre-pandemic (1/1/2019 to 2/29/2020) were compared to infants born during the pandemic (3/1/2020 to 4/30/2021). Maternal and neonatal variables were analyzed by group. The primary outcome was provision of MOM (defined as feeding exclusively MOM, or a combination of MOM and formula) at NICU discharge. Analyses were performed for time periods, and multivariable regression analyses were run for the total cohort and by insurance type. Analysis included 268 infants born pre-pandemic and 262 infants born during the pandemic. Pandemic group mothers vs. pre-pandemic were less likely to be single (27%, 63/233 vs. 38%, 93/243; p = 0.01) and more likely to have a diagnosis of chorioamnionitis (16%, 38/236 vs. 7%, 17/243; p = 0.002). Rates of public insurance were similar (55% pre-pandemic and 50% pandemic). There was no significant change in provision of MOM between time periods. In multivariable analysis, public insurance decreased the odds of MOM at discharge for the entire study period (aOR 0.31, 95% CI: 0.19-0.50; p = 0.0001). On analysis by insurance type, rates of MOM increased from 77% pre-pandemic to 88% during the pandemic (p = 0.03) for mothers with private insurance and remained unchanged for mothers with public insurance (52% pre-pandemic and 53% pandemic; p = 0.86). Mothers with private insurance had twice the odds (aOR 2.02, 95% CI: 1.02-3.97; p = 0.04) of providing MOM during the pandemic vs. pre-pandemic. For those with public insurance, the odds for any MOM provision during the pandemic were unchanged (aOR 0.95, 95% CI: 0.5-1.7; p = 0.86). These differences may be related to health care disparities requiring additional exploration of risk factors and the need for equitable opportunities for all mother-infant dyads.

The Implications of COVID-19 on Family-Centered Care in the NICU

During the recent COVID-19 pandemic, neonatal intensive care units (NICUs) issued strict visiting policies that limited parent visitation and impacted how family-centered care was practiced. This article describes how these visiting policies impacted parents and neonates. Implications for clinical practice and future research will also be discussed.

Parents' pandemic NICU experience in the United States: a qualitative study

Background

Prior to the COVID-19 pandemic, parents of infants in the Neonatal Intensive Care Unit (NICU) frequently reported high levels of stress, uncertainty, and decreased parenting confidence. Early research has demonstrated that parents have had less access to their infants in the hospital due to restrictions on parental presence secondary to the pandemic. It is unknown how parents have perceived their experiences in the NICU since the beginning of the COVID-19 pandemic. The purpose of this study was to describe the lived experience of parents who had an infant in the NICU in the context of the COVID-19 pandemic to inform healthcare providers and policy makers for future development of policies and care planning.

Methods

The study design was a qualitative description of the impact of the COVID-19 pandemic on parents’ experiences of having an infant in the NICU. Free-text responses to open-ended questions were collected as part of a multi-method study of parents’ experiences of the NICU during the first six months of the pandemic. Participants from the United States were recruited using social media platforms between the months of May and July of 2020. Data were analyzed using a reflexive thematic approach.

Findings

Free-text responses came from 169 parents from 38 different states in the United States. Three broad themes emerged from the analysis: (1) parents’ NICU experiences during the COVID-19 pandemic were emotionally isolating and overwhelming, (2) policy changes restricting parental presence created disruptions to the family unit and limited family-centered care, and (3) interactions with NICU providers intensified or alleviated emotional distress felt by parents. A unifying theme of experiences of emotional distress attributed to COVID-19 circumstances ran through all three themes.

Conclusions

Parents of infants in the NICU during the first six months of the COVID-19 pandemic experienced emotional struggles, feelings of isolation, lack of family-centered care, and deep disappointment with system-level decisions. Moving forward, parents need to be considered essential partners in the development of policies concerning care of and access to their infants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-03028-w.

