Preterm care during COVID-19 and the survival benefit of kangaroo mother care

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Given the disruption of neonatal health services through the COVID-19 pandemic, a two-scenarios-analysis was conducted to weigh the risk of not implementing kangaroo mother care (KMC) among neonates with neonatal deaths from COVID-19. The undeniable survival benefit of KMC far outweighs the small risk of death due to the virus and encourage its practice.

There are conflicting global guidelines on mother-newborn care during the COVID-19 pandemic, particularly regarding kangaroo mother care (KMC), a skin-to-skin practise between parents and infants. This common practice has had positive results on the development of babies with low birth weight, therefore lowering preterm complications, which is the leading cause of death in neonates.

At the same time, the impact of the SARS-CoV-2 virus on newborns is still unclear. Previous studies suggest a low horizontal transmission rate, mild to non-existing symptoms and a very low risk of neonatal death due to the virus. Other studies analysed the impact of disrupted care for small and sick newborns during the pandemic. These showed concerning numbers that call for more evidence on KMC practice during the pandemic and revising the guidelines concerning mother-infant separation and breastfeeding.

Having these findings in mind, a comparative risk analysis was conducted to compare the maximum neonatal lives saved by KMC versus maximum lives lost from COVID-19, taking the incremental deaths caused by reduced KMC into consideration. The data from 127 low-and middle-income countries (LMIC) was used, seeing that these countries have been most affected by the pandemic. With the help of the “Lives Saved Tool” two scenarios were put into motion for 12 months, and projections were made for each country. The first scenario represented the possible benefits of KMC on neonatal survival, assuming 99% KMC-recommendation coverage, plus the maximum harm that could come from COVID-19. The second scenario considered excess deaths reflecting real-world possibilities of a 50% reduction or a complete disruption of KMC. This scenario was modelled under the assumption of a 20% global recommendations coverage of KMC before the pandemic, leaving the coverage rate at 10% or 0% after the pandemic stroked.

The results from the first scenario of maximum benefit versus maximum harm showed 125,680 neonatal lives being globally saved due to KMC. Conversely, considering a worst-case scenario of 100% mother-infant transmission of SARS-CoV-2, the maximum number of COVID-related neonatal deaths was 1950. Together, Africa and Asia account for roughly 85% of both lives saved and lives lost. A sensitivity analysis made with different transmission rates proved the benefit of providing KMC to be 65 to 630 times higher than the risk of neonates dying from COVID-19.

On the contrary, in the second scenario of reduced KMC coverage, the 50% reduction would account for 12,570 additional annual neonatal deaths. This number represents a 2-3% increase in mortality per year and could even double in a scenario of full disruption of KMC coverage.

There is still limited evidence regarding the pandemic’s consequences on routine care for small and sick newborns, but many concerns have been raised. Fear of the virus transmission can result in mother-infant separation. Visitation restrictions furthermore interfere with KMC when the mother cannot provide skin-to-skin care and relies on family members for care provision. Relocation of staff could result in a reduction of quality of care. Movement restrictions could finally impact the use of follow-up services for infants.

Given the long-term benefits of skin-to-skin contact for babies born preterm or with low birthweight and the importance of breastfeeding, public health policies must be revisited. Policymakers and healthcare professionals need to take the small neonatal incidence- and mortality rates of COVID-19 into consideration, protect family-centred care services, and ensure SARS-CoV-2 positive mothers and newborns remain together.

Paper available at: EClinicalMedicine by THE LANCET

Full list of authors: Nicole Minckas, Melissa M. Medvedev Ebunoluwa A. Adejuyigbe, Helen Brotherton, Harish Chellani, Abiy Seifu Estifanos, Chinyere Ezeaka, Abebe G. Gobezayehu, Grace Irimu, Kondwani Kawaza, Vishwajeet Kumar, Augustine Massawe, Sarmila Mazumder, Ivan Mambule, Araya Abrha Medhanyie, Elizabeth M. Molyneux, Sam Newton, Nahya Salim, Henok Tadele, Cally J. Tann, Sachiyo Yoshida, Rajiv Bahl, Suman P.N. Rao, Joy E. Lawn

DIO: 10.1016/j.eclinm.2021.100733