Frequently Asked Questions (FAQs) about the NICU and family-centred care in times of COVID-19:

What kind of risk of COVID-19 is there for preterm born babies?

Professor Christoph Bührer, Medical Director Department of Neonatology, Charité Berlin spoke in an interview with the European Foundation for the Care of Newborn Infants (EFCNI) about this topic.
“Infants, as compared to adults, have a much lower risk of getting infected with the new corona virus. Moreover, they are also less likely to develop symptoms. In China, only 9 infants less than 1 year of age were identified by early February 2020, at a time when the total number of infected people had already risen to more than 50,000. None of the infants with a positive test result was seriously ill, none of them was admitted to an intensive care unit. At present, there is no specific data for preterm infants available. As manuscripts on the epidemiology of COVID-19 are published at high speed, there is reason to assume that infants, both term and preterm, are just not the prime target of this virus. If a COVID-19 infection turns into pneumonia, preterm infants with bronchopulmonary dysplasia should be expected develop more serious symptoms (such as shortness of breath, increased rates of breathing, or poor oxygenation) than those with healthy lungs, so they would be more likely to be tested for COVID-19. However, there is lack of reports on COVID-19 ravaging preterm infants which is rather reassuring.”

(Source: EFCNI)

Can I touch and hold my newborn baby if I have COVID-19?

Yes, you can touch and hold your newborn baby. The World Health Organization (WHO) encourages close contact and early connecting, exclusive breastfeeding because it helps a baby to thrive. You should be supported to

• Breastfeed safety, with good respiratory hygiene
• Wearing a mask
• Hold your newborn skin-to-skin, and
• Share a room with your baby

Bear in mind to wash your hands before and after touching your baby, and keep all surfaces clean.

(Source: WHO)

Is it recommended to wear a medical mask in the Neonatal Intensive Care Unit (NICU)?

Wearing a mask reduces the likelihood that COVID-19 infected persons spread the disease to others. Thus, it is tribute to the health of others, notably the nurses and doctors working in the NICU. However, the use of a mask alone is insufficient, thorough handwashing with soap and water at regular intervals is also required. Please talk to your NICU team for further information.

(Source: WHO)

What can I do to bond with my baby, even if we are separated?

Your newborn baby is already familiar with your voice and your odour. So, even if you cannot be with your baby as much as you would like there are still options to give your baby a sense of familiarity and comfort.

Voice perception
Talk to your healthcare team, if you can phone or video chat (with a special camera system or similar technical systems) with your baby or leave a tape recorder with them. You can for example share what you are doing, read a text or sing a lullaby for your baby.

Bear in mind, that once you and your baby are together there are even more wonderful things you can do to bond like breastfeeding, skin-to-skin care, play with your child, read something to your child, sing a lullaby or simply talk

(Source: raisingchildren)

Note: Please make sure to take proper care of yourself. This is a very stressful time and you might forget about your own well-being. The World Health Organization (WHO) advises that parent and caregivers who may need to be separated from their children, should have access to appropriately trained health or non-health workers for mental health and psychosocial support.

(Source: WHO)

You might also get support from a national parent organisation. Here is an overview of our partner parent organisations.

How can we as a family stay connected to our baby and the healthcare team if there is limited access to the Neonatal Intensive Care Unit (NICU)?

Ask your NICU team about what options you have. They might be able to offer secure camera systems in their unit. These digital options might give you and your family time to see your baby. Maybe it is possible that you can read a story for your baby or sing to him/her a lullaby and record this. Your baby can listen to your voice, when you are not around. Of course, these alternatives are not replacing skin-to-skin or speaking directly to your baby. In this challenging situation, these suggestions may assist you in supporting your baby and give you and your family the opportunity to connect with him/her.

(Source: BAPM)

I feel completely overwhelmed by being a preterm mom/dad and trying to protect my baby from COVID-19. What can I do?

It is natural to feel overwhelmed for both mothers and fathers/partners in situations like these. Most parents might rank their own needs below the needs of their baby. However, it is very important for them to look after themselves. Lowering levels of distress for parents is likely to have a positive effect on the baby as well. Basic needs such as eating and drinking sufficiently and getting enough sleep, may help you to structure the day, which can be comforting.