Starting parenting in isolation a qualitative user-initiated study of parents' experiences with hospitalization in Neonatal Intensive Care units during the COVID-19 pandemic

BACKGROUND

Worldwide, strict infection control measures including visitation regulations were implemented due to the COVID-19 pandemic at Neonatal Intensive Care Units (NICUs). These regulations gave restricted access for parents to their hospitalized infants. The consequence was limited ability to involve in the care of their infants. At Oslo University Hospital entry to NICU was denied to all except healthy mothers in March 2020. The absolute access ban for fathers lasted for 10 weeks. The aim of this study was to explore parental experiences with an infant hospitalized in the NICU during this absolute visitation ban period.

METHODS

We invited post discharge all parents of surviving infants that had been hospitalized for at least 14 days to participate. They were interviewed during autumn 2020 using an explorative semi-structured interview approach. Data were analyzed via inductive thematic analysis.

RESULTS

Nine mothers and four fathers participated. The COVID-19 regulations strongly impacted the parent's experiences of their stay. The fathers' limited access felt life-impacting. Parents struggled to become a family and raised their voices to be heard. Not being able to experience parenthood together led to emotional loneliness. The fathers struggled to learn how to care for their infant. The regulations might lead to a postponed attachment. On the other hand, of positive aspect the parents got some quietness. Being hospitalized during this first wave was experienced as exceptional and made parents seeking alliances by other parents. Social media was used to keep in contact with the outside world.

CONCLUSIONS

The regulations had strong negative impact on parental experiences during the NICU hospitalization. The restriction to fathers' access to the NICU acted as a significant obstacle to early infant-father bonding and led to loneliness and isolation by the mothers. Thus, these COVID-19 measures might have had adverse consequences for families.

Fears, Reassurance, and Milestones: A Twitter Analysis around World Prematurity Day during the COVID-19 Pandemic

Preterm birth (birth <37 completed weeks’ gestation) is common, affecting 10.6% of live births globally (nearly 15 million babies per year). Having a new baby admitted to a neonatal unit often triggers stress and anxiety for parents. This paper seeks to explore experiences of preterm birth via Twitter. The intermingling of COVID-19 restrictions and World Prematurity Day allows for an understanding of both the additional stresses incurred as a consequence of the pandemic and the more “everyday” experiences in the NICU and beyond. The content analysis of the data included 3161 tweets. Three themes were identified: 1. COVID-19 was not the only trauma; 2. Raising awareness, especially World Prematurity Day; and, 3. Baby milestones. These themes highlight the multi-level challenges faced by parents of premature babies and the healthcare professionals involved in their care. The COVID-19 pandemic and the consequent restrictions imposed on parents’ contact with their babies have resulted in immense emotional strain for families. The reported COVID-19 pandemic “baby blind spot” appears to particularly impact this group of babies. Improved understanding of the lived experiences of preterm babies and their families should inform greater awareness and improved support.

Maternal Stress, Depression, and Attachment in the Neonatal Intensive Care Unit Before and During the COVID Pandemic: An Exploratory Study

The main aim of the present study was to investigate the effects of the COVID-19 pandemic on the mothers' postnatal depression, stress, and attachment during their stay in the Neonatal Intensive Care Unit (NICU). Twenty mothers of very premature infants born before 32weeks of gestational age were recruited at the Geneva University Hospital between January 2018 and February 2020 before the COVID-19 pandemic started. Mothers were screened for postnatal depression after their preterm infant's birth (Edinburgh Postnatal Depression Scale, EPDS), then for stress (Parental Stressor Scale: Neonatal Intensive Care Unit, PSS:NICU), and attachment (Maternal Postnatal Attachment Scale, MPAS) at infant's term-equivalent age. Data were compared with 14 mothers recruited between November 2020 and June 2021 during the COVID-19 pandemic. No significant differences were found in the scores for depression, stress, and attachment between the two groups. However, a non-statistically significant trend showed a general increase of depression symptoms in mothers during the COVID-19 pandemic, which significantly correlated to the attachment and stress scores. Moreover, the PSS:NICU Sights and Sounds score was significantly positively correlated with EPDS scores and negatively with the MPAS score only in the During-COVID group. To conclude, we discussed a possible dampened effect of the several protective family-based actions that have been adopted in the Geneva University Hospital during the health crisis, and we discussed the most appropriate interventions to support parents in this traumatic period during the COVID-19 pandemic.