Kuwait Medical Electronic Library

Born into an isolating world: family-centred care for babies born to mothers with COVID-19

G Dowse 1 2, E J Perkins 1, H M Stein 3, G Chidini 4, O Danhaive 5 6, Y N Elsayed 7, W B Carvalho 8, N AlNaqeeb 9, S Rooze 10, M Cetinkaya 11, S Vetter-Laracy 12, F J Pilar-Orive 13, P Torpiano 14, W A Gonçalves Ferri 15, D Buonsenso 16, B Rogdo 17, A Medina 18, A Polito 19, C N M Brouwer 20, M C J Kneyber 21 22, D De Luca 23 24, D G Tingay 1 2; ESPNIC COVID-19 Paediatric and Neonatal (EPICENTRE) Registry

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Affiliations

Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia.
2Department of Paediatrics, University of Melbourne, Melbourne, Australia.
3Department of Pediatrics, Division of Neonatology, Promedica Ebied Children's Hospital, Toledo, OH, USA.
4Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
5Division of Neonatology (Pediatrics), Catholic University of Louvain, Brussels, Belgium.
6Division of Neonatology (Pediatrics), University of California San Francisco, California, USA.
7Pediatrics, University of Manitoba, Winnipeg, Canada.
8Pediatric Intensive Care/Neonatology of the Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
9Neonatal Department, AL-Adan Hospital, Ahmadi Area, Kuwait.
10Unités de Soins Intensifs, Hôpital Universitaire des Enfants Reine Fabiola, Laeken, Belgium.
11Health Sciences University, Department of Neonatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
12Division of Neonatology (Pediatrics), University Hospital Son Espases / Balearic Island Health Research Institute IdISBa, Palma, Spain.
13Pediatrics Department, PICU, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.
14Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Msida, Malta.
15Department of Pediatrics, Ribeirão Preto Medical School - University of São Paulo, São Paulo State, Ribeirão Preto, Brazil.
16Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
17NICU/PICU, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland.
18Pediatric Intensive Care Unit, University Hospital Central de Asturias, Oviedo, Spain.
19Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Geneva, Switzerland.
20Pediatric Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands.
21Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, Groningen, the Netherlands.
22Critical Care, Anesthesiology, Peri-operative & Emergency Medicine (CAPE), University Medical Center Groningen, the Netherlands.
23Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France.
24Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.

02 January 2023

doi: 10.1016/j.eclinm.2022.101822

Abstract

Background: The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic.

Methods: Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the 'EsPnIC Covid paEdiatric NeonaTal REgistry' (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines.

Findings: 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March-June 2020 to 74% in January-March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March-June 2020 and January-March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth.

Interpretation: This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed.

Funding: The National Health and Medical Research Council (Australia): Grant ID 2008212 (DGT), Royal Children's Hospital Foundation: Grant ID 2019-1155 (EJP), Victorian Government Operational Infrastructure Support Program.

Keywords: Breastfeeding; Breastmilk; COVID-19; Family-centred care; Mother-baby contact; Pandemic; Perinatal care; Rooming-in; SARS-CoV-2; Skin-to-skin care.

Conflict of interest statement

AM received an honorarium from Medtronic for one lecture in a symposium related to mechanical ventilation.

Figures

Fig. 1 Rooming Practices. 311 (46%) of neonates roomed-in with their mother and 369 (54%) were separated from mother during birth admission. Of those rooming-in, 292 mother-baby dyads were both asymptomatic (white bar) whilst the mother and/or neonate was symptomatic in 19 cases (dotted bar). Of the separated neonates, 319 were asymptomatic and isolated on the postnatal ward (light grey bar), in a cohort in the NICU or SCN (grey bar) or in a single room in the NICU or SCN (dark grey bar). 50 separated neonates were symptomatic in the NICU or SCN (black bar). Total neonates 680 (12 missing data).

Fig. 2 Bubble plot representing the percentage of all mother-baby dyads rooming-in by number of enrolled neonates for each northern hemisphere season. Number indicates the total number of neonates for each season, and the bubble visualises the overall magnitude of each season to total sample population (n = 692). Separation was only mandated at 3 sites, and only during the first phase of the COVID-19 pandemic (March–June 2020). A total of 35 infants (highlighted with italicised box on graph) were born in these 3 sites and all were separated. By July–September 2020, all three sites had changed practice to allow rooming-in. The number of infants born to sites in which rooming-in practice was unknown are detailed in Online Supplementary Table S5.

Fig. 3 Percentage of neonates who received maternal breastmilk from any method by northern hemisphere season. Number indicates the total number of neonates for each season, and the bubble is a representation of the overall magnitude of each season to total sample population (n = 692).

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KMEL References

https://pubmed.ncbi.nlm.nih.gov/

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Born into an isolating world: family-centred care for babies born to mothers with COVID-19

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Abstract

Conflict of interest statement

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