Psychologists, social workers, or special trained healthcare professionals can help you and other family members to cope with the shock as well as to interact with the baby. Talking to the NICU team, your family members or friends (preferable with digital solutions), or to other affected families at the unit can also be helpful in the beginning and later on. You can also contact your local or national parent organisation. They offer advice; an open ear and some even have digital support groups during the COVID-19 pandemic. Here is an overview of our partner parent organisations.

There are also good tips online on how to cope, like in this infographic or this video.

What if a member of the Neonatal Intensive Care Unit (NICU) staff is COVID-19 positive?

Any healthcare worker who has been identified as being COVID-19 positive will be sent home for two weeks to prevent spreading of the virus. After that time, tests might still detect remnants of the virus but these are not infectious any more. However, as any healthcare worker might unknowingly be COVID-19 positive without having symptoms and not being tested, nurses and doctors in NICUs wear masks to prevent them from spreading the virus. Incubators not only keep preterm babies warm but also protect them from little droplets in the air that might contain the virus from what source so ever.

Some hospitals offer videos and pictures out of the Neonatal Intensive Care Unit (NICU). Is the use of a mobile phone or tablet within the NICU hygiene standard or protocol?

Due to the current isolation situation a mobile phone/tablet, used by the healthcare team is a useful gadget to stay in contact with the baby’s family. If the mobile/tablet is disinfected properly and appropriate hand hygiene is used, the use of a mobile phone should not cause any concerns.

(Source: Researchgate, NHS)

My children at home have not had the chance to see their new sister/brother. What can I do to make them feel included?

It is very useful to involve older siblings as much as possible in the new situation. Make sure you explain the current situation to your child/children in an appropriate language. You can encourage them to take pictures from themselves or to paint pictures in order to show them to the baby or if allowed hang them close to the baby’s incubator. Parents can also take pictures of the new baby and show them to older siblings.

At home, you can plan to spend some time alone with each of your other children. There are plenty of recommendable picture books about birth and preterm birth, which could be used to explain the situation to the siblings. Sometimes older children may be jealous or angry because the new baby gets most of the attention in the first weeks and months and their everyday life has changed a lot. Children should be encouraged to talk about their feelings and concerns and parents should react both sympathetically and consistently. You might also get support from a national parent organisation. Here is an overview of our partner parent organisations.
(Source: EFCNI)

My baby is severely ill, and I was informed that he/she will pass away soon. Can we as parents or family still accompany our baby in this situation?

Please ask your NICU team what options you could have to support your baby in this challenging situation. So far, there is no guidance from concerning palliative care in times of COVID-19. If the health status of your baby is critical, talk to your healthcare team about protective equipment for you, like masks, gloves etc. Ask them also, if it is allowed to take photos or videos, foot and hand prints. If possible, try to get psychological and spiritual support and discuss advance care plans.

As autumn and winter are approaching fast, what would be your most important advice to protect preterm born infants from (severe) respiratory infections such as RSV, flu and COVID, in this time of ongoing COVID pandemic?

As all respiratory viral infections are transmitted by tiny droplets in the air, COVID-19 precautions are effective against all of them: Face masks, hand washing, social distancing. Avoid mass gatherings, including large family reunions.
RSV is common from November to March, but it creates symptoms severe enough to warrant hospital admissions only in infants. There is a passive vaccination available for very preterm infants with some kind of bronchopulmonary dysplasia who experience the first RSV season of their life. Flu, on the other hand, is rather dangerous for elderly people, for whom active immunization is highly recommended. Elderly people are also the most vulnerable to COVID-19 (shrugged off by the vast majority of children) and therefore in desperate need for a vaccine.

(Source: EFCNI in collaboration with Professor Christoph Bührer, Medical Director Department of Neonatology, Charité Berlin)

More Frequently Asked Questions (FAQs) about newborn and maternal health:

Birth in times of COVID-19
Breastfeeding and donor milk in times of COVID-19
Pregnancy in times of COVID-19
Discharge and follow-up in times of COVID-19