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Scientific Letter
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Available online 9 November 2021
Kangaroo care during the SARS-CoV-2 pandemic in Spain
El método canguro durante la pandemia por SARS-CoV-2 en España
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Álvaro Solaz-Garcíaa, Ana Gimeno-Navarroa,b, Rosario Ros-Navarretc, Isabel Izquierdo-Maciána,b, Pilar Sáenz-Gonzáleza,b,
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saenz_pilgon@gva.es

Corresponding author.
a Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
b Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
c Área de Enfermedades del Niño, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Table 1. Resulted of the survey on the impact of the SARS-CoV-2 pandemic on kangaroo care in neonatal units in Spain.
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To the editor:

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.

Table 1.

Resulted of the survey on the impact of the SARS-CoV-2 pandemic on kangaroo care in neonatal units in Spain.

Items  Total (N = 263) 
Restrictions to parental access to the unit at any point in the pandemic  179 (68.1%) 
Restrictions to access of siblings and other family members to the unit at any point in the pandemic  262 (99.6%) 
Provided parents written information regarding the unit, rules, hygiene and protective measures against COVID-19  193 (73.4%) 
Specific preventive measures for the practice of kangaroo care during the pandemic  91 (34.6%) 
Restrictions on kangaroo care during pandemic
No  121 (46%) 
Time limits  18 (6.8%) 
Limit on individuals performing care (only 1 parent)  69 (26.2%) 
Limit on individuals performing care (only 2 parents)  25 (9.5%) 
Other  30 (11.4%) 
At present, the unit remains open 24 hours  224 (85.2%) 
At present, there are restrictions to parental access to unit
No restrictions  51 (19.4%) 
Only 1 parent WITH time restrictions  30 (11.4%) 
Only 1 parent WITHOUT time restrictions  173 (65.8%) 
Both parents WITH time restrictions  9 (3.4%) 
At present, kangaroo care is part of the routine care of infants in the unit  250 (95.1%) 
The provided written information sufficed to address the needs of families and guarantee safety  127 (52.5%) 
Use of masks could be a barrier to bonding between parents and newborn infants  107 (40.7%) 
The pandemic may have increased parental stress and fear of transmitting the virus to their babies through kangaroo care  206 (78.3%) 
Impact of pandemic on frequency of kangaroo care sessions
Increase in sessions  6 (2.3%) 
Decrease in sessions  158 (60.1%) 
No impact  99 (37.6%) 
Restrictions on 24-hour access to unit should be imposed or maintained  104 (39.5%) 
Restrictions on kangaroo care should be imposed or maintained  53 (20.2%) 
Impact of measures and restrictions related to the pandemic on breastfeeding
No impact  60 (23.4%) 
Low impact  131 (51.2%) 
High impact  61 (23.8%) 
No answer  4 (1.6%) 

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.

Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgments

We thank all professionals working in neonatal units in Spain that collaborated in the survey by completing the questionnaire and who have continued to promote and practice kangaroo care. Also, we especially acknowledge the support and collaboration of the Committee on Humanization of the Sociedad Española de Neonatología (SENeo) and Sociedad Española de Enfermería Neonatal (SEEN) and the Cuidando Neonatos blog for the distribution of the questionnaire.

References
[1]
M. Sánchez-Luna, B. Fernández Colomer, C. de Alba Romero, A. Alarcón Allen, A. Baña Souto, F. Camba Longueira, et al.
Neonates Born to Mothers With COVID-19: Data From the Spanish Society of Neonatology Registry.
[2]
A. Darcy Mahoney, R.D. White, A. Velasquez, T.S. Barrett, R.H. Clark, K.A. Ahmad.
Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019.
J Perinatol, 40 (2020), pp. 36-46
[3]
M.E. Cavicchiolo, D. Trevisanuto, E. Lolli, V. Mardegan, A.M. Saieva, E. Franchin, et al.
Universal screening of high-risk neonates, parents, and staff at a neonatal intensive care unit during the SARS-CoV-2 pandemic.
Eur J Pediatr, 179 (2020), pp. 1949-1955
[4]
M. López-Maestro, J. De la Cruz, J. Perapoch-Lopez, A. Gimeno-Navarro, S. Vazquez-Roman, C. Alonso-Diaz, et al.
Eight principles for newborn care in neonatal units: Findings from a national survey.
Acta Paediatr Jul de, 109 (2020), pp. 1361-1368
[5]
D.S. Morsch, Z.A. de Oliveira Custódio, Z.C. Lamy.
Psycho-emotional care in a neonatal unit during the covid-19 pandemic.
Rev Paul Pediatr, 38 (2020),
[6]
C. Boscia.
Skin-to-Skin Care and COVID-19.
Pediatrics, 146 (2020),

Please cite this article as: Solaz-García Á, Gimeno-Navarro A, Ros-Navarret R, Izquierdo-Macián I, Sáenz-González P. El método canguro durante la pandemia por SARS-CoV-2 en España. An Pediatr (Barc). 2021. https://doi.org/10.1016/j.anpedi.2021.06.016

Copyright © 2021. Asociación Española de Pediatría
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