Threats and opportunities to improve care for premature babies

Updated:11/17/2020 10: 23h

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Just two years ago the NeNe Foundation claimed the 12 aspects it considered essential to offer excellent care to premature newborns and their families during their hospitalization in the Neonatology Units. However, in March of this year, in a sudden and unexpected way, the Covid-19 pandemic has put the Neonatology Units in check, disturbing many of the aspects of care considered essential. The NeNe Foundation, today more than ever, in the World Prematurity Day, wants to make visible and vindicate the need to recover all the essential and essential pillars in the care of the premature babies.

Needs for optimal neurodevelopment of the premature newborn

The premature infant’s brain carries out a crucial part of its development and maturation outside the womb in the environment of the Neonatal Intensive Care Unit (NICU). These brain development and maturation processes can be adversely affected when the stimuli these vulnerable children receive are not adequate. At present, we have a solid understanding that individualized, neurodevelopmental, and family-focused care improves brain development and maturation, as well as psycho-emotional well-being of the premature newborn. Among the star care measures, the continued presence and role of parents in care, breastfeeding, and skin-to-skin contact stands out. All of them are interventions of high therapeutic value, low economic cost and enormous importance.

High impact of the pandemic on the care of the premature baby

During the months that we have been in the pandemic, we have appreciated that Covid-19 positive motherspregnant rarely pass the infection on to their children, both before and during fetal life, and after delivery. And horizontal transmission, even when babies are housed in the same room as their mothers and are directly breastfed, is very rare.

This good news has been clouded by the limitations established from the contingency plans. These did not take into account the unique and exceptional character that the star measures have to favor the neurodevelopment and global health of premature babies. Contingency plans have made it difficult to offer quality care to the premature newborn and his family on the grounds of protecting the health of all newborns admitted, their families and health professionals.

As in almost everything that is happening in our health system in this pandemic, neonatal units have suffered unevenly from the interruption of their open door policy and the integrative approach to the family, restricting entry to a single parent and with time limits. In other words, the parents returned to being visitors, which dragged us to the last century: adoption of homogeneous drastic norms without taking into account the needs of the family and the premature newborn individually, even when it was extremely serious. Interventions such as skin-to-skin care, breastfeeding, donor recruitment in milk banks, and early home discharge programs have been severely constrained during the first months of the pandemic. Although these last aspects have been normalized, it is essential to recover the whole set of measures and actions that characterize the care approach to family-centered care, which has widely proven to be beneficial for babies and parents.

From the NeNe Foundation we will not tire of remembering that the non-inclusion of parents during the long hospitalization of their premature babies, in addition to causing emotional stress and suffering in families, affects neurosensory and emotional development of the premature newborn. That is why we must seek new formulas and strategies that preserve the quality of care within the approach to care focused on development and the family.

Lessons learned and opportunities for improvement

We have also drawn positive lessons from this situation we are experiencing: it has pushed us into the virtual world in an accelerated way and we have discovered the potential value of social networks to improve the socio-emotional experience of families. We have learned that ongoing care, support and care for families, as well as education (parents’ school) and follow-up of premature infants after discharge, can be done, to a large extent, through telemedicine. For this, we need hospitals to have robust online platforms. Web cameras for live transmission of the baby’s status can make up for the lack of direct contact of a mother, of a father who cannot come to be with his daughter or son.

On the other hand, virtual or mixed meetings can be adequate for the discussion of patients between professionals and have the advantage of facilitating the incorporation of nurses, as well as allied specialists involved in the care of premature infants. All this with strict respect for confidentiality and communication security

One aspect that we at the NeNe Foundation believe is crucial and that must be established without delay is the systematic and periodic screening with diagnostic tests. (antigens and / or CRP) to parents of premature infants who will have a prolonged income. This would reduce the stress on families and caregivers and would facilitate the recovery of the family-centered care scenario.

The professionals who make up the NeNe Foundation consider it necessary to improve the training of professional teams in psychology and sociology and strengthen social services in order to face the sociological challenges of assisting premature newborns and their families in the context of the economic crisis and its consequences: homelessness, insecurity, food deficits in many families and poor access to medical care in some minority groups.

On the other hand, we consider it necessary to have objective data on the impact of this pandemic on the care of premature newborns, as well as the results of the strategies established to overcome the difficulties.

This will shed light on the changes that have occurred and on what aspects need to be reinforced and what strategies can be effective to maintain the quality of care for the preterm newborn in a long-anticipated pandemic.

Alfredo García-Alix, neonatologist and president of the NeNe Foundation.

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