Family Presence Restrictions and Telemedicine Use in Neonatal Intensive Care Units during the Coronavirus Disease Pandemic
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Parents’ and Family Visiting Screening and Restriction
3.2. Telemedicine
3.3. NICU Design
3.4. Effect of Parental Restriction on Nursing Care and Parental Self-Refrain from Visiting
3.5. Association between Delayed Discharge during COVID-19 and NICU Design and Policies
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Appendix A. Web Survey of Parents’ Admission Restriction in NICUs
- <Consent to participate in research> (one item)
- Do you understand the content of the research description and agree to participate in this study? Yes/No
- <NICU demographics> (six items)
- 2.
- Please select a location. Hokkaido/Tohoku/Kanto/Chubu/Kinki/Chugoku/Shikoku/Kyushu
- 3.
- Was your facility applicable to 13 prefectures that showed significantly increasing COVID-19 patients compared to other prefectures in April 2020? Yes/No
- 4.
- Which description accurately describes your unit about acceptance of patients with COVID-19? Inborn only/Inborn and transported admission/Out born only
- 5.
- Number of NICU beds
- 6.
- Number of GCU beds
- 7.
- Which design accurately describes your unit?
- Open Bay: 90% or more of beds in room.
- Hybrid: 11–89% of beds in single-patient rooms.
- Single-Family Room: 90% or more of beds in single-patient rooms.
- <Visiting policies and nursing care to bond parent and neonates before COVID-19> (three items)
- 8.
- What was your Pre-COVID (December 2019) NICU visiting policy?
- (1)
- Screening question for travel history? Yes/No
- (2)
- Screening question for fever or illness? Yes/No
- (3)
- Screening for temperature? Yes/No
- (4)
- Parents always welcome (24 h)? Yes/No
- If you answered “No,” how many hours per day were parents able to visit the NICU? hours
- (5)
- Was it possible for non-parental families to enter the NICU? Only grandparents/Only siblings/Both/No possible
- 9.
- From the following, select the care that was provided for bonding between parents and children. [Multiple answers allowed]
- Kangaroo care/Parental hug/Parental touching/Breastfeeding/Parental bottle feeding/Milking in the units/Parental bathing/Parents changing diapers/Rooming in/Parent–nurse exchange diary/Recorded parent’s voice/Place a cloth with the scent of parents near neonates/Place parent and family photos near neonates/Providing a video of neonates/Providing photos of neonates/Siblings visit/Grandparents visit/Peer support between parents/Mental support from psychologists and social workers
- 10.
- What was your Pre-COVID telemedicine approach? [Multiple answers allowed]
- Online visit/Telephone call visit/Not implement
- <Visiting policies and nursing care to bond parent and neonates after COVID-19 pandemic> (6 items)
- 11.
- When did your NICU change its visiting policy? Date:
- 12.
- Which of the following reason(s) was/were applicable for parental restriction in your NICU? (Multiple answers allowed)
- Policy of restricting visits to hospitals/ Parent is infected/suspected of the new coronavirus infection/ Parental cohabitant suspected of the new coronavirus infection/ Parental cohabitant had a risk of infection from work or school/ Parental cohabitant with a high risk of becoming critically ill/Parental cohabitant had a risk of infection due to contact with an unspecified number of people on outings/Declaration of emergency situations and requests from local governments to refrain from going out coronavirus/Parents living with new coronavirus infected/suspected patient
- 13.
- What is your current COVID NICU visiting policy? Same as 8. (1)–(5)
- (6)
- Can parents enter the NICU simultaneously? Yes/No
- (7)
- If you answered “No,” which policy accurately describes of your unit? Parents can enter the unit separately/Only those who decide which one can enter/Only mothers can enter/Only fathers can enter
- 14.
- From the following, select the care provided for forming a bond between the parents and the children. (Multiple answers allowed) Same as 9.
- 15.
- What is your current COVID telemedicine approach? Same as 10.
- 16.
- When did you start telemedicine during COVID-19? Date:
- <Self-restrain from visiting> (one item)
- 17.
- Did parents refrain from visiting your unit due to COVID-19? Yes/No/I don’t know/There may have been something I did not understand
- <Impact on acquisition of childcare skills and length of hospital stay> (four items)
- 18.
- Did parental admission restrictions, nursing care restrictions, and self-restraint visits affect parents’ acquisition of childcare skills? Yes/No/I don’t know
- 19.
- If you answered “Yes,” Please describe in detail why.
- 20.
- Did parental admission restrictions, nursing care restrictions, and self-restraint visits cause delay in the discharge of neonates? Yes/No
- 21.
- If you answered “Yes,” Please describe in detail why
- <Future infectious disease countermeasures and parent-neonates support> (one item)
- 22.
