How the NICU Changes During a Pandemic
When a baby named Clara was transferred to the neonatal intensive care unit (NICU) at Children's Hospital Colorado in the midst of a pandemic, both of her parents were allowed to visit, but her siblings were among those unable to. New COVID-19 restrictions forced hospitals like this one to change safety protocols, including those for their youngest and most vulnerable residents in the NICU.
But Children's Hospital Colorado found a creative workaround using an Omnibot robot complete with a digital screen through which Clara's siblings could "visit" her. In fact, all the rooms in the NICU are now equipped for virtual visits.
It's just one of the many ways NICUs across the country are adapting to the new normal while protecting patients and staff alike. Along with their already strict protocol regarding things like hand-washing, many NICUs are now restricting visitation to parents only—and in some cases, only one parent is allowed. These protocols are creating a new reality for families.
In Florida, neonatologist and co-founder of Kidz Medical Services Jorge Perez, M.D., has been at the helm of the safety protocols being implemented at numerous NICUs, including the one at South Miami Hospital. Using their experience dealing with previous viruses like Zika and H1N1, Dr. Perez and his team began changing safety protocols once they received word of the virus, akin to the recommendations later issued by the Centers for Disease Control and Prevention (CDC).
"We immediately implemented a restrictive visitation policy and treated everyone as persons under investigation (PUI), requiring the health care team and parents to wear personal protective equipment (PPE) at all times and continue using good hand hygiene; social distancing of greater than six feet while health care team remained in the delivery room; separating Baby from Mom if Mom was COVID-19 positive or a PUI; and having moms extract their breast milk and then feeding through a bottle to avoid close contact," says Dr. Perez.
The Challenge of NICU Changes
While these new protocols are meant to keep everyone safe and healthy, they can still be difficult on families. Jessica Wade, CEO and president of Mighty Little Giants (MLG)—a nonprofit dedicated to supporting NICU families—has been keeping on top of the changing conditions of NICUs across Los Angeles County. Along with the decrease in visitors, hospitals are also taking temperatures at the security desk. Parents who have a fever are forced to quarantine for 14 days prior to returning to the hospital to visit their babies.
"That [can] result in no [breastfeeding], no kangaroo care, and no way to physically care for and bond with their children at such a crucial time," says Wade, who adds that it's contributed to a new level of fear among the moms in MLG's NICU support program.
Wade says she also knows of a mom who tested positive for COVID-19 prior to giving birth prematurely. "She wasn't able to have any contact with her baby while he was in the NICU," says Wade. "Thank goodness that this mother was able to fight COVID-19 and the virus did not transfer to her son."
How Parents Can Cope
Being able to trust the NICU staff made all the difference for Nikki Harmon, who recently gave birth to her fourth child, Rylie, at 37 weeks. Baby Rylie was taken to the NICU when she was struggling to clear fluid from her lungs, and her stay was extended due to jaundice. Harmon is no stranger to the NICU—she had another child in the NICU in 2015—and says she didn't notice much of a difference other than the requirement of wearing masks, and new procedures around the communal areas in the NICU.
"Both parents were considered essential to care and allowed to freely come and go. I was also allowed to stay 24/7 in-room with Rylie once I was discharged," says the Clermont, Florida-based mother. She adds she initially had a lot of anxiety about going to the hospital during the peak of the virus in her area, but felt secure with the medical team. "We had a great care team, and I knew that everyone was doing the best they could possibly do to keep me and my baby safe."
Still it can be difficult for parents to minimize their fears about having a baby in the NICU during the pandemic. That's why Snehal Doshi, M.D., medical director of the NICU at Baptist Hospitals of Southeast Texas and CEO of Millennium Neonatology, recommends individuals call their local hospitals ahead of time to inquire about precautions and screening questions. For example, "if you have recently traveled outside of your local area or been in close contact with a lot of people, you may not be allowed in," says Dr. Doshi.
Parents can look at their local hospital's guidelines online to see if they are adopting similar precautions. Or they can call and ask whether the hospital is doing temperature checks upon arrival or checking for additional symptoms of COVID-19; how they are handling social distancing within the hospital; what their current cleaning and disinfecting protocol is; and whether COVID-19 testing is available to them or their families should they have any symptoms.
It's also more important than ever for parents to reach out to their hospitals and local organizations for support. The March of Dimes is currently hosting an online education series on what to expect in the NICU during COVID-19, which can help keep parents informed and lessen their fears during such a complicated time. The organization Hand to Hold is also holding virtual NICU support groups to help parents feel less alone. New Orleans-based nonprofit Saul's Light is also offering virtual support groups, as is the Connecticut-based Tiny Miracles Foundation. And Wade's Mighty Little Giants is also hosting weekly virtual Q&A-style support groups for parents on bed rest, in the NICU, or who are fresh out of the NICU.
While the NICU experience coupled with the pandemic can feel overwhelming, it's good to know that doctors and hospitals are doing everything they can to keep our little ones safe.
"The last thing anyone wants is to get an infant sick with this disease. Even if it is a short-term separation between the parents and their child, know that the hospital has put policies in place to protect every baby in the NICU," says Dr. Doshi. "We all want the best possible outcomes for our patients."