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We would like to congratulate Suman PN Rao et al on this very important and useful work.
On behalf of the Global Newborn Society would strongly advocate unrestricted access of parents to their infants and to skin to skin care.
Current SARS-CoV-2 pandemic-related restrictions on skin-to-skin contact (SSC) and parental involvement in neonatal care, in place in many parts of the world, are not based on clinical evidence. Hospitals and neonatal units have, to varying degrees, restricted parental access and SSC without due consideration of the harms this might cause on multiple fronts (1). Based on current evidence a ‘blanket ban’ on SSC by various maternity and neonatal services across the globe is unfortunate, not evidence based and needs to be reviewed on an urgent basis.
The World Health Organization (WHO) recommends skin-to-skin contact (SSC) following delivery in babies weighing 2000 grams or less at birth, as soon as they are clinically stable to prevent hypothermia (2). In low resource settings lack of initiation of early SSC is an independent predictor of hypothermia, contributing to neonatal mortality and morbidity (3). The United Nations Children’s Fund Baby Friendly Hospital Initiative recommends immediate SSC after birth based on physiological, social, and psychological benefits for both mother and baby (4).
The risk of SARS-CoV-2 infection in neonates both vertical and horizontal is relatively low with no significant mortality (5), how...
The risk of SARS-CoV-2 infection in neonates both vertical and horizontal is relatively low with no significant mortality (5), however lack of SSC and parental involvement will lead to increased mortality and additional adverse long term outcomes (6). Systematic reviews and guidelines have already provided guidance on the treatment and management of COVID-19 positive mothers and their infants (7, 8).
All these restrictions, largely knee jerk reactions to the pandemic, will only serve to negate a lot of the hard work invested in best practice guidance and standards outlined for both low and high income countries (9, 10,11).
Recently, in response to suboptimal practice during the pandemic, both professional and parent organizations have joined the call to re-establish parents as essential partners in care, and not to be considered as visitors, which they most definitely aren’t. (12, 13).
We recommend that neonatal organizations, hospitals and health services all across the world urgently advocate on this important issue and ensure that we encourage unrestricted SSC and zero separation of infants and parents, to prevent significant long term collateral damage.
1. Rao SPN, et al. Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers' voices and experiences. BMJ Glob Health. 2021 Mar;6(3):e004347. doi: 10.1136/bmjgh-2020-004347.2.
2. World Health Organization. (2015). WHO recommendations on interventions to improve preterm birth outcomes.
3. Moore ER, Bergman N, Anderson GC,et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016 Nov 25;11:CD0035193.
4. Brimdyr K, Cadwell K, Steevens J, Takahashi Y. An implementation algorithm to improve skin-to-skin practice in the first hour after birth. Matern Child Nutr. 2018;14(2):e12571.
5. Mullins E, Hudak ML, Banerjee J, et al. Pregnancy and neonatal outcomes of COVID-19: co-reporting of common outcomes from PAN-COVID and AAP SONPM registries. Ultrasound Obstet Gynecol. 2021 Feb 23. doi: 10.1002/uog.23619.
6. Bergman NJ. Birth practices: Maternal-neonate separation as a source of toxic stress. Birth Defects Res 2019; 111:1087–109.
7. RCPCH/BAPM Paediatric COVID-19 guidance. Available online: https://www.rcpch.ac.uk/resources/covid-19-guidance-paediatric-services
8. American Academy of Paediatrics: COVID-19 guidance. Available online: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infect...
9. EFCNI. European Standards of Care for Newborn Health. 2018.
10. WHO (World Health Organization). Survive & thrive: Transforming care for every small and sick newborn. 2019.
11. Global Alliance for Newborn Care - GLANCE [Internet]. [cited 2020 Jul 8]. Available online: https://www.glance-network.org/
12. British Association of Perinatal Medicine: Family Integrated Care for COVID-19. Available online: https://hubble-live-assets.s3.amazonaws.com/bapm/redactor2_assets/files/...
13. Bliss. Bliss Statement: COVID-19 and parental involvement on neonatal units. Available online: https://www.bliss.org.uk/health-professionals/information-and-resources/...