The coronavirus disease 2019 (COVID-19) pandemic started in Wuhan (China) in December 2019. The novel coronavirus (SARS-CoV-2) spread rapidly through every country in the world, and in March 2020 the first case in a neonate was detected in Spain.1

In neonatal units, the practice of kangaroo care (KC) was affected in the first months of the pandemic due to the lack of robust evidence on the mechanisms of viral transmission and the potential impact on neonates.2 For instance, to guarantee infant safety, the University Hospital of Padua (Italy) implemented screening of all neonates, parents and health care professionals in neonatal units, which achieved good outcomes even at times when the incidence was peaking.3

The aim of our study was to assess the impact of the SARS-CoV-2 pandemic on KC in neonatal units in Spain and identify possible opportunities for improvement in the context of the pandemic.

We conducted a cross-sectional, observational and descriptive study. We developed an ad hoc questionnaire that was distributed through social networks to professionals staffing neonatal units in Spain. The study focused on assessing the impact of the pandemic on KC and the opinions and perceptions of health care workers regarding the situation.

A total of 263 health care workers, with representation of every autonomous community in Spain, participated in the survey, the results of which are summarised in Table 1.

As would be expected, there was evidence of a decrease in the unrestricted practice of KC during the pandemic, from a frequency of 97% before the pandemic based on data published in 2020 by López et al4 to 46% based on our findings. In addition, the proportion of units that offered unrestricted 24-hour access to parents decreased from 95.4% to 85.2%.4

At the international level, a similar study in the United States found a significant decrease in parental presence (from 85% to 53%) and parental participation in infant care (71% to 32%), leading the authors to conclude that restrictions had significantly limited the presence of families in neonatal units.2

Despite the low incidence of SARS-CoV-2 infection in neonates, as evinced by data from the Sociedad Española de Neonatología (Spanish Society of Neonatology),1 the pandemic has brought significant changes in neonatal care delivery and practices, with a negative impact on practices in which there had been substantial progress.5 In March 2020, as the pandemic emerged, uncertainty and the rapid spread of the virus led to the implementation of measures that restricted parental visits to neonatal units, with an impact on their active participation in infant care, including KC, and barring grandparents, siblings and other relatives that provided psychological and social support to the parents from the units.

These restrictive strategies meant to reduce the spread of the virus and protect neonates and health care workers carried different risks for infants and their families and were a source of additional concern for health care workers on account of their potential impact, as limiting developmental care practices could have a negative impact on parent-child bonding, the prevalence of breastfeeding and neurodevelopmental outcomes in preterm infants.5,6

The current global health crisis and constant changes in protocols and guidelines constitute a substantial professional and emotional challenge.6 But as the data available to date suggest,1–4 the risk of vertical transmission in the infant is very low. In addition, the benefits offered by KC, parent-child bonding and breastfeeding vastly exceed the risks associated with infection by SARS-CoV-2 in newborn infants.

After a very slow introduction of KC, which has taken more than 20 years in neonatal units in Spain, the pandemic has had a substantial negative impact on its practice. In only a few months, there has been a significant decrease in the practice of KC due to general restrictions on parental presence in neonatal units and specific restrictions on skin-to-skin contact that may have a negative impact on infants and their families. If there is uncertainty regarding potential transmission, a screening programme could be contemplated, or even prioritizing the vaccination of families with infants in neonatal units.