- Until the COVID-19 countermeasures are established, please answer the perception of need for countermeasure to support parent and neonates in your unit with a seven-point Likert scale (1: Not needed at all; 7: Very needed)
- ●
- Admission screening by PCR test for parents
- ●
- Admission screening by antigen test for parents
- ●
- Admission screening by antibody test for parents
- ●
- Telemedicine using phone, smartphones, tablets, and PCs
- ●
- Early discharge support in collaboration with home-visit nursing
- ●
- Online visits within the family members
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Number of NICU hospital beds, median (range) | 15 | 6–36 |
Acceptance of pregnant women and newborns newly infected with coronavirus | ||
Hospital-born only (n, %) | 11 | 21.1 |
Nosocomial and out-of-hospital (n, %) | 41 | 78.8 |
Only out-of-hospital born (n, %) | 0 | 0 |
n (%) | |
---|---|
Local policy restriction | 21 (40) |
Hospital policy restriction | 45 (87) |
Parental cohabitant had a risk of infection due to contact with an unspecified number of people on outings | 16 (31) |
Parent is infected/suspected of the novel coronavirus disease | 14 (27) |
Parental cohabitant with/suspected of novel coronavirus disease | 12 (23) |
Parental cohabitant stays in areas at high risk of infection | 12 (23) |
Parental cohabitant had a risk of infection from the collective life | 10 (19) |
Parental cohabitant with a high risk of becoming critically ill | 4 (8) |
Pre- COVID-19 | During COVID-19 | ||||
---|---|---|---|---|---|
n = 52 | n = 52 | ||||
No. | (%) | No. | (%) | p | |
Confirmation of parent’s history of stay and transfer | 2 | 4 | 42 | 81 | 0.021 * |
Checking parents’ physical condition | 35 | 67 | 51 | 98 | <0001 * |
Parental temperature measurement | 7 | 13 | 50 | 96 | 0.096 * |
Parents can enter the room for up to 24 h | 22 | 42 | 0 | 0 | 0.001 * |
Parental presence possible time, h, median (range) | 12 | (2, 24) | 1 | (0, 23) | <0001 § |
Family members other than parents can enter the room | <0001 † | ||||
Grandparents only | 26 | 50 | 2 | 4 | |
Siblings only | 2 | 4 | 0 | 0 | |
Grandparents and siblings | 15 | 29 | 0 | 0 | |
Not possible | 9 | 17 | 50 | 96 | |
Telemedicine | 0.033 † | ||||
Telephone call visit | 16 | 31 | 11 | 21 | |
Online visits | 1 | 2 | 5 | 10 | |
Telephone + online | 1 | 2 | 10 | 19 | |
Not performed | 34 | 65 | 26 | 50 |
Open Bay Design | Hybrid Design | |||||||
---|---|---|---|---|---|---|---|---|
n = 45 | n = 7 | |||||||
Pre- COVID-19 | During COVID-19 | Pre-COVID-19 | During COVID-19 | |||||
n | % | n | % | n | % | n | % | |
Screening questions for travel history | 2 | 4 | 37 | 82 | 0 | 0 | 5 | 71 |
Screening questions for illness | 29 | 64 | 44 | 98 | 6 | 86 | 7 | 100 |
Screening temperature check | 6 | 13 | 43 | 96 | 1 | 14 | 7 | 100 |
Parental always welcome (24 h) | 19 | 42 | 0 | 0 | 3 | 21 | 0 | 0 |
Parental presence possible time, h, median | 12 | (2, 24) | 1 | (0, 18) | 20 | (2, 24) | 4 | (0.5, 23) |
Pre- COVID-19 | During COVID-19 | |||
---|---|---|---|---|
n = 52 | n = 52 | |||
No. | (%) | No. | (%) | |
Kangaroo care | 50 | 96 | 36 | 69 |
Parental hug | 51 | 98 | 49 | 94 |
Parental touching | 52 | 100 | 49 | 94 |
Breastfeeding | 51 | 98 | 49 | 94 |
Parental bottle feeding | 52 | 100 | 50 | 96 |
Milking in the units | 51 | 98 | 46 | 89 |
Parental bathing | 51 | 98 | 50 | 96 |
Parents changing diapers | 52 | 100 | 51 | 98 |
Rooming in | 33 | 63 | 30 | 58 |
Parent–nurse exchange diary | 33 | 63 | 33 | 63 |
Recorded parent’s voice | 3 | 6 | 3 | 6 |
Place a cloth with the scent of parents near neonates | 21 | 40 | 21 | 40 |
Place parent and family photos near neonates | 37 | 71 | 37 | 71 |
Providing parent videos of neonates | 2 | 4 | 2 | 4 |
Providing parent photos of neonates | 27 | 52 | 27 | 52 |
Siblings visit | 25 | 48 | 11 | 21 |
Grandparents visit | 42 | 81 | 21 | 40 |
Peer support between parents | 9 | 17 | 6 | 12 |
Mental support from psychologists and social workers | 45 | 87 | 45 | 87 |
Delay Discharge | |
---|---|
n (%) | |
p * | |
NICU design | 0.242 |
Open bay design, n = 45 | 18 (40) |
Hybrid design, n = 7 | 1 (14) |
Telemedicine | 0.221 |
Telephone call visit, n = 11 | 3 (27) |
Online visits, n = 5 | 4 (80) |
Telephone + online, n = 10 | 4 (40) |
Not performed, n = 26 | 8 (31) |
Both parents entered the NICU simultaneously | 0.047 |
Yes, n = 29 | 7 (24) |
No, n = 23 | 12 (52) |
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Ozawa, M.; Sakaki, H.; Meng, X. Family Presence Restrictions and Telemedicine Use in Neonatal Intensive Care Units during the Coronavirus Disease Pandemic. Children 2021, 8, 590. https://doi.org/10.3390/children8070590
Ozawa M, Sakaki H, Meng X. Family Presence Restrictions and Telemedicine Use in Neonatal Intensive Care Units during the Coronavirus Disease Pandemic. Children. 2021; 8(7):590. https://doi.org/10.3390/children8070590
Chicago/Turabian StyleOzawa, Mio, Haruyo Sakaki, and Xianwei Meng. 2021. "Family Presence Restrictions and Telemedicine Use in Neonatal Intensive Care Units during the Coronavirus Disease Pandemic" Children 8, no. 7: 590. https://doi.org/10.3390/children8070590