Risks of separating babies from their mothers during covid-19

 New study: separating babies from their mothers during the COVID-19 pandemic poses significant risks

Keeping mothers and babies together could save more than 125,000 lives, according to the WHO

A new study by the World Health Organization (WHO) and its partners shows that the COVID-19 pandemic severely compromises the quality of care for sick newborns and causes unnecessary suffering and death.

A study published in The Lancet EclinicalMedicine shows that close contact between babies and their parents after birth is vital, especially for low birth weight and premature babies. However, in many countries, babies are routinely separated from their mothers in confirmed or suspected cases of COVID-19, increasing the risk of death and irreversible complications.

This is particularly the case in poor countries, which have the highest incidence of premature births and infant mortality. According to the report, the risks increase when the "kangaroo mode," in which a parent, usually the mother, has close contact with the child, is abandoned.

If the kangaroo method were universally applied, up to 125,000 newborns could be saved. For premature and low birth weight babies, the kangaroo method (direct and prolonged skin contact with the parents and exclusive breastfeeding) is of particular importance. Kangaroo care has been shown to reduce infant mortality by at least 40%, hypothermia by more than 70%, and serious infections by 65%.

"The disruption of essential health services during the COVID-19 pandemic seriously compromised the quality of care for some of the most vulnerable children, including their right to the vital contact they need with their parents," said Anshu Banerjee, head of the Division of Maternal, Newborn, Child and Adolescent Health and Ageing at WHO. "Decades of progress in reducing infant mortality will be at risk if we do not act now to protect and improve the quality of care for mothers and newborns and expand coverage of life-saving interventions such as the mother-cow method."

WHO recommends that the baby be kept in the same room as the mother from birth, so that the mother can breastfeed and have skin-to-skin contact, even in cases where COVID-19 infection is suspected or confirmed, and that the mother be supported to take appropriate infection control measures.

"Much more needs to be done to ensure that health workers and policy makers around the world know that mothers and babies need to be together during these critical first days, especially in the case of low birth weight or premature babies," said Queen Dube, director of health at Malawi's Ministry of Health and one of the authors of the report. "The kangaroo method is one of the most effective and inexpensive ways to protect premature and low birth weight babies. Our analysis shows that the risks are much greater than the small chance of a child becoming seriously ill from COVID-19."

"The kangaroo method is one of the best ways to increase the survival rate of a premature or low birth weight baby, especially in low-income countries," he added.

Available evidence suggests that the limitations of the kangaroo method are already widespread. A systematic review of 20 clinical guidelines published in 17 countries during the COVID-19 pandemic found that a third recommended separation of mother and child if the mother had COVID-19 or showed evidence of it. In a global survey of thousands of newborn care providers, published in a related article in the British Medical Journal (BMJ) Global Health, two-thirds of care providers in 62 countries reported not allowing skin-to-skin breastfeeding by mothers with confirmed or suspected COVID-19, and nearly a quarter did not allow breastfeeding even by uninfected staff.

Studies have shown that newborns infected with COVID-19 often show no or mild symptoms and that the risk of neonatal death is low. According to the new study, the risk of COVID-19 infection in newborns would result in fewer than 2,000 deaths.

However, infection during pregnancy can increase the risk of preterm birth, making it even more important to care for premature babies and parents during a COVID-19 pandemic.

According to recent estimates, 15 million babies are born prematurely (before 37 weeks of gestation) each year and 21 million have low birth weight (less than 2.5 kg). These children face significant health risks - disability, developmental delays and infections - and complications of preterm birth are the leading cause of death in newborns and children under five.

About the Study

The authors contributed to the following article: Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths avoided by kangaroo mother care versus mortality due to SARS-CoV-2 infection in The Lancet Eclinical Medicine. The COVID-19 Small and Sick Newborn Care Collaborative Group is currently publishing a related study in the British Medical Journal entitled Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers' voices and experiences. BMJ GH. DOI:10.1136/bmjgh-2020-004347