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

G Dowse^{1

2}, E J Perkins¹, H M Stein³, G Chidini⁴, O Danhaive^{5

6}, Y N Elsayed⁷, W B Carvalho⁸, N AlNaqeeb⁹, S Rooze¹⁰, M Cetinkaya¹¹, S Vetter-Laracy¹², F J Pilar-Orive¹³, P Torpiano¹⁴, W A Gonçalves Ferri¹⁵, D Buonsenso¹⁶, B Rogdo¹⁷, A Medina¹⁸, A Polito¹⁹, C N M Brouwer²⁰, M C J Kneyber^{21

22}, D De Luca^{23

24}, D G Tingay^{1

2}; ESPNIC COVID-19 Paediatric and Neonatal (EPICENTRE) Registry

Collaborators, Affiliations

Collaborators

ESPNIC COVID-19 Paediatric and Neonatal (EPICENTRE) Registry:
G Dowse, E J Perkins, D G Tingay, D De Luca, H M Stein, W B Carvalho, O Danhaive, Y Elsayed, G Chidini, M C J Kneyber, A MedinaVillanueva, A Polito, J Shoemaker, O Danhaive, B Piersigilli, O Bekkouch, S Rooze, W A Gonçalves Ferri, A A Oliveira, R Morello, V Krebs, D Buonsenso, R Morello, P Valentini, N Al-Naqeeb, S M H Sabbour, A E A Hegazi, P Torpiano, P Sammut, D Pace, S Vetter-Laracy, M Roldán, F J Pilar-Orive, B Rogdo, M Cetinkaya, B Yasa, E Letamendia-Richard, G Regiroli, A Vivanti, R Centorrino, N F Oliveira, M H M Dittrich, R Felgueira, C Neves, P Tissieres, A Amigoni, M Daverio, A Tosoni, M C Andre, B Wagner, T Riedel, P Rimensberger, A-S Ramelet, M-H Perez, M Marston, V Chanez, D Longchamp, J Natterer, T Ferry, B Brotschi

Affiliations

¹ Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia.
² Department of Paediatrics, University of Melbourne, Melbourne, Australia.
³ Department of Pediatrics, Division of Neonatology, Promedica Ebied Children's Hospital, Toledo, OH, USA.
⁴ Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁵ Division of Neonatology (Pediatrics), Catholic University of Louvain, Brussels, Belgium.
⁶ Division of Neonatology (Pediatrics), University of California San Francisco, California, USA.
⁷ Pediatrics, University of Manitoba, Winnipeg, Canada.
⁸ Pediatric Intensive Care/Neonatology of the Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
⁹ Neonatal Department, AL-Adan Hospital, Ahmadi Area, Kuwait.
¹⁰ Unités de Soins Intensifs, Hôpital Universitaire des Enfants Reine Fabiola, Laeken, Belgium.
¹¹ Health Sciences University, Department of Neonatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
¹² Division of Neonatology (Pediatrics), University Hospital Son Espases / Balearic Island Health Research Institute IdISBa, Palma, Spain.
¹³ Pediatrics Department, PICU, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.
¹⁴ Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Msida, Malta.
¹⁵ Department of Pediatrics, Ribeirão Preto Medical School - University of São Paulo, São Paulo State, Ribeirão Preto, Brazil.
¹⁶ Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
¹⁷ NICU/PICU, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland.
¹⁸ Pediatric Intensive Care Unit, University Hospital Central de Asturias, Oviedo, Spain.
¹⁹ Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Geneva, Switzerland.
²⁰ Pediatric Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands.
²¹ Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, Groningen, the Netherlands.
²² Critical Care, Anesthesiology, Peri-operative & Emergency Medicine (CAPE), University Medical Center Groningen, the Netherlands.
²³ Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France.
²⁴ Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.

PMID: 36846297
PMCID: PMC9941883
DOI: 10.1016/j.eclinm.2022.101822

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

G Dowse et al. EClinicalMedicine. 2023 Feb.

. 2023 Feb:56:101822.

doi: 10.1016/j.eclinm.2022.101822. Epub 2023 Feb 21.

Authors

Collaborators

ESPNIC COVID-19 Paediatric and Neonatal (EPICENTRE) Registry:
G Dowse, E J Perkins, D G Tingay, D De Luca, H M Stein, W B Carvalho, O Danhaive, Y Elsayed, G Chidini, M C J Kneyber, A MedinaVillanueva, A Polito, J Shoemaker, O Danhaive, B Piersigilli, O Bekkouch, S Rooze, W A Gonçalves Ferri, A A Oliveira, R Morello, V Krebs, D Buonsenso, R Morello, P Valentini, N Al-Naqeeb, S M H Sabbour, A E A Hegazi, P Torpiano, P Sammut, D Pace, S Vetter-Laracy, M Roldán, F J Pilar-Orive, B Rogdo, M Cetinkaya, B Yasa, E Letamendia-Richard, G Regiroli, A Vivanti, R Centorrino, N F Oliveira, M H M Dittrich, R Felgueira, C Neves, P Tissieres, A Amigoni, M Daverio, A Tosoni, M C Andre, B Wagner, T Riedel, P Rimensberger, A-S Ramelet, M-H Perez, M Marston, V Chanez, D Longchamp, J Natterer, T Ferry, B Brotschi

Affiliations

¹ Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia.
² Department of Paediatrics, University of Melbourne, Melbourne, Australia.
³ Department of Pediatrics, Division of Neonatology, Promedica Ebied Children's Hospital, Toledo, OH, USA.
⁴ Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁵ Division of Neonatology (Pediatrics), Catholic University of Louvain, Brussels, Belgium.
⁶ Division of Neonatology (Pediatrics), University of California San Francisco, California, USA.
⁷ Pediatrics, University of Manitoba, Winnipeg, Canada.
⁸ Pediatric Intensive Care/Neonatology of the Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
⁹ Neonatal Department, AL-Adan Hospital, Ahmadi Area, Kuwait.
¹⁰ Unités de Soins Intensifs, Hôpital Universitaire des Enfants Reine Fabiola, Laeken, Belgium.
¹¹ Health Sciences University, Department of Neonatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
¹² Division of Neonatology (Pediatrics), University Hospital Son Espases / Balearic Island Health Research Institute IdISBa, Palma, Spain.
¹³ Pediatrics Department, PICU, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.
¹⁴ Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Msida, Malta.
¹⁵ Department of Pediatrics, Ribeirão Preto Medical School - University of São Paulo, São Paulo State, Ribeirão Preto, Brazil.
¹⁶ Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
¹⁷ NICU/PICU, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland.
¹⁸ Pediatric Intensive Care Unit, University Hospital Central de Asturias, Oviedo, Spain.
¹⁹ Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Geneva, Switzerland.
²⁰ Pediatric Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands.
²¹ Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, Groningen, the Netherlands.
²² Critical Care, Anesthesiology, Peri-operative & Emergency Medicine (CAPE), University Medical Center Groningen, the Netherlands.
²³ Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France.
²⁴ Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.

PMID: 36846297
PMCID: PMC9941883
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.

PubMed Disclaimer

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).

See this image and copyright information in PMC

References

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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous