Lucy Morgan

Lucy Morgan

The impact of COVID-19 on care for premature babies

17 November 2021

This World Prematurity Day, we must understand how the pandemic has affected maternal and neonatal care.

Approximately one in ten babies is born prematurely, that is, before 37 weeks of pregnancy. This equates to an estimated 15 million babies every year. World Prematurity Day takes place on 17 November to raise awareness about these premature births and the health effects they can have.

There are both short- and long-term health impacts for premature babies, many of whom will spend time in a neonatal intensive care unit. Complications associated with preterm birth are the number one cause of death in children under five years old worldwide. In 2015, an estimated 1 million premature babies died.

In addition to the health impacts for premature babies, their families may experience extensive mental, emotional and physical stress – both before and after the birth.

With appropriate healthcare, the challenges associated with premature birth can be overcome. But the COVID-19 pandemic has negatively impacted both maternal and neonatal care.

 

Maternal care

Sometimes premature births are planned, to protect the health of the baby or the person carrying them (for example, in cases of pre-eclampsia, a pregnancy-related condition characterised by high blood pressure). But most premature births are unplanned. Ultimately, healthier pregnancies have a lower risk of resulting in preterm births, so a large part of managing premature birth is trying to prevent it. This can be achieved with regular medical care throughout pregnancy and appropriate screening and monitoring.

Complications associated with preterm birth are the number one cause of death in children under five years old worldwide.

 

The COVID-19 pandemic has stretched medical services, disrupting maternity care across the world. Many consultations switched to virtual meetings, and the number of people who could attend appointments was limited. Studies, including ones in the UK and Uganda, indicate a decline in the number of appointments during pregnancy throughout compared with before the pandemic.

Although analysis of births from the first year of the pandemic indicated there was no increase in the number of premature births, it is widely accepted that limited or delayed medical care during pregnancy is associated with a higher risk of premature birth. The long-term impacts of disrupted maternity care services on premature birth rates have yet to be seen.

The social isolation experienced during the pandemic has also put parents at a higher risk of experiencing mental health conditions. With premature birth already associated with increased risk of postpartum depression (highlighted in multiple studies), it is important that adequate support is available for families of premature babies.

During the COVID-19 pandemic, restrictions meant that only one visitor was allowed at a time. Not only can this make it more difficult for parents to bond with their babies, but it can also impact their ability to make informed decisions about healthcare.

 

Neonatal care

Premature babies often require additional care, so they may be taken away from their parents shortly after birth to be looked after in a neonatal unit. In these circumstances, it can be difficult for parents to bond with their babies. In recognition of this, the theme of this year’s World Prematurity Day is ‘keeping parents and babies born too soon together’.

During the COVID-19 pandemic, restrictions meant that, in many hospitals, only one visitor was allowed at a time. With visitation time effectively cut in half, parents had limited time with their newborns, and families were not able to support each other on the wards. Not only can this make it more difficult for parents to bond with their babies, but it can also impact their ability to make informed decisions about healthcare.

Some forms of lifesaving neonatal care, such as kangaroo care, require skin-to-skin contact. While the requirement for hospital visitors to wear personal protective equipment (PPE) was an entirely appropriate public health measure to reduce the spread of COVID-19, policies around the use of PPE were often indiscriminate. Many parents were not able to touch or visit their babies without PPE, despite the recognised benefits of skin-to-skin contact.

The response to the COVID-19 pandemic had to be swift, and the road to recovery will likely be long. But as we make policy decisions going forward, we need to keep the newly born members of our society in mind – ensuring that guidelines account for the unique needs of premature babies and their families.

 

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.
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