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Impact of the COVID-19 pandemic on developmental care practices for infants born preterm
Melissa Scala1, Virginia A Marchman2, Edith Brignoni-Pérez3
1Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA.
Insights
The COVID-19 pandemic significantly reduced hospital visitation and developmental care for preterm infants in the neonatal intensive care unit (NICU). These essential practices, crucial for infant well-being, saw substantial decreases during the pandemic.
Area of Science:
- Neonatal care
- Public health
- Pediatric development
Background:
- The COVID-19 pandemic introduced unprecedented challenges to healthcare systems globally.
- Neonatal intensive care units (NICUs) rely on family-centered care models, including frequent visitation and developmental care practices.
- Developmental care is critical for optimizing neurodevelopmental outcomes in preterm infants.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on hospital visitation rates for preterm infants.
- To assess changes in the frequency and duration of developmental care practices provided to preterm infants during the pandemic.
- To compare developmental care delivered by families and clinical staff before and during the pandemic.
Main Methods:
- Retrospective analysis of electronic medical records from 129 preterm infants (<32 weeks gestational age) at a single NICU.
- Comparison of data from a COVID-19-affected period (March-November 2020) with an analogous period in 2019.
- Statistical comparison of family visitation rates and developmental care activities (frequency, duration, provider) between the two periods, adjusting for covariates.
Main Results:
- Infant family visitation rates were nearly halved during the pandemic period compared to 2019 (p=0.001).
- Preterm infants received developmental care less frequently (3.0 vs. 4.3 activities/day) and for shorter durations (77.5 vs. 130.0 minutes/day) in 2020 (p=0.001).
- Reductions in developmental care were observed for both family- and staff-delivered activities, with effects persisting and worsening throughout late 2020.
Conclusions:
- The COVID-19 pandemic adversely affected crucial family engagement and developmental care for preterm infants in the NICU.
- Interventions are needed to enhance family visitation and support developmental care practices, particularly during public health crises.
- Long-term monitoring of preterm infants and their families is essential to address potential lasting impacts of pandemic-related disruptions.
Objectives:
To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm.
Methods:
We analyzed electronic medical record data from 129 infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n = 67) and the analogous period in 2019 (n = 62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates.
Results:
Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 (p = 0.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p = 0.001), resulting in fewer minutes per day (77.5 vs. 130.0; p = 0.001). In 2020, developmental care activities were 5 min shorter, on average, than in 2019, p = 0.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies.
Conclusions:
The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.
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