Perinatal care of moderate and late preterm in Spain. Impact of the SARS-CoV-2 pandemic 夽

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AnalesdePediatría97(2022)61---68

Perinatal care of moderate and late preterm in Spain. Impact of the SARS-CoV-2 pandemic ^夽

Cuidados perinatales del prematuro moderado y tardío en Espa˜ na. Impacto de la pandemia por SARS-CoV-2

Totheeditor:

Moderate-latepreterm(MLPT)infantsamountto80%ofallinfants born preterm.Theyexhibita lesserdegreeofmyelinizationand sulcidevelopmentandareducedcerebralvolume^1,2comparedto terminfants,differences thatare maintainedcompared toterm infantsofthesamecorrectedage,³suggestingthatMLPTbirthcould beacauseofneurodevelopmentaldisordersintheshortandlong term.⁴

Theevidencethathasemergedontheincreasedvulnerabilityof MLPTinfantsinrecentyearshascontributedtotheapplicationof

Table1 Surveyofperinatalcarepracticesinmoderate-latepreterminfantsinSpainbeforeandduringtheSARS-CoV-2.

夽 Pleasecitethisarticleas:Martínez-NadalS,GarcíaReymundo M,GinovartG,AnquelaI,HurtadoJA.Cuidadosperinatalesdelpre- maturomoderadoytardíoenEspa˜na.Impactodelapandemiapor SARS-CoV-2.AnPediatr.2022;97:69---71.

patient-andfamily-centredcareinthissubsetofpreterminfants.

TherearenocurrentdataonthesubjectintheSpanishpopulation, andformostofSpain,⁵itisalsonotknownwhethertheSARS-CoV-2 pandemichasledtochangesinthistypeofcare.

Weconductedadescriptivestudybysubmittinganonlineques- tionnairetothemembersoftheSociedadEspa˜noladeNeonatología (SpanishSocietyofNeonatology,SENeo).Wecollecteddemographic datafortherespondentsanddifferentaspectsregardingthemana- gementofMLPTinfantsinthedeliveryroomandtheneonatalunit (Table1).

If we received more than one response from a single facil- ity, we only included the one received first in the study. We received117responsescorrespondingto87hospitalsrepresenting everyautonomouscommunityofSpainwiththeexceptionofthe autonomouscityofMelilla.Of allresponses,95.4%weresubmit- tedbyneonatologistsorpaediatricians,3.5%bynursesand1.1%by paediatricsmedicalresidents.Inthedeliveryroom,delayedcord clampingwaspracticedinallMLPTnewbornsthatdonotrequire resuscitationin72.1% offacilities,while11.6% ofhospitals only practiceditinlatepretermnewborns,5.8%practiceditinevery caseand10.5%didnotpracticeityet.Kangaroocarepracticesdid notchangeduringthepandemic,with50.6%offacilitiespractic- ingitinMLPTnewbornsthatdonotrequireresuscitation,5.7%in

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SCIENTIFICLETTERS

Figure1 NeonatalunitvisitandaccesspolicybeforeandafterthestartoftheSARS-CoV-2pandemic.

everycase,36.8%onlyinlatepretermnewbornsand6.9%nothaving introducedityet.Somefacilitiesrestrictedaccesstothedelivery roomtothepartnerofthemother,withtheoverallaccess(forall typesofdelivery)decreasingfrom42.5%to34.5%(P=.27),andthe presenceofthepartnerbannedineverycasein5.7%offacilities, comparedtoonly1.1%beforethepandemic(P=.09).

Whenitcametorooming-in,practicesinMLPTnewbornshave not changed much, although the frequency of rooming-in has decreasedfrom50.6%to47.1%(P=.65)inhospitalsthatpractice rooming-inin newbornsdelivered ator after35weeks,while it remainedstableinhospitalsthatpracticeitineveryMLPTinfant.

Ifthemotherrequiredadmissiontotheintensivecareunit,3.4%

ofhospitalsallowedcontactwiththeinfantduringthepandemic, comparedto11.5%before(P =.04).Thepercentageofhospitals thatdidnotallowitincreasedby6%duringthepandemicto65.5%

(P=.4).

Initiation of feeding at the breast remained stable in MLPT infants; duringthepandemic, 55.2% ofhospitals practiceditall MLPTinfants,14.9%inthosebornatorafter33weeks,24.1%in thosebornatorafter34weeksand5.7%ininfantsbornatorafter 35weeks.

When itcameto post-dischargehospital-levelcare,86.2% of facilitiesdidnotoffertheseservices,6%offeredittomoderately preterminfantsand8%toMLPTinfants.

Neonatal unit access policy changes during the pandemic resulted in a decrease in theunits that allowedfree access to allfamilymembers50.6%to1.1%(P<.001)andintheunitsthat allowedfreeaccesstoparentsandoccasionallysiblingsfrom19.5%

to4.6%(P=.002)(Fig.1).Thehospitalsthatallowed24-haccess decreasedfrom93.1%to82.7%(P=.03).Respondentsdidnotreport changesinthetimeofskin-to-skincontact(90.8%).

In conclusion, the perinatal care of MLPT infants includes practicesassociatedwithprotective factors thatlower neurode- velopmental riskand thatpromote parent-childbonding inmost neonatalunitsinSpain.Thesecarepracticeshavebeenintroduced duetothegrowingunderstandingandinterestinthevulnerabil- ityofMLPTinfants.Wefoundchangesinperinatalcarepractices inresponsetotheSARS-CoV-2pandemic,withrestrictedaccessto thedeliveryroomand,inthecaseofhospitaladmission,decreased contactbetweeninfantsandthefamilyduetolimitedaccess to neonatalunits,whichcouldcreateadditionalemotionalstresson parents and health care professionals; it is also likely that the decreaseinthefrequencyofrooming-in,thelackofpost-discharge home-basedcareprogrammes,thedifficultyaccessingprimarycare centresand thedecrease inbreastfeedingsupport groups hada negativeimpactonbreastfeedingrates.

AgreatereffortinimprovingthespecificcareofMLPTinfants accordingtotheguidelinesproposedbytheSEN32-36workinggroup oftheSENeoforperinatalcareinMLPTinfants⁶wouldcontribute tomakingcarepracticesmoreconsistentthroughoutSpain.

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Recomendacionespara el manejo perinataly seguimiento del recién nacido prematuro tardío. An Pediatr (Barc). 2014;81, 327.e1---7.

SílviaMartínez-Nadal^a,^∗,MercedesGarcíaReymundo^b,Gemma Ginovart^c,IsraelAnquela^d,JoséAntonioHurtado^e

aGrupoSEN32-36,SociedadEspa˜noladeNeonatología,Serviciode Neonatología-Pediatría,SCIAS,HospitaldeBarcelona,Barcelona, Spain

bGrupoSEN32-36,SociedadEspa˜noladeNeonatología,Serviciode Pediatría,HospitaldeMérida,Badajoz,Spain

cGrupoSEN32-36,SociedadEspa˜noladeNeonatología,Unidadde Neonatología,HospitalGermansTriasiPujol,Badalona,Spain

dGrupoSEN32-36,SociedadEspa˜noladeNeonatología,Serviciode Neonatología-Pediatría,HospitalGeneraldeGranollers,

Granollers,Spain

eGrupoSEN32-36,SociedadEspa˜noladeNeonatología,Unidadde Neonatología,HospitalUniversitarioVirgendelasNieves, Granada,Spain

∗Correspondingauthor.

E-mailaddress:[email protected] (S.Martínez-Nadal).

https://doi.org/10.1016/j.anpede.2022.04.001

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