Hospitals leaned toward strict COVID-19 NICU policies despite low prevalence of infection

Two studies examining the impact of COVID-19 on neonatal intensive care units (NICUs) found the prevalence of COVID-19 in NICU infants is low, yet many hospitals at the start of the pandemic put in place strict parental visitation policies and scaled back NICU services such as lactation support and therapy.

In “Longitudinal Survey of SARS-CoV-2 Burden and Related Policies in US Neonatal Intensive Care Units,” published in the American Journal of Perinatology, researchers, including Ashley Darcy-Mahoney, associate professor of nursing at the George Washington University and Pediatrix-affiliated neonatal nurse practitioner, conducted a series of cross-sectional surveys of U.S. NICUs between early March 2020 and late May 2020 during the first wave of the COVID-19 outbreak, and more recently between mid July 2020 and early August 2020. They found:

• Confirmed COVID-19 disease in NICU-admitted infants was rare, with the prevalence rising from 0.03% to 0.44% across the four survey rounds.
• During early rounds of the survey, hospitals provided universal screenings of expectant mothers, with a preponderance to separate mother and baby for 14 days if the mother tested positive for COVID-19, and a majority of hospitals allowing infants only expressed breastmilk. Data from the final survey round, however, suggests NICUs are using the latest evidence and following American Academy of Pediatrics and Center for Disease Control guidelines to inform these policies with rapid cycle changes.
• At the beginning of the pandemic, most NICUs enacted policies that leaned toward substantial caution, limiting interactions between parents and their infants at a time when close contact is critical for neonate care.

The new study aligns closely with a study published at the end of August by Darcy-Mahoney and her co-authors in the Journal of Perinatology. In “Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019,” the researchers surveyed 277 facilities globally in April 2020. They found:

• NICU policies allowing 24/7 parental presence decreased (from 83% before COVID-19 to 53% during COVID-19). The researchers also saw a decrease in NICUs allowing full parental participation in rounds (71-32%).
• Of the 277 NICUs surveyed, 120 (43%) reported reductions in therapy services, lactation medicine, and/or social work support.
• NICUs with single-family room designs best preserved 24/7 parental presence after the emergence of COVID-19 (64% of NICUs surveyed) when compared to a hybrid design (57%) or open bay design (45%).

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FROM THE RESEARCHER

“Ultimately, as health care systems attempt to prevent the spread of coronavirus, new policies have led to families interacting very differently with their infants in the NICU–or not at all. These rapidly instituted changes may carry with them the risk of secondary unintended consequences”
– Ashley Darcy-Mahoney, associate professor of nursing at the George Washington and Pediatrix-affiliated neonatal nurse practitioner

OTHER INFORMATION

To schedule an interview with Darcy-Mahoney, please contact Timothy Pierce at [email protected]