Small and sick babies are at increased risk of dying due to disruptions in care caused by coronavirus, a survey of health workers across 62 mainly developing countries has found.
Every year, 2.5 million babies die within 28 days of birth, and more than 80% of them have low birth weight. A technique for premature and small babies known as kangaroo mother care (KMC), involving early prolonged skin-to-skin contact with their mothers and breastfeeding, can help reduce mortality.
But a survey of 1,100 health professionals, published in the British Medical Journal Global Health, conducted by a partnership of researchers led by the World Health Organization (WHO) and the London School of Hygiene & Tropical Medicine, found that this life-saving intervention was delayed or not used.
Staff told researchers they were not implementing the technique due to fear of infection and of Covid transmission from mother to baby. Other concerns included PPE shortages, stress and safety. In some hospitals, neonatal staff reported losing vital resources, including oxygen and nurses, to Covid wards.
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Two-thirds of respondents said they would not allow mothers whose Covid status was positive or unknown to practise KMC. A quarter said they would not allow breastfeeding. There was a lack of clarity on guidelines on newborn care for mothers suspected or confirmed as Covid positive. KMC was practised routinely by 85% of respondents before the pandemic, compared with 55% during it.
“It’s fear for the baby, fear of infection on the ward and fear for themselves,” said Prof Joy Lawn, director of the centre for maternal and child health at the London School of Hygiene & Tropical Medicine.
The Covid status of mothers was often unknown – only a third of respondents reported that testing was available for heavily pregnant women.
“Nurses are more stressed, they don’t have PPE, they aren’t vaccinated,” said Lawn. “They worry about doing it and during the pandemic they don’t want mothers on the ward, they don’t want mothers handling babies.”
Separating newborns from their mothers can put them more at risk, said Lawn.
“A preterm baby dies in minutes if you are not doing the right thing. It was already a big problem. Then the pandemic comes along. We are separating mothers and babies. Even more shockingly, oxygen equipment and also nurses are being taken off wards.”
The survey, conducted in the last six months of 2020, did not include details about mortality rates of newborns as a result of this change. But a separate study in the Lancet’s EClinicalMedicine found that the benefit of KMC “far outweighs” the small risk of a newborn weighing under 2kg dying of Covid.
The Lancet study, conducted by a global collaboration including the University of California, San Francisco and led by the WHO and the London School of Hygiene & Tropical Medicine, estimated that if universal coverage of KMC was achieved, 125,000 newborns would be saved, while fewer than 2,000 newborns would die from Covid. Conversely, a 50% reduction in KMC could result in 12,500 more deaths, it found.
Prof Suman Rao, of St John’s Medical College, Bengaluru, India, a lead author on both studies, said: “KMC is one of our most cost-effective ways to protect small and sick newborns. Now it is more critical than ever to ensure mothers are supported and that healthcare professionals feel safe and comfortable to support in the delivery.”
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