Impact of Lockdown and Visiting Restrictions For COVID-19 on Breast Milk and Short-Term Morbidities in a Tertiary Neonatal Intensive Care Unit in Türkiye

Year 2024, Volume: 18 Issue: 2, 96 - 101, 18.03.2024

İstemi Han Çelik , Mehtap Durukan Tosun , Safiye Elif Uzlu , Ahmet Yağmur Baş , Nihal Demirel

https://doi.org/10.12956/tchd.1337561

Abstract

Objective: In the COVID-19 pandemic era, visiting restrictions and lockdown measures have been leaded to serious concerns in breastfeeding and maternal-infant interaction. We aimed to evaluate the effects of visiting restrictions as no physical visits allowed period (March 13th and June 20th, 2020) on feeding with breast milk, breastfeeding and associated morbidities.

Material and Methods: Neonates admitted to neonatal intensive care unit in pre-COVID-19 pandemic and during strict visiting restrictions constituted control and study groups.

Results: Study and control groups included 197 and 193 mother-baby dyads. Study group had insignificant lower gestational age, birthweight and higher prematurity rate. Median first enteral feeding and first breast milk days were similar. First enteral feeding with breast milk was insignificantly higher in control group. Median breast milk percentage at full enteral feeding (FEF) did not differ. Median time of FEF, FEF with only breast milk and intravenous fluid duration were higher in study group (p<0.050). Full enteral feeding with breast milk during NICU stay was less in study group (78.1 vs 87%, p<0.050) while at discharge there was no difference (78.1% vs 81.3%). Feeding intolerance was insignificantly higher in study group (23.8% vs 14.6%). Median duration of NICU stay was higher in study group but not significant (13.5 vs 12 d, p>0.050).

Conclusion: No visits allowed period leaded to impaired breastfeeding, breast milk supply and associated morbidities. Parents should be informed about breastfeeding and breast milk in prenatal period, after birth and during NICU stay in COVID-19 era as before and precautions should be taken.

Keywords

Breastfeeding, Breast milk, COVID-19, Neonatal morbidities, Visiting restrictions

COVID-19 nedeniyle sokağa çıkma yasakları ve ziyaret kısıtlamasının Türkiye’de üçüncü basamak bir yenidoğan yoğun bakım ünitesinde anne sütü ve kısa dönem morbiditeler üzerine etkisi

Abstract

Amaç: COVİD-19 pandemi sürecinde ziyaret kısıtlamaları ve sokağa çıkma yasaklarının anne sütü ile beslenme ve anne-bebek ilişkisinde sorunlar yaratacağından endişe edildi. Bu çalışmanın amacı ülkemizde ziyaret yasağı sürecinin (13 Mart 2020-20 Haziran 2020) anne sütü ile beslenme, emzirme ve ilişkili morbiditeler üzerine etkisini değerlendirmektir.

Gereç ve Yöntemler: Yenidoğan yoğun bakım ünitesinde (YYBÜ) COVİD-19 pandemisi öncesi ve ziyaret yasağının uygulandığı dönemde yatan bebekler kontrol ve çalışma gruplarını oluşturdu.

Bulgular: Çalışma ve kontrol gruplarını 197 ve 193 anne-bebek çifti oluşturdu. Çalışma grubu daha düşük gestasyonel yaş, doğum ağırlığı ve daha yüksek prematürite oranına sahipti ancak istatistiksel anlamlı değildi. Ortanca ilk enteral beslenme ve anne sütü alma günleri benzerdi. Kontrol grubunda ilk beslenmenin anne sütü ile yapılma oranı daha fazlaydı ancak istatistiksel anlamlı değildi. Tam enteral beslenmeye geçişteki anne sütü oranı benzerdi. Ortanca tam enteral beslenmeye geçiş zamanı, tam enteral beslenmede anne sütü oranı ve intravenöz sıvı süresi çalışma grubunda daha yüksekti (p<0.050). Tam enteral beslenmenin anne sütü ile yapılması yatış sürecinde çalışma grubunda daha azken (78.1 ve %87, p<0.050) taburculuk sırasında benzerdi (%78.1 vs %81.3). Beslenme intoleransı (%23.8 vs %14.6) ve yatış süresi (13.5 ve 12 gün) çalışma grubunda daha yüksekken istatistiksel anlamlı değildi.

Sonuç: Ziyaretin yasaklanmasının emzirme, anne sütü sağlanması ve ilişkili morbiditeler üzerine olumsuz etkileri mevcuttur. Aileler COVİD-19 pandemisi öncesinde olduğu gibi anne sütü ve emzirmenin önemi hakkında gebelik süreci, doğum ve YYBÜ yatış sürecinde bilgilendirilmeli ve önlemler alınmalıdır.

