Keeping mothers and babies together could save more than 125 000 lives: WHO

New research from WHO and partners shows that the COVID-19 pandemic is severely affecting the quality of care given to small and sick newborns, resulting in unnecessary suffering and deaths.

A study published in the Lancet EclinicalMedicine highlights the critical importance of ensuring newborn babies have close contact with parents after birth, especially for those born too small (at low birthweight) or too soon (preterm). However, in many countries, if COVID-19 infections are confirmed or suspected, newborn babies are being routinely separated from their mothers, putting them at higher risk of death and lifelong health complications.

This is especially the case in the poorest countries where the greatest number of preterm births and infant deaths occur. According to the report, disruptions to kangaroo mother care – which involves close contact between a parent, usually a mother, and a newborn baby – will worsen these risks.

Up to 125 000 babies’ lives could be saved with full coverage of kangaroo mother care. For babies born preterm or at low birthweight, kangaroo mother care (early, prolonged skin-to-skin contact with a parent and exclusive breastfeeding) is particularly critical. Among infants born preterm or at low birthweight, kangaroo mother care has been shown to reduce infant deaths by as much as 40%, hypothermia by more than 70%, and severe infections by 65%.

“Disruptions to essential health services during COVID-19 have severely affected the quality of care provided to some of the most vulnerable babies, and this includes their right to the lifesaving contact they need with their parents,” said Dr Anshu Banerjee, Director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO. “Decades of progress in reducing child deaths will be jeopardized unless we act now to protect and improve quality care services for mothers and newborns, and expand coverage of lifesaving interventions like kangaroo mother care.”

WHO advises that mothers should continue to share a room with their babies from birth and be able to breastfeed and practice skin-to-skin contact – even when COVID-19 infections are suspected or confirmed – and should be supported to ensure appropriate infection prevention practices.

“Much more attention is needed to ensure health practitioners and policymakers globally are aware of the need to keep mothers and babies together in these critical early days, especially for babies born too small or too soon,” said Queen Dube, Director of Health at the Ministry of Health in Malawi, one of the report authors. “Kangaroo Mother Care is one of our most cost-effective ways to protect small and sick newborns. According to our analysis, these risks by far outweigh the small chance of a newborn baby getting severe disease from COVID-19.”

“Kangaroo mother care is among the best interventions to improve a premature or low birthweight baby’s chances of survival, especially in low-income countries,” she added.

Evidence suggests that disruptions to kangaroo mother care may already be worryingly widespread. A systematic review of 20 clinical guidelines from 17 countries during the COVID-19 pandemic found that one-third recommended separation of mothers and newborns if the mother has or may have COVID-19. In a global survey of thousands of neonatal healthcare providers, published today in a related paper in the British Medical Journal (BMJ) Global Health, two-thirds of health workers in 62 countries reported they do not allow mothers with confirmed or suspected COVID-19 to practice routine skin to skin contact, while nearly one-quarter did not allow breastfeeding, even by uninfected caregivers.

Studies have reported mainly no symptoms or mild disease from COVID-19 in infected newborns, with low risk of neonatal death. This new study estimates that the risk of newborns catching COVID-19 would result in fewer than 2000 deaths.

However, infection during pregnancy may result in increased risk of preterm birth, which means it is even more important to ensure the right care is given to support preterm babies and their parents during the COVID-19 pandemic.

According to the most recent estimates, 15 million babies are born preterm (before 37 weeks) each year and 21 million are born at low birthweight (under 2.5kg). These babies face significant health risks including disabilities, developmental delays and infections, while prematurity-related complications are the leading causes of death of newborns and children under 5.

About the study

WHO authors have contributed to the following paper: Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection in The Lancet Eclinical Medicine. A related study by the COVID-19 Small and Sick Newborn Care Collaborative Group was published today in the British Medical Journal, Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers’ voices and experiences. BMJ GH. DOI:10.1136/bmjgh-2020-004347