As COVID-19 cases continue to rise, Neonatal Intensive Care Units, better known as NICUs, are grappling with difficult questions about how to keep the tiniest humans safe. While policies differ from one hospital to the next, some NICUs are jumping to ban any visitors from entering, including moms and dads.
The desire to take the most extreme precautions to protect vulnerable little ones is understandable and well-intentioned. Many are born with premature lungs and develop respiratory distress syndrome (RDS), a common breathing disorder, making the prospect of coronavirus particularly scary. But blanket policies separating infants from their parents come at their own health costs, and should be used as a last resort.
NICU Parents Aren’t the Same
COVID-19 requires Americans to make all sorts of worst-case-scenario sacrifices. Doctors, nurses, and other hospital staff are risking being exposed. Non-emergent, but still important, surgeries are being cancelled or postponed. Loved ones are getting sick in hospitals and dying alone.
The shortage of personal protective equipment, coupled with the contagious nature of the disease, has made many of these policies medically necessary. However, parents visiting their babies in the NICUs aren’t like everyone else—especially not NICU moms.
Premature babies require what’s called kangaroo care, or skin-to-skin contact on a parent’s chest. Kangaroo care has been proven to have incredible medical benefits for premature babies, including reducing death and illness. It also has important health benefits for moms. The benefits of kangaroo care to the baby include:
- Stabilizating the baby’s heart rate
- Improved (more regular) breathing pattern
- Improved oxygen saturation levels (an indicator of how well oxygen is being delivered to all the infant’s organs and tissues)
- Gain in sleep time
- More rapid weight gain
- Decreased crying
- More successful breastfeeding episodes
- Earlier hospital discharge
The benefits of kangaroo care to the parents include:
- Improved bonding, feelings of closeness with their babies
- Increased breast milk supply
- Increased confidence in ability to care for their babies
- Increased confidence that their babies are well cared for
- Increased sense of control
The health benefits are so great, kangaroo care is recommended for infants regardless of geographic location or economic status. It’s a treatment no amount of money or resources can buy. Taking that away from parents and babies is akin to depriving patients of important medicine that can help them survive and thrive.
Take More Reasonable Precautions
There are reasonable ways to balance protections for NICU infants and employees from COVID-19 with parents’ ability to visit. A NICU nurse of 15 years in a large Level IV Texas NICU described the steps her unit is taking. (She asked to remain anonymous to protect her job.)
“What we are already doing: taking temperatures of parents and asking screening questions when they are entering the NICU,” she said, adding: “If they have a low-grade fever, or have even one symptom, or have had contact with a COVID + person, then they don’t come in. Cleaning their phones and washing their hands well before entering. We’ve closed the family room where parents can sit and eat so we are maintaining social distancing in the unit. We’re strictly social distancing with staff also. Less nurses in the break room. Stopped morning huddles. No education classes or meetings for parents or nurses right now.”
Hospital workers have just as much chance of being unknowingly positive without any symptoms as a baby’s mother or father. After all, NICU staff still have to go to the grocery store, the pharmacy, and get gas. To assume new parents of two-, three-, and four-pound babies wouldn’t take the same precautions, if not more, is wrong. Parents and caretakers of premature babies have an extremely strong motivation to stay healthy.
If availability of personal protective equipment is a problem, NICU parents can bring their own. As rapid COVID-19 tests develop, you’d be hard-pressed to find any American unwilling to place NICU parents towards the front of the line.
As the Texas NICU nurse explained, “Parents have to be at the bedside working with the speech therapists and nurses learning how to successfully feed their baby before discharge. This can’t be done over a video call. Parents sometimes actually need a lot of education and hands-on training in the NICU before taking their baby home.”
No One Envies This Decision
Instead of responding with fear and establishing authoritarian policies that risk lifelong mental and physical health for babies and parents, hospitals should take measured approaches that reflect the situation on the ground.
In hospitals in major outbreak areas such as New York City, limiting visitors to one parent is hard, but reasonable. Medical workers could direct high-risk deliveries to COVID-free facilities, when possible, and keep NICUs protected that way. If necessary and possible to do safely, some preemies could be transferred to neighboring states where hospitals aren’t so overwhelmed.
If personal protective equipment continues to be a problem, NICUs could allow parents to sleep overnight next to their babies on a cot, thereby limiting their exposure to the outside. NICUs don’t typically allow parents to eat or sleep there, but in a crisis, we must remove the red tape and get creative.
No matter how the COVID-19 pandemic plays out, it’s important to remember that NICU doctors and nurses are a different kind. If parents have to be banned, NICU doctors and nurses are angels among us, who would go above and beyond to provide love and care.
No one envies those tasked with making decisions about who’s allowed to do what during a crisis. And now is not the time to doubt or lose faith in our medical providers, who are sacrificing their own health to keep us safe.
But as a NICU parent myself, I would rather starve and sleep on a hospital floor than go weeks or months without seeing my baby girl, and provide her with life-saving care that is unique to being a mom. Yes, the risk of catching COVID-19 is a serious concern, but so are the risks of leaving the tiniest among us alone.