CONCERNS HAVE BEEN raised about new restrictions implemented in neonatal intensive care units, with hospitals implementing different restrictions in each unit and parents saying that they feel left out of the loop.

There are 19 neonatal intensive care units (NICUs) in Ireland. Four of them are tertiary (level three) units, which care for the sickest babies; four others are regional (level two) units, and 11 are local (level one) units, which is for infants who are the least sick.

Two of the four tertiary units are in Dublin, which have implemented limits to visitation each day, which means only one parent can visit their baby for a maximum of 15 minutes each day.

According to the Irish Neonatal Health Alliance, a third tertiary unit in the Coombe hospital “has worked with families” to ensure mothers get to visit their child for longer. 

This is done by implementing a type of roster where mothers can visit the 40-bed NICU one at a time to ensure social distancing is maintained.

The Coombe The Coombe

“It’s really hard to hand back a child who’s critically unwell,” Mandy Daly of the Irish Neonatal Health Alliance (INHA) told TheJournal.ie.

You don’t know is that baby going to be there the next time you come to visit. Every minute you spend with those babies is precious, because you don’t know if you’re going to given another day, it’s not guaranteed.

Daly highlighted the mixed restrictions made by each ICU: in University Hospital Waterford, parents are restricted to an hour a day, while in  Cork University Maternity Hospital, access to the NICU is restricted but staff are trying to accommodate visits from parents at some point. 

She said that the main problem IS that NICUs are very small, which means infections can spread quicker, and infections can kill premature babies.

Of the parents who have contacted the INHA, Daly says that parents have said that communication from the hospitals hasn’t been adequate enough.

“When they went back the next day after the restrictions came in, one mother in particular had her baby taken off her after 15 minutes. I think parents were flabbergasted that the staff was literally sticking to what they said: 15 minutes.”

‘It might be the only time they get’

Mandy Daly says that something that hasn’t been spoken about enough is that some infants might not survive, and this time that mothers get with their children may be the only moments they get.

“Some of these babies die,” she says. “And you’re a mom who’s been allowed 15 minutes access to your baby for the last three or four weeks, and that baby dies of an infection - how do you get on with your life knowing that somebody restricted your access to your baby who is now gone?”

She also said that there are fathers who are “beyond words” at these restrictions – some of them haven’t seen their newborn baby in person.

It’s literally looking at parents and going ‘Mum is more important, dad isn’t important’, without any consideration for the parent-infant interactions, the attachment bond which is formed in the early days.

Poor dads may not have been at the birth, they haven’t got to see their child, they certainly have no prospect of seeing them in the short term. And again, no one’s thinking about the damage to the family as a result of these actions.

Daly sais that these restrictions go against the advice in other cities: in Paris, New York, Madrid, Porto and Rotterdam, NICUs are functioning as normal.

“A specialist doctor working in a NICU in Madrid, where they are being absolutely hammered by Covid, and she she was just speechless [at these restrictions].

She said: ‘Nothing has changed in our NICU. Parents are still coming in, they’re doing exactly what they always did. They gown up, they put a mask on, they wear gloves. If they have any symptoms they’re there obviously not allowed in. They breastfeed, they skin-to-skincare their kids.’ They are doing nothing different.

“Internationally, there has been advice put out by the WHO, Unicef, and Kangaroo mother care, all stating the importance of continuing to provide care to these children, and that there is no scientific evidence to suggest that parents are any more likely to bring in Covid-19 into the unit than a healthcare provider”.

She says that involving parents more in the care of their children when they’re in NICUs is something that they have been campaigning for, and this situation is a good example of why it could be proven useful.

We were hoping that they would actually take advantage of the parents in the unit and have them [trained] to do a lot more of the care, which is what we’ve always been advocating for – and reduce the contact between the infant and the healthcare worker.

Statements from hospitals with tertiary NICUs

In a statement to TheJournal.ie, a spokesperson for the National Maternity Hospital attempted to explain the reasons for the NICU restrictions:

“In the NICU, a very small pool of highly specialist staff is dealing with the highest risk babies.

It is of critical importance to the babies in our care that we retain this complement of staff, and that they are given maximum protection from Covid-19 so that we can continue to give the high level of care these vulnerable infants require.

It said that because of these reasons, parents could not carry out the same duties.

The spokesperson said that the NMH was “very aware of advice from the HSE and the WHO”.

“Each hospital’s facilities and staffing situation differ, and we are taking decisions purely in the interests of ensuring we can continue to provide the highest quality of care to mothers and infants at this time.”

A statement on the Rotunda Hospital’s website says: “The Rotunda NICU hosts the most vulnerable population of patients in the country – premature babies. Covid-19 poses a serious risk to these patients, whose lungs and immune system may not be developed enough to fight off this disease.”

We have the oldest hospital buildings in the country, which make adequate patient and visitor spacing impossible. This is why we have taken the decision to bring our visiting restrictions to the absolute maximal possible level, in order to keep mothers, babies and staff safe.

A spokesperson for the Rotunda Hospital said:

“NICU restrictions are the same across all the Dublin maternity hospitals and are in place to protect all the babies and staff in the most vulnerable area in the hospital.”

A spokesperson from the Coombe Women & Infants Hospital said:

“Covid-19 is a really difficult time for families so we have worked with them to make restrictions as bearable as possible. The restrictions we’ve had to put in place are for the safety of babies, parents and staff.

From early March we restricted visiting to one parent. In nearly all cases this has been the mother. A tablet we made available in order to facilitate contact through FaceTime has been hugely successful, particularly for fathers and siblings who have been largely unable to see or meet the new arrival.

We plan to build on this and create more FaceTime for parents. We hope to buy further tablets, which can be mounted on incubators, to increase the number of FaceTime opportunities for parents.

“We’ve been delighted that mothers regard themselves as part of the NICU team at the Coombe and have taken responsibility to create more safe-distancing opportunities. A number of mothers have agreed a roster of visit times, and this has been a huge benefit to staff,” the statement said.

The HSE said that restrictions are in place for the protection of babies, parents and staff.

It’s understood that the HSE is going to publish advice on visits to neonatal units during the Covid-19 pandemic this week. 

The Department of Health, and Cork University Maternity Hospital were also contacted for comment.