Keywords

Emzirme, Anne sütü, COVİD-19, Neonatal morbiditeler, Ziyaret kısıtlamaları

References

• World Health Organization (WHO). Maintaining essential health ser- vices: operational guidance for the COVID-19 context: interim guidance, 1 June 2020. https://apps.who.int/iris/handle/10665/332240. Access date: June 1, 2023.
• Hugelius K, Harada N, Marutani M. Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review. Int J Nurs Stud 2021; 121: 104000.
• Vance AJ, Duy J, Laventhal N, Iwashyna TJ, Costa DK. Visitor Guidelines in US Children’s Hospitals During COVID-19. Hosp Pediatr 2021; 11: e83-e9.
• Conde-Agudelo A, Diaz-Rossello JL, Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003: CD002771.
• Minckas N, Medvedev MM, Adejuyigbe EA, Brotherton H, Chellani H, Estifanos AS, et al. Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection. EClinicalMedicine 2021;33:100733.
• Bembich S, Tripani A, Mastromarino S, Di Risio G, Castelpietra E, Risso FM. Parents experiencing NICU visit restrictions due to COVID-19 pandemic. Acta Paediatr 2021; 110: 940-1.
• Muniraman H, Ali M, Cawley P, Hillyer J, Heathcote A, Ponnusamy V, et al. Parental perceptions of the impact of neonatal unit visitation policies during COVID-19 pandemic. BMJ Paediatr Open 2020; 4: e000899.
• World Health Organization. 2020. Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. . Access date: July 3, 2020.
• Von Kohorn I, Flaherman V. Human Milk for the Term Newborn. Clin Perinatol 2021; 48: 513-31.
• Eidelman AI, Schanler RJ, Johnston M, Landers S, Noble L, Szucs K, et al. Breastfeeding and the use of human milk. Pediatrics 2012; 129: e827-41.
• Granger CL, Embleton ND, Palmer JM, Lamb CA, Berrington JE, Stewart CJ. Maternal breastmilk, infant gut microbiome and the impact on preterm infant health. Acta Paediatr 2021; 110: 450-7.
• Belfort MB, Anderson PJ, Nowak VA, Lee KJ, Molesworth C, Thompson DK, et al. Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks’ Gestation. J Pediatr 2016; 177: 133-9 e1.
• Inder TE, Perlman JM, Volpe JJ. Preterm Intraventricular Hemorrhage/Posthemorrhagic Hydrocephalus. In: Volpe JJ, editor Volpe’s Neurology of the Newborn,. 6th ed. Philadelphia: Elsevier 2018.
• Jensen EA, Dysart K, Gantz MG, McDonald S, Bamat NA, Keszler M, et al. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach. Am J Respir Crit Care Med 2019; 200: 751-9.
• Jadcherla SR, Kliegman RM. Studies of feeding intolerance in very low birth weight infants: definition and significance. Pediatrics 2002; 109: 516-7.
• Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1-7.
• Gunes AO, Dincer E, Karadag N, Topcuoglu S, Karatekin G. Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit. J Perinat Med 2021; 49: 500-5.
• Yi YZ, Su T, Jia YZ, Xue Y, Chen YZ, Zhang QS, et al. Family-centered care management strategies for term and near-term neonates with brief hospitalization in a level III NICU in Shenzhen, China during the time of COVID-19 pandemic. J Matern Fetal Neonatal Med 2021: 1-4.
• Spatz DL, Davanzo R, Muller JA, Powell R, Rigourd V, Yates A, et al. Promoting and Protecting Human Milk and Breastfeeding in a COVID-19 World. Front Pediatr 2020; 8: 633700.
• WHO. Clinical Management of Severe Acute Respiratory Infection (SARI) When COVID-19 Disease Is Suspected: Interim Guidance. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/331446/WHO-2019-nCoV clinical-2020.4eng.pdf? Access date: October 10, 2020.
• Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study. Appetite 2021; 156: 104985.
• Stampini V, Monzani A, Caristia S, Ferrante G, Gerbino M, De Pedrini A, et al. The perception of Italian pregnant women and new mothers about their psychological wellbeing, lifestyle, delivery, and neonatal management experience during the COVID-19 pandemic lockdown: a web-based survey. BMC Pregnancy Childbirth 2021; 21: 473.
• Ceulemans M, Verbakel JY, Van Calsteren K, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health 2020; 17: 6766.
• Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, et al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med 2017; 45: 103-28.
• Darcy Mahoney A, White RD, Velasquez A, Barrett TS, Clark RH, Ahmad KA. Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. J Perinatol 2020; 40: 36